In the largest study of hospitalized COVID-19 patients in the US, researchers leveraged EHR data to find that hypertension, diabetes, and obesity are key chronic diseases in the acuity of the virus.
The study, published in JAMA, examined the clinical course and outcomes of 5,700 Northwell Health patients hospitalized between March 1 and April 4.
A team from the Northwell Health COVID-19 Research Consortium and the Feinstein Institutes for Medical Research collected data on the patients from the enterprise EHR reporting database. Researchers collected information on patient demographics, home medications, triage visits, initial laboratory tests, inpatient medications, treatments, and other key data points.
“New York has become the epicenter of this epidemic. Clinicians, scientists, statisticians and laboratory professionals are working tirelessly to provide best care and comfort to the thousands of COVID-19 patients in our Northwell hospitals,” said Karina W. Davidson, PhD, MASc, professor and senior vice president at the Feinstein Institutes.
“Through our consortium, we will share our clinical and scientific insights as we evolve the ways to care for and treat COVID-19 patients.”
Researchers found that of the patients studied, 56.6 percent had hypertension, 41.7 percent had obesity, and 33.8 percent had diabetes – the most common comorbidities among the research subjects.
Additionally, the results showed that patients with diabetes were more likely to have received invasive mechanical ventilation, received treatment in the ICU, or developed acute kidney disease.
Of the 2,634 hospitalized patients for whom outcomes were known, 14 percent were treated in the ICU, 12 percent received invasive mechanical ventilation, and three percent were treated with kidney replacement therapy. Twenty-one percent passed away, and 88 percent of individuals receiving mechanical ventilation died.
The majority of patients were male, and the median age of all patients treated was 63 years old. At triage, about one-third of all patients presented with a fever, 986 had a high respiratory rate, and 1,584 patients received supplemental oxygen. Mortality rates were higher for male patients than female patients at every adult ten-year age interval.
“To our knowledge, this study represents the first large case series of sequentially hospitalized patients with confirmed COVID-19 in the US,” researchers stated.
“Older persons, men, and those with pre-existing hypertension and/or diabetes were highly prevalent in this case series and the pattern was similar to data reported from China. However, mortality rates in this case series were significantly lower, possibly due to differences in thresholds for hospitalization.”
The team pointed out that further research will be necessary to better understand mortality among COVID-19 patients.
“This study reported mortality rates only for patients with definite outcomes (discharge or death), and longer-term study may find different mortality rates as different segments of the population are infected. The findings of high mortality rates among ventilated patients are similar to smaller case series reports of critically ill patients in the US,” the group wrote.
The results illustrate an initial view of the link between common comorbidities and the impact of COVID-19.
“Dr. Davidson and the Northwell Consortium research team provide a crucial early insight into the frontline response to the COVID-19 outbreak in New York,” said Kevin J. Tracey, MD, president and CEO of the Feinstein Institutes. “These observational studies and other randomized clinical trial results from the Feinstein Institutes will improve the care for others confronting COVID outbreaks.”