Risk factors for severe illness in hospitalized Covid-19 patients at a regional hospital.
Aged
Aged, 80 and over
Betacoronavirus
/ genetics
COVID-19
Coronavirus Infections
/ epidemiology
Critical Illness
Female
Health Care Rationing
Hospital Mortality
Hospitalization
Hospitals, Community
Humans
Intensive Care Units
Length of Stay
Male
Maryland
/ epidemiology
Middle Aged
Pandemics
Pneumonia, Viral
/ epidemiology
Respiration, Artificial
Retrospective Studies
Reverse Transcriptase Polymerase Chain Reaction
Risk Factors
SARS-CoV-2
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2020
2020
Historique:
received:
03
06
2020
accepted:
29
07
2020
entrez:
14
8
2020
pubmed:
14
8
2020
medline:
29
8
2020
Statut:
epublish
Résumé
The Covid-19 pandemic threatens to overwhelm scarce clinical resources. Risk factors for severe illness must be identified to make efficient resource allocations. To evaluate risk factors for severe illness. Retrospective, observational case series. Single-institution. First 117 consecutive patients hospitalized for Covid-19 from March 1 to April 12, 2020. None. Intensive care unit admission or death. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 32785285
doi: 10.1371/journal.pone.0237558
pii: PONE-D-20-16851
pmc: PMC7423129
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0237558Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
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