The largest US prospective study of patients to date shows most COVID-19 patients in the ICU are older, minorities, have underlying cardiometabolic disease—and are highly likely to require mechanical ventilation.
The largest prospective assessment of the coronavirus 2019 (COVID-19) in US patients to date showed more than 20% of patients admitted to 1 of 2 New York City hospitals became critically ill, and that nearly 80% of critically ill patients required mechanical ventilation to support breathing.
The new findings from clinicians at the Columbia University Irving Medical Center in northern Manhattan detailed trends and patterns among 1150 adult patients hospitalized with COVID-19 in March this year.
Investigators, led by Matthew Cummings, MD, observed the status and progression of adults admitted to the hospital with laboratory-confirmed coronavirus between March 2 and April 1.
They found 257 (22%) were critically ill, requiring treatment in either a high-dependency or intensive care unit (ICU). Common symptoms among these patients were shortness of breath, fever, cough, muscle pain, and diarrhea. As of April 28, 101 (39%) of these patients had died, and 94 (37%) remained hospitalized.
Just 58 (23%) had been discharged from the hospital.
Two-thirds of all critically-ill patients were male (171 [67%]), with a median patient age of 62 years. That said, 55 patients (22%) were <50 years old. Four in every 5 critically ill patients were minorities—Hispanic or Latino (62%) and black or African American (19%) comprised 198 of the 257 observed patients.
Healthcare workers made up 5% (13) of the observed critically ill patient population.
At least 1 chronic illness was prevalent in more than 80% of all critically-ill coronavirus patients; hypertension (162 [63%]) and diabetes (92 [36%]) were the most commonly reported conditions. Patients with pre-existing lung or heart conditions had the greatest risk of poorer outcomes.
Cummings and colleagues reported that 203 (79%) of critically-ill COVID-19 patients required mechanical ventilation, for a man duration of 18 days (range, 9-28).
Another 79 patients (31%) developed severe kidney damage while hospitalized, and required therapy including dialysis to support their kidney function.
Though the rate and severity of ventilator use was greater than that previously observed by clinicians in a Washington state hospital, the New York-based findings correlate with those reported recently in Italy facilities.
In fact, according to a statement from publishing journal The Lancet, the report is similar to those to have come from China, Italy, and the UK.
“Of particular interest is the finding that over three quarters of critically ill patients required a ventilator and almost one third required renal dialysis support,” senior author Max O’Donnell, MD, said. “This has important implications for resource allocation in hospitals, where access to equipment and specialized staff needed to deliver this level of care is limited.”
Study author Natalie Yip, MD, emphasized the need for identified risk factors associated with mortality in US-based patients with critically ill COVID-19 status. As of the study’s publishing, the country has neared 100,000 deaths from the virus.
“Although the clinical spectrum of disease has been characterized in reports from China and Italy, until now, detailed understanding of how the virus is affecting critically ill patients in the US has been limited to reports from a small number of cases,” Yip said.