The Clinical Course of Coronavirus Disease 2019 in a US Hospital System: A Multistate Analysis. Issue 4 (22nd December 2020)

• Record Type: Journal Article
• Authors: Mody, Aaloke; Lyons, Patrick G; Vazquez Guillamet, Cristina; Michelson, Andrew; Yu, Sean; Namwase, Angella Sandra; Sinha, Pratik; Powderly, William G; Woeltje, Keith; Geng, Elvin H
• Is Part Of: American journal of epidemiology. Volume 190:Issue 4(2021)
• Page Start: 539
• Page End: 552
• Publication Date: 2020-12-22
• Subjects: age-stratified mortality -- clinical course -- coronavirus disease 2019 -- COVID-19 hospitalizations -- intensive care unit -- longitudinal trajectory -- mechanical ventilation -- multistate analysis; Epidemiology -- Periodicals; Public health -- Periodicals; 614.4
• DOI: 10.1093/aje/kwaa286
• Languages: English
• ISSNs: 0002-9262

Abstract

Abstract: There are limited data on longitudinal outcomes for coronavirus disease 2019 (COVID-19) hospitalizations that account for transitions between clinical states over time. Using electronic health record data from a hospital network in the St. Louis, Missouri, region, we performed multistate analyses to examine longitudinal transitions and outcomes among hospitalized adults with laboratory-confirmed COVID-19 with respect to 15 mutually exclusive clinical states. Between March 15 and July 25, 2020, a total of 1, 577 patients in the network were hospitalized with COVID-19 (49.9% male; median age, 63 years (interquartile range, 50–75); 58.8% Black). Overall, 34.1% (95% confidence interval (CI): 26.4, 41.8) had an intensive care unit admission and 12.3% (95% CI: 8.5, 16.1) received invasive mechanical ventilation (IMV). The risk of decompensation peaked immediately after admission; discharges peaked around days 3–5, and deaths plateaued between days 7 and 16. At 28 days, 12.6% (95% CI: 9.6, 15.6) of patients had died (4.2% (95% CI: 3.2, 5.2) had received IMV) and 80.8% (95% CI: 75.4, 86.1) had been discharged. Among those receiving IMV, 35.1% (95% CI: 28.2, 42.0) remained intubated after 14 days; after 28 days, 37.6% (95% CI: 30.4, 44.7) had died and only 37.7% (95% CI: 30.6, 44.7) had been discharged. Multistate methods offer granular characterizations of the clinical course of COVID-19 and provide essential information for guiding both clinical decision-making and public health planning.