Factors associated with hospitalization and critical illness among 4,103 patients with COVID-19 disease in New York City

Christopher M. Petrilli; Simon A. Jones; Jie Yang; Harish Rajagopalan; Luke F. O'Donnell; Yelena Chernyak; Katie Tobin; Robert J. Cerfolio; Fritz Francois; Leora I. Horwitz

In this report, we describe characteristics of 4,103 patients with laboratory-confirmed Covid-19 disease in New York City, of whom 1,999 required hospital admission and 650 required intensive care, mechanical ventilation, were discharged to hospice and/or died. We find particularly strong associations of older age, obesity, heart failure and chronic kidney disease with hospitalization risk, with much less influence of race, smoking status, chronic pulmonary disease and other forms of heart disease. Moreover, we also noted the importance of hypoxia despite supplemental oxygen and early elevations in inflammatory markers (especially d-dimer and c-reactive protein) in distinguishing among patients who go on to develop critical illness and In fact, outcomes in the majority of reports are similar to ours. A commentary by the Chinese Center for Disease Control and Prevention described outcomes for 72,314 cases, of which 14% were severe (similar to hospitalized patients in our series) and 5% critical with respiratory or multiorgan failure (similar to those with critical illness in our series). 23 Among critical cases, mortality was 49%; ours is 45% to date. This is also similar to the typical mortality rate from acute respiratory distress syndrome (ARDS) of about 35-45%. 24,25 Finally, our results are also consistent with a recent national case series reported by the US CDC that found that 457 of 1,037 (44%) hospitalized patients required ICU admission, and that three quarters had at least one chronic condition. 5 The risk factors we identified for hospitalization in Covid-19 are largely similar to those associated with any type of severe disease requiring hospitalization or ICU level care, though we 1 3 were surprised that cancer and chronic pulmonary disease did not feature more prominently in the risk models. 26 Moreover, the demographic distribution of hospitalized patients is also similar to other acute respiratory infections. For instance, while advanced age was by far the most important predictor of hospitalization and an important predictor of severe outcomes (as it is for most illnesses), 54% of hospitalized patients were younger than 65 years. This is typical of the hospitalization pattern in viral respiratory disease. Studies of influenza hospitalizations in the United States have found that people younger than 65 years account for 53-57% of influenzarelated hospitalizations. 27,28 While men made up a grossly disproportionate number of both hospitalizations and critical illness, this difference was attenuated by multivariable adjustment for comorbidities such that gender was no longer one of the most prominent risk variables.