Clinical Characteristics and Outcomes of Non‐ICU Hospitalization for COVID‐19 in a Nonepicenter, Centrally Monitored Healthcare System. Issue 1 (1st January 2021)

• Record Type: Journal Article
• Authors: Nemer, David M; Wilner, Bryan R; Burkle, Alicia; Aguilera, Jose; Adewumi, Joseph; Gillombardo, Carl; Wazni, Oussama; Menon, Venu; Pengel, Shannon; Foxx, Meredith; Petre, Marc; Hamilton, Aaron C; Cantillon, Daniel J
• Is Part Of: Journal of hospital medicine. Volume 16:Issue 1(2021)
• Page Start: 7
• Page End: 14
• Publication Date: 2021-01-01
• Subjects: Hospital care -- Periodicals; Clinical medicine -- Periodicals; 610
• DOI: 10.12788/jhm.3510
• Languages: English
• ISSNs: 1553-5592

Abstract

Abstract : BACKGROUND: The clinical characteristics and outcomes associated with non–intensive care unit (non‐ICU) hospitalizations for coronavirus disease 2019 (COVID‐19) outside disease epicenters remain poorly characterized. METHODS: Systematic analysis of all non‐ICU patient hospitalizations for COVID‐19 completing discharge between March 13 and May 1, 2020, in a large US health care system utilizing off‐site central monitoring. Variables of interest were examined in relation to a composite event rate of death, ICU transfer, or increased oxygen requirement to high‐flow nasal cannula, noninvasive ventilation, or mechanical ventilation. RESULTS: Among 350 patients (age, 64 ± 16 years; 55% male), most (73%) required 3 L/min or less of supplemental oxygen during admission. Telemetry was widely utilized (79%) yet arrhythmias were uncommon (14%) and were predominantly (90%) among patients with abnormal troponin levels or known cardiovascular disease. Ventricular tachycardia was rare (5%), nonsustained, and not associated with hydroxychloroquine/azithromycin treatment. Adverse events occurred in 62 patients (18%), including 22 deaths (6%), 48 ICU transfers (14%), and 49 patients with increased oxygen requirement (14%) and were independently associated with elevated C‐reactive protein (odds ratio, 1.09 per 1 mg/dL; 95% CI, 1.01‐1.18; P = .04) and lactate dehydrogenase (OR, 1.006 per 1U/L; 95% CI, 1.001‐1.012; P = .03) in multivariable analysis. CONCLUSION: Among non–critically ill patients hospitalized within a nonepicenter health care system, overall survival was 94% with the development of more severe illness or death independently associated with higher levels of C‐reactive protein and lactate dehydrogenase on admission. Clinical decompensation was largely respiratory‐related, while serious cardiac arrhythmias were rare, which suggests that telemetry can be prioritized for high‐risk patients. Abstract :