Background

Over 40 000 patients with COVID-19 have been hospitalised in New York City (NY, USA) as of April 28, 2020. Data on the epidemiology, clinical course, and outcomes of critically ill patients with COVID-19 in this setting are needed.

Methods

This prospective observational cohort study took place at two NewYork-Presbyterian hospitals affiliated with Columbia University Irving Medical Center in northern Manhattan. We prospectively identified adult patients (aged ≥18 years) admitted to both hospitals from March 2 to April 1, 2020, who were diagnosed with laboratory-confirmed COVID-19 and were critically ill with acute hypoxaemic respiratory failure, and collected clinical, biomarker, and treatment data. The primary outcome was the rate of in-hospital death. Secondary outcomes included frequency and duration of invasive mechanical ventilation, frequency of vasopressor use and renal replacement therapy, and time to in-hospital clinical deterioration following admission. The relation between clinical risk factors, biomarkers, and in-hospital mortality was modelled using Cox proportional hazards regression. Follow-up time was right-censored on April 28, 2020 so that each patient had at least 28 days of observation.

Findings

Between March 2 and April 1, 2020, 1150 adults were admitted to both hospitals with laboratory-confirmed COVID-19, of which 257 (22%) were critically ill. The median age of patients was 62 years (IQR 51–72), 171 (67%) were men. 212 (82%) patients had at least one chronic illness, the most common of which were hypertension (162 [63%]) and diabetes (92 [36%]). 119 (46%) patients had obesity. As of April 28, 2020, 101 (39%) patients had died and 94 (37%) remained hospitalised. 203 (79%) patients received invasive mechanical ventilation for a median of 18 days (IQR 9–28), 170 (66%) of 257 patients received vasopressors and 79 (31%) received renal replacement therapy. The median time to in-hospital deterioration was 3 days (IQR 1–6). In the multivariable Cox model, older age (adjusted hazard ratio [aHR] 1·31 [1·09–1·57] per 10-year increase), chronic cardiac disease (aHR 1·76 [1·08–2·86]), chronic pulmonary disease (aHR 2·94 [1·48–5·84]), higher concentrations of interleukin-6 (aHR 1·11 [95%CI 1·02–1·20] per decile increase), and higher concentrations of D-dimer (aHR 1·10 [1·01–1·19] per decile increase) were independently associated with in-hospital mortality.

Interpretation

Critical illness among patients hospitalised with COVID-19 in New York City is common and associated with a high frequency of invasive mechanical ventilation, extrapulmonary organ dysfunction, and substantial in-hospital mortality.

Funding

National Institute of Allergy and Infectious Diseases and the National Center for Advancing Translational Sciences, National Institutes of Health, and the Columbia University Irving Institute for Clinical and Translational Research.

中文翻译：

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纽约市COVID-19危重成年人的流行病学，临床历程和结局：一项前瞻性队列研究。

背景

截至2020年4月28日，已有超过40000例COVID-19患者在纽约市住院。在这种情况下，需要有关COVID-19危重患者的流行病学，临床病程和结局的数据。

方法

这项前瞻性观察性队列研究在曼哈顿北部哥伦比亚大学欧文医学中心的两家纽约长老会医院进行。我们前瞻性地确定了从2020年3月2日至2020年4月1日在两家医院就诊的成年患者（≥18岁），这些患者被诊断为实验室确诊的COVID-19，并患有严重的低氧血症性呼吸衰竭，并收集了临床，生物标志物，和治疗数据。主要结果是院内死亡率。次要结果包括有创机械通气的频率和持续时间，使用血管加压药和肾脏替代疗法的频率以及入院后医院内临床恶化的时间。临床危险因素，生物标志物，并使用Cox比例风险回归对医院内死亡率进行建模。随访时间在2020年4月28日进行了右删失，因此每个患者至少需要观察28天。

发现

在2020年3月2日至4月1日之间，两家医院均通过实验室确认的COVID-19收治了1150名成年人，其中257名（22％）病危。患者的中位年龄为62岁（IQR 51-72），男性为171（67％）。212名（82％）患者至少患有一种慢性病，其中最常见的是高血压（162 [63％]）和糖尿病（92 [36％]）。119名（46％）患有肥胖症。截至2020年4月28日，已有101名患者（39％）死亡，94名患者（37％）仍在住院治疗。203名（79％）患者接受了有创机械通气，平均时间为18天（IQR 9-28），257名患者中有170名（66％）接受了血管加压药，79名（31％）接受了肾脏替代治疗。住院恶化的中位时间为3天（IQR 1–6）。在多变量Cox模型中，年龄较大（每增加10年，调整后的危险比[aHR] 1·31 [1·09-1·57]），

解释

在纽约市，因COVID-19住院的患者中的危重病很常见，并且与有创机械通气，肺外器官功能障碍和住院死亡率相当高。

资金

美国国家过敏和传染病研究所，美国国家转化科学促进中心，美国国立卫生研究院和哥伦比亚大学欧文临床与转化研究所。