Clinical Management of Hospitalized Coronavirus Disease 2019 Patients in the United States | Zendy

Essy Mozaffari | Zendy; Aastha Chandak | Zendy; Zhiji Zhang | Zendy; Shuting Liang | Zendy; Julie Gayle | Zendy; Mark Thrun | Zendy; Robert Gottlieb | Zendy; Daniel R. Kuritzkes | Zendy; Paul E. Sax | Zendy; David A. Wohl | Zendy; Roman Casciano | Zendy; Paul Hodgkins | Zendy; Richard Haubrich | Zendy

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Clinical Management of Hospitalized Coronavirus Disease 2019 Patients in the United States

Author(s) -

Essy Mozaffari,

Aastha Chandak,

Zhiji Zhang,

Shuting Liang,

Julie Gayle,

Mark Thrun,

Robert Gottlieb,

Daniel R. Kuritzkes,

Paul E. Sax,

David A. Wohl,

Roman Casciano,

Paul Hodgkins,

Richard Haubrich

Publication year - 2021

Publication title -

open forum infectious diseases

Language(s) - English

Resource type - Journals

SCImago Journal Rank - 1.546

H-Index - 35

ISSN - 2328-8957

DOI - 10.1093/ofid/ofab498

Subject(s) - medicine , interquartile range , extracorporeal membrane oxygenation , mechanical ventilation , intensive care unit , covid-19 , fraction of inspired oxygen , oxygen therapy , emergency medicine , disease , infectious disease (medical specialty)

Background The objective of this study was to characterize hospitalized coronavirus disease 2019 (COVID-19) patients and describe their real-world treatment patterns and outcomes over time. Methods Adult patients hospitalized on May 1, 2020–December 31, 2020 with a discharge diagnosis of COVID-19 were identified from the Premier Healthcare Database. Patient and hospital characteristics, treatments, baseline severity based on oxygen support, length of stay (LOS), intensive care unit (ICU) utilization, and mortality were examined. Results The study included 295657 patients (847 hospitals), with median age of 66 (interquartile range, 54–77) years. Among each set of demographic comparators, the majority were male, white, and over 65. Approximately 85% had no supplemental oxygen charges (NSOc) or low-flow oxygen (LFO) at baseline, whereas 75% received no more than NSOc or LFO as maximal oxygen support at any time during hospitalization. Remdesivir (RDV) and corticosteroid treatment utilization increased over time. By December, 50% were receiving RDV and 80% were receiving corticosteroids. A higher proportion initiated COVID-19 treatments within 2 days of hospitalization in December versus May (RDV, 87% vs 40%; corticosteroids, 93% vs 62%; convalescent plasma, 68% vs 26%). There was a shift toward initiating RDV in patients on NSOc or LFO (68.0% [May] vs 83.1% [December]). Median LOS decreased over time. Overall mortality was 13.5% and it was highest for severe patients (invasive mechanical ventilation/extracorporeal membrane oxygenation [IMV/ECMO], 53.7%; high-flow oxygen/noninvasive ventilation [HFO/NIV], 32.2%; LFO, 11.7%; NSOc, 7.3%). The ICU use decreased, whereas mortality decreased for NSOc and LFO. Conclusions Clinical management of COVID-19 is rapidly evolving. This large observational study found that use of evidence-based treatments increased from May to December 2020, whereas improvement in outcomes occurred over this time-period.

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