Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series

被引：401

作者：

Argenziano, Michael G. ^{[1
,2
]}

Bruce, Samuel L. ^{[1
,2
]}

Slater, Cody L. ^{[1
,2
]}

Tiao, Jonathan R. ^{[1
,2
]}

Baldwin, Matthew R. ^{[3
]}

Barr, R. Graham ^{[4
]}

Chang, Bernard P. ^{[5
]}

Chau, Katherine H. ^{[6
]}

Choi, Justin J. ^{[7
]}

Gavin, Nicholas ^{[5
]}

Goyal, Parag ^{[7
]}

Mills, Angela M. ^{[5
]}

Patel, Ashmi A. ^{[4
]}

Romney, Marie-Laure S. ^{[5
]}

Safford, Monika M. ^{[7
]}

Schluger, Neil W. ^{[3
]}

Sengupta, Soumitra ^{[2
]}

Sobieszczyk, Magdalena E. ^{[8
]}

Zucker, Jason E. ^{[8
]}

Asadourian, Paul A. ^{[1
]}

Bell, Fletcher M. ^{[1
]}

Boyd, Rebekah ^{[1
]}

Cohen, Matthew F. ^{[1
]}

Colquhoun, MacAlistair I. ^{[1
]}

Colville, Lucy A. ^{[1
]}

de Jonge, Joseph H. ^{[1
]}

Dershowitz, Lyle B. ^{[1
]}

Dey, Shirin A. ^{[1
]}

Eiseman, Katherine A. ^{[1
]}

Girvin, Zachary P. ^{[1
]}

Goni, Daniella T. ^{[1
]}

Harb, Amro A. ^{[1
]}

Herzik, Nicholas ^{[1
]}

Householder, Sarah ^{[1
]}

Karaaslan, Lara E. ^{[1
]}

Lee, Heather ^{[1
]}

Lieberman, Evan ^{[1
]}

Ling, Andrew ^{[1
]}

Lu, Ree ^{[1
]}

Shou, Arthur Y. ^{[1
]}

Sisti, Alexander C. ^{[1
]}

Snow, Zachary E. ^{[1
]}

Sperring, Colin P. ^{[1
]}

Xiong, Yuqing ^{[1
]}

Zhou, Henry W. ^{[1
]}

Natarajan, Karthik ^{[2
]}

Hripcsak, George ^{[2
]}

Chen, Ruijun ^{[2
,7
]}

机构：

[1] Columbia Univ, Vagelos Coll Phys & Surg, New York, NY USA

[2] Columbia Univ, Irving Med Ctr, Dept Biomed Informat, 622 West 168th St,PH-20, New York, NY 10032 USA

[3] Columbia Univ, Irving Med Ctr, Div Pulm Allergy & Crit Care Med, Dept Med,New York Presbyterian, New York, NY USA

[4] Columbia Univ, Irving Med Ctr, New York Presbyterian, Div Gen Med,Dept Med, New York, NY USA

[5] Columbia Univ, Irving Med Ctr, New York Presbyterian, Dept Emergency Med, New York, NY USA

[6] Columbia Univ, Irving Med Ctr, New York Presbyterian, Div Cardiol,Dept Med, New York, NY USA

[7] Weill Cornell Med, Dept Med, New York, NY 10065 USA

[8] Columbia Univ, Irving Med Ctr, New York Presbyterian, Div Infect Dis,Dept Med, New York, NY USA

来源：

BMJ-BRITISH MEDICAL JOURNAL | 2020年 / 369卷

基金：

美国国家卫生研究院;

关键词：

D O I：

10.1136/bmj.m1996

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVE To characterize patients with coronavirus disease 2019 (covid-19) in a large New York City medical center and describe their clinical course across the emergency department, hospital wards, and intensive care units. DESIGN Retrospective manual medical record review. SETTING NewYork-Presbyterian/Columbia University Irving Medical Center, a quaternary care academic medical center in New York City. PARTICIPANTS The first 1000 consecutive patients with a positive result on the reverse transcriptase polymerase chain reaction assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who presented to the emergency department or were admitted to hospital between 1 March and 5 April 2020. Patient data were manually abstracted from electronic medical records. MAIN OUTCOME MEASURES Characterization of patients, including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition. RESULTS Of the first 1000 patients, 150 presented to the emergency department, 614 were admitted to hospital (not intensive care units), and 236 were admitted or transferred to intensive care units. The most common presenting symptoms were cough (732/1000), fever (728/1000), and dyspnea (631/1000). Patients in hospital, particularly those treated in intensive care units, often had baseline comorbidities including hypertension, diabetes, and obesity. Patients admitted to intensive care units were older, predominantly male (158/236, 66.9%), and had long lengths of stay (median 23 days, interquartile range 12-32 days); 78.0% (184/236) developed acute kidney injury and 35.2% (83/236) needed dialysis. Only 4.4% (6/136) of patients who required mechanical ventilation were first intubated more than 14 days after symptom onset. lime to intubation from symptom onset had a bimodal distribution, with modes at three to four days, and at nine days. As of 30 April, 90 patients remained in hospital and 211 had died in hospital. CONCLUSIONS Patients admitted to hospital with covid-19 at this medical center faced major morbidity and mortality, with high rates of acute kidney injury and inpatient dialysis, prolonged intubations, and a bimodal distribution of time to intubation from symptom onset.

引用

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