Clinical management of hospitalized COVID-19 patients in the United States

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

OBJECTIVE: The objective of this study was to characterize hospitalized COVID-19 patients and describe their real-world treatment patterns and outcomes over time. METHODS: Adult patients hospitalized 5/1/2020–12/31/2020 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), ICU utilization and mortality were examined. RESULTS: The study included 295 657 patients (847 hospitals), with median age(IQR) of 66(54-77) years. Majority were male, white, and over 65. Approximately 85% had no supplemental oxygen charges (NSOc) or low-flow oxygen (LFO) at baseline, while 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 two days of hospitalization in December vs 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/ECMO (IMV/ECMO):53.7%, high-flow oxygen/non-invasive ventilation (HFO/NIV):32.2%, LFO:11.7%, NSOc:7.3%). ICU use decreased, while 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, while improvement in outcomes occurred over this time-period.