Risk factors for severe illness in hospitalized Covid-19 patients at a regional hospital.
Identifieur interne : 000704 ( Main/Corpus ); précédent : 000703; suivant : 000705Risk factors for severe illness in hospitalized Covid-19 patients at a regional hospital.
Auteurs : Justin J. Turcotte ; Barry R. Meisenberg ; James H. Macdonald ; Nandakumar Menon ; Marcia B. Fowler ; Michaline West ; Jane Rhule ; Sadaf S. Qureshi ; Eileen B. MacdonaldSource :
- PloS one [ 1932-6203 ] ; 2020.
English descriptors
- KwdEn :
- Aged (MeSH), Aged, 80 and over (MeSH), Betacoronavirus (genetics), Coronavirus Infections (epidemiology), Coronavirus Infections (mortality), Coronavirus Infections (pathology), Coronavirus Infections (virology), Critical Illness (MeSH), Female (MeSH), Health Care Rationing (MeSH), Hospital Mortality (MeSH), Hospitalization (MeSH), Hospitals, Community (MeSH), Humans (MeSH), Intensive Care Units (MeSH), Length of Stay (MeSH), Male (MeSH), Maryland (epidemiology), Middle Aged (MeSH), Pandemics (MeSH), Pneumonia, Viral (epidemiology), Pneumonia, Viral (mortality), Pneumonia, Viral (pathology), Pneumonia, Viral (virology), Respiration, Artificial (MeSH), Retrospective Studies (MeSH), Reverse Transcriptase Polymerase Chain Reaction (MeSH), Risk Factors (MeSH).
- MESH :
- geographic , epidemiology : Maryland.
- epidemiology : Coronavirus Infections, Pneumonia, Viral.
- genetics : Betacoronavirus.
- mortality : Coronavirus Infections, Pneumonia, Viral.
- pathology : Coronavirus Infections, Pneumonia, Viral.
- virology : Coronavirus Infections, Pneumonia, Viral.
- Aged, Aged, 80 and over, Critical Illness, Female, Health Care Rationing, Hospital Mortality, Hospitalization, Hospitals, Community, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Pandemics, Respiration, Artificial, Retrospective Studies, Reverse Transcriptase Polymerase Chain Reaction, Risk Factors.
Abstract
BACKGROUND
The Covid-19 pandemic threatens to overwhelm scarce clinical resources. Risk factors for severe illness must be identified to make efficient resource allocations.
OBJECTIVE
To evaluate risk factors for severe illness.
DESIGN
Retrospective, observational case series.
SETTING
Single-institution.
PARTICIPANTS
First 117 consecutive patients hospitalized for Covid-19 from March 1 to April 12, 2020.
EXPOSURE
None.
MAIN OUTCOMES AND MEASURES
Intensive care unit admission or death.
RESULTS
In-hospital mortality was 24.8% and average total length of stay was 11.82 days (95% CI: 10.01 to 13.63 days). 30.8% of patients required intensive care unit admission and 29.1% required mechanical ventilation. Multivariate regression identified the amount of supplemental oxygen required at admission (OR: 1.208, 95% CI: 1.011-1.443, p = .037), sputum production (OR: 6.734, 95% CI: 1.630-27.812, p = .008), insulin dependent diabetes mellitus (OR: 11.873, 95% CI: 2.218-63.555, p = .004) and chronic kidney disease (OR: 4.793, 95% CI: 1.528-15.037, p = .007) as significant risk factors for intensive care unit admission or death. Of the 48 patients who were admitted to the intensive care unit or died, this occurred within 3 days of arrival in 42%, within 6 days in 71%, and within 9 days in 88% of patients.
CONCLUSIONS
At our regional medical center, patients with Covid-19 had an average length of stay just under 12 days, required ICU care in 31% of cases, and had a 25% mortality rate. Patients with increased sputum production and higher supplemental oxygen requirements at admission, and insulin dependent diabetes or chronic kidney disease may be at increased risk for severe illness. A model for predicting intensive care unit admission or death with excellent discrimination was created that may aid in treatment decisions and resource allocation. Early identification of patients at increased risk for severe illness may lead to improved outcomes in patients hospitalized with Covid-19.
DOI: 10.1371/journal.pone.0237558
PubMed: 32785285
PubMed Central: PMC7423129
Links to Exploration step
pubmed:32785285Le document en format XML
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<author><name sortKey="Macdonald, James H" sort="Macdonald, James H" uniqKey="Macdonald J" first="James H" last="Macdonald">James H. Macdonald</name>
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<term>Aged, 80 and over (MeSH)</term>
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<term>Coronavirus Infections (epidemiology)</term>
<term>Coronavirus Infections (mortality)</term>
<term>Coronavirus Infections (pathology)</term>
<term>Coronavirus Infections (virology)</term>
<term>Critical Illness (MeSH)</term>
<term>Female (MeSH)</term>
<term>Health Care Rationing (MeSH)</term>
<term>Hospital Mortality (MeSH)</term>
<term>Hospitalization (MeSH)</term>
<term>Hospitals, Community (MeSH)</term>
<term>Humans (MeSH)</term>
<term>Intensive Care Units (MeSH)</term>
<term>Length of Stay (MeSH)</term>
<term>Male (MeSH)</term>
<term>Maryland (epidemiology)</term>
<term>Middle Aged (MeSH)</term>
<term>Pandemics (MeSH)</term>
<term>Pneumonia, Viral (epidemiology)</term>
<term>Pneumonia, Viral (mortality)</term>
<term>Pneumonia, Viral (pathology)</term>
<term>Pneumonia, Viral (virology)</term>
<term>Respiration, Artificial (MeSH)</term>
<term>Retrospective Studies (MeSH)</term>
<term>Reverse Transcriptase Polymerase Chain Reaction (MeSH)</term>
<term>Risk Factors (MeSH)</term>
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<term>Aged, 80 and over</term>
<term>Critical Illness</term>
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<front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b>
</p>
<p>The Covid-19 pandemic threatens to overwhelm scarce clinical resources. Risk factors for severe illness must be identified to make efficient resource allocations.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b>
</p>
<p>To evaluate risk factors for severe illness.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>DESIGN</b>
</p>
<p>Retrospective, observational case series.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>SETTING</b>
</p>
<p>Single-institution.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>PARTICIPANTS</b>
</p>
<p>First 117 consecutive patients hospitalized for Covid-19 from March 1 to April 12, 2020.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>EXPOSURE</b>
</p>
<p>None.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>MAIN OUTCOMES AND MEASURES</b>
</p>
<p>Intensive care unit admission or death.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>In-hospital mortality was 24.8% and average total length of stay was 11.82 days (95% CI: 10.01 to 13.63 days). 30.8% of patients required intensive care unit admission and 29.1% required mechanical ventilation. Multivariate regression identified the amount of supplemental oxygen required at admission (OR: 1.208, 95% CI: 1.011-1.443, p = .037), sputum production (OR: 6.734, 95% CI: 1.630-27.812, p = .008), insulin dependent diabetes mellitus (OR: 11.873, 95% CI: 2.218-63.555, p = .004) and chronic kidney disease (OR: 4.793, 95% CI: 1.528-15.037, p = .007) as significant risk factors for intensive care unit admission or death. Of the 48 patients who were admitted to the intensive care unit or died, this occurred within 3 days of arrival in 42%, within 6 days in 71%, and within 9 days in 88% of patients.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b>
</p>
<p>At our regional medical center, patients with Covid-19 had an average length of stay just under 12 days, required ICU care in 31% of cases, and had a 25% mortality rate. Patients with increased sputum production and higher supplemental oxygen requirements at admission, and insulin dependent diabetes or chronic kidney disease may be at increased risk for severe illness. A model for predicting intensive care unit admission or death with excellent discrimination was created that may aid in treatment decisions and resource allocation. Early identification of patients at increased risk for severe illness may lead to improved outcomes in patients hospitalized with Covid-19.</p>
</div>
</front>
</TEI>
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<DateCompleted><Year>2020</Year>
<Month>08</Month>
<Day>28</Day>
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<DateRevised><Year>2020</Year>
<Month>08</Month>
<Day>28</Day>
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<JournalIssue CitedMedium="Internet"><Volume>15</Volume>
<Issue>8</Issue>
<PubDate><Year>2020</Year>
</PubDate>
</JournalIssue>
<Title>PloS one</Title>
<ISOAbbreviation>PLoS One</ISOAbbreviation>
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<ArticleTitle>Risk factors for severe illness in hospitalized Covid-19 patients at a regional hospital.</ArticleTitle>
<Pagination><MedlinePgn>e0237558</MedlinePgn>
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<Abstract><AbstractText Label="BACKGROUND">The Covid-19 pandemic threatens to overwhelm scarce clinical resources. Risk factors for severe illness must be identified to make efficient resource allocations.</AbstractText>
<AbstractText Label="OBJECTIVE">To evaluate risk factors for severe illness.</AbstractText>
<AbstractText Label="DESIGN">Retrospective, observational case series.</AbstractText>
<AbstractText Label="SETTING">Single-institution.</AbstractText>
<AbstractText Label="PARTICIPANTS">First 117 consecutive patients hospitalized for Covid-19 from March 1 to April 12, 2020.</AbstractText>
<AbstractText Label="EXPOSURE">None.</AbstractText>
<AbstractText Label="MAIN OUTCOMES AND MEASURES">Intensive care unit admission or death.</AbstractText>
<AbstractText Label="RESULTS">In-hospital mortality was 24.8% and average total length of stay was 11.82 days (95% CI: 10.01 to 13.63 days). 30.8% of patients required intensive care unit admission and 29.1% required mechanical ventilation. Multivariate regression identified the amount of supplemental oxygen required at admission (OR: 1.208, 95% CI: 1.011-1.443, p = .037), sputum production (OR: 6.734, 95% CI: 1.630-27.812, p = .008), insulin dependent diabetes mellitus (OR: 11.873, 95% CI: 2.218-63.555, p = .004) and chronic kidney disease (OR: 4.793, 95% CI: 1.528-15.037, p = .007) as significant risk factors for intensive care unit admission or death. Of the 48 patients who were admitted to the intensive care unit or died, this occurred within 3 days of arrival in 42%, within 6 days in 71%, and within 9 days in 88% of patients.</AbstractText>
<AbstractText Label="CONCLUSIONS">At our regional medical center, patients with Covid-19 had an average length of stay just under 12 days, required ICU care in 31% of cases, and had a 25% mortality rate. Patients with increased sputum production and higher supplemental oxygen requirements at admission, and insulin dependent diabetes or chronic kidney disease may be at increased risk for severe illness. A model for predicting intensive care unit admission or death with excellent discrimination was created that may aid in treatment decisions and resource allocation. Early identification of patients at increased risk for severe illness may lead to improved outcomes in patients hospitalized with Covid-19.</AbstractText>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Turcotte</LastName>
<ForeName>Justin J</ForeName>
<Initials>JJ</Initials>
<Identifier Source="ORCID">0000-0002-5591-8033</Identifier>
<AffiliationInfo><Affiliation>Department of Orthopedics, Anne Arundel Medical Center, Annapolis, MD, United States of America.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Meisenberg</LastName>
<ForeName>Barry R</ForeName>
<Initials>BR</Initials>
<AffiliationInfo><Affiliation>Department of Medicine, Anne Arundel Medical Center, Annapolis, MD, United States of America.</Affiliation>
</AffiliationInfo>
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<Author ValidYN="Y"><LastName>MacDonald</LastName>
<ForeName>James H</ForeName>
<Initials>JH</Initials>
<AffiliationInfo><Affiliation>Department of Orthopedics, Anne Arundel Medical Center, Annapolis, MD, United States of America.</Affiliation>
</AffiliationInfo>
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<Author ValidYN="Y"><LastName>Menon</LastName>
<ForeName>Nandakumar</ForeName>
<Initials>N</Initials>
<AffiliationInfo><Affiliation>Department of Orthopedics, Anne Arundel Medical Center, Annapolis, MD, United States of America.</Affiliation>
</AffiliationInfo>
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<AffiliationInfo><Affiliation>Department of Orthopedics, Anne Arundel Medical Center, Annapolis, MD, United States of America.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>West</LastName>
<ForeName>Michaline</ForeName>
<Initials>M</Initials>
<AffiliationInfo><Affiliation>Department of Orthopedics, Anne Arundel Medical Center, Annapolis, MD, United States of America.</Affiliation>
</AffiliationInfo>
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<ForeName>Jane</ForeName>
<Initials>J</Initials>
<AffiliationInfo><Affiliation>Anne Arundel Research Institute, Anne Arundel Medical Center, Annapolis, MD, United States of America.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Qureshi</LastName>
<ForeName>Sadaf S</ForeName>
<Initials>SS</Initials>
<AffiliationInfo><Affiliation>Anne Arundel Research Institute, Anne Arundel Medical Center, Annapolis, MD, United States of America.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>MacDonald</LastName>
<ForeName>Eileen B</ForeName>
<Initials>EB</Initials>
<AffiliationInfo><Affiliation>Department of Medicine, Anne Arundel Medical Center, Annapolis, MD, United States of America.</Affiliation>
</AffiliationInfo>
</Author>
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<Language>eng</Language>
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<MeshHeading><DescriptorName UI="D015276" MajorTopicYN="N">Health Care Rationing</DescriptorName>
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<MeshHeading><DescriptorName UI="D017052" MajorTopicYN="N">Hospital Mortality</DescriptorName>
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<MeshHeading><DescriptorName UI="D006760" MajorTopicYN="Y">Hospitalization</DescriptorName>
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<MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D007362" MajorTopicYN="N">Intensive Care Units</DescriptorName>
</MeshHeading>
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</MeshHeading>
<MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008396" MajorTopicYN="N" Type="Geographic">Maryland</DescriptorName>
<QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D058873" MajorTopicYN="N">Pandemics</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D011024" MajorTopicYN="N">Pneumonia, Viral</DescriptorName>
<QualifierName UI="Q000453" MajorTopicYN="Y">epidemiology</QualifierName>
<QualifierName UI="Q000401" MajorTopicYN="N">mortality</QualifierName>
<QualifierName UI="Q000473" MajorTopicYN="Y">pathology</QualifierName>
<QualifierName UI="Q000821" MajorTopicYN="N">virology</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D012121" MajorTopicYN="N">Respiration, Artificial</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D020133" MajorTopicYN="N">Reverse Transcriptase Polymerase Chain Reaction</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D012307" MajorTopicYN="N">Risk Factors</DescriptorName>
</MeshHeading>
</MeshHeadingList>
<CoiStatement>The authors have declared that no competing interests exist.</CoiStatement>
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