Analysis Yields In-depth Insights Into Illness Trajectory of Hospitalized COVID-19 Patients

New research takes an in-depth look at data collected during the entire hospital stay from some of the first patients hospitalized with COVID-19 in the United States.

“Characteristics and Outcomes of U.S. Patients Hospitalized With COVID-19” is one of the few studies conducted in diverse, multicenter patient populations that describes patients’ illness trajectory, patterns of organ failure, therapies and clinical outcomes. The study is published in the American Journal of Critical Care.

The analysis provides fresh insights about clinical outcomes in ways that are meaningful to patients, clinicians, health system planners and researchers.

Participating hospitals were members of the National Heart, Lung, and Blood Institute PETAL Network (Prevention and Early Treatment of Acute Lung Injury) and included 57 geographically diverse U.S. hospitals in 12 regional clinical centers.

Adult patients admitted to a study hospital from March 1 to April 1, 2020, were eligible for inclusion if they had laboratory-confirmed SARS-CoV-2 infection and symptoms of COVID-19. The study included data from a total of 1,480 patients, with eight to 41 patients from each hospital.

Lead author Ithan Peltan, MD, MSc, is a pulmonologist and an assistant professor, division of pulmonary and critical care medicine, in the department of medicine at Intermountain Medical Center, Murray, Utah.

“We have learned much about COVID-19 over the past two years, but many studies are constrained by short observation periods, scarce data on the illness’s progression and other limitations. For this study, we leveraged a nationwide acute care trials network to develop a more granular and geographically diverse set of data to follow patients from their arrival at the hospital until their departure,” Peltan said.

The data highlights the high inpatient morbidity and prolonged hospitalization experienced by patients with COVID-19, but the analysis also revealed that COVID-19-related critical illness and death often result from multiorgan dysfunction rather than isolated respiratory failure.

“Our findings suggest that efforts to reduce severe illness should consider the multiorgan effects of SARS-CoV-2 infection,” Peltan said.

The researchers evaluated a comprehensive and generalizable array of demographic and clinical characteristics as potential risk factors for COVID-19 mortality and respiratory failure. As with prior studies, men made up a disproportionately large portion of hospitalized patients with COVID-19 and experienced poorer outcomes than women.

Mortality among the patients included in the analysis was 17.7%, which was associated with comorbidity burden, male sex and advancing age.

Respiratory failure affected nearly 40% of the patients, half of whom experienced respiratory failure within 24 hours of arriving at the hospital.

Clinically diagnosed acute respiratory distress syndrome (ARDS) was the most common complication, affecting 32.6% of the patients, including more than three-quarters of those who died in the hospital. Among patients not receiving dialysis before admission, acute renal failure was also more common in nonsurvivors (59.4%) than in survivors (14.6%).

Overall, 38.9% of the patients received care in an intensive care unit (ICU) during their hospitalization, with ICU admission, when required, usually occurring within four days of hospital arrival. The median hospital stay was eight days overall, and 15 days among patients admitted to an ICU.

Among survivors, 18.1% were discharged with respiratory support that was new or higher in intensity than baseline. Nearly one in four survivors admitted from home required new at-home or facility-based healthcare services upon discharge.

Source: American Association of Critical-Care Nurses