Outcomes and Mortality Among Adults Hospitalized With COVID-19 at U.S. Medical Centers

Nguyen, et al. (2021) report that to date, there have been regional reports on outcomes among patients who developed serious symptoms requiring hospitalization. The objectives of their study were to examine the characteristics and outcomes among adults hospitalized with COVID-19 at U.S. medical centers and analyze changes in mortality over the initial six-month period of the pandemic.

The data for this cohort study were obtained from the Vizient clinical database, an administrative, clinical, and financial database of more than 650 academic centers and their affiliates from 47 U.S. states. Discharge records of adults 18 years or older who had received a diagnosis of COVID-19 and were admitted to the hospital between March 1 and Aug. 31, 2020, were reviewed. Patients with COVID-19 were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code U07.1. The primary outcome was in-hospital mortality, which was analyzed according to the month of admission and age group and in a subgroup of patients requiring intensive care unit (ICU) admission. Secondary outcomes included length of hospital stay, length of ICU stay, and median cost of ICU stay vs non-ICU stay. Survival probabilities by length of stay were plotted according to month of admission and patient age group.

Among 192,550 adults hospitalized with COVID-19 who were discharged from 555 U.S. medical centers, 101 089 (52.5%) were men, 83 567 (43.3%) were White, and 125 543 (65.2%) had Medicare or Medicaid insurance. The most common comorbidities included hypertension (118 418 [61.5%]), diabetes (73 939 [38.4%]), and obesity (52 759 [27.4%]). Of patients in this cohort, 55 593 (28.9%) were admitted to the ICU, 26 221 (13.6%) died during the index hospitalization, and 5839 (3.0%) were transferred to hospice care. In-hospital mortality increased in association with increasing age; 179 of 12 644 patients (1.4%) aged 18 to 29 years died, and 8277 of 31 135 patients (26.6%) 80 years or older died. Of the patients admitted to the ICU, 15 431 of 55 593 (27.8%) died. The median hospital length of stay among patients who were not admitted to the ICU was 6 days (interquartile range [IQR], 3-8 days), with a median cost per admission of $10 520 (IQR, $8031-$14 550). The median hospital length of stay for those admitted to the ICU was 15 days (IQR, 6-20 days), with a median cost per admission of $39 825 (IQR, $25 763-$56 804). There was a significant reduction in mortality over the course of the 6-month period, with the highest mortality in March (3657 of 16 517 patients died [22.1%]); mortality decreased each month until the end of the study period in August (1154 of 17 776 patients died [6.5%]) (χ2 for trend, 3592.3; P < .001).

Reference: Nguyen NT, et al. Outcomes and Mortality Among Adults Hospitalized With COVID-19 at US Medical Centers. JAMA Netw Open. 2021;4(3):e210417. doi:10.1001/jamanetworkopen.2021.0417

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