OBJECTIVE To describe outcomes of people admitted to hospital with coronavirus disease 2019 (covid-19) in the United States, and the clinical and laboratory characteristics associated with severity of illness. DESIGN Prospective cohort study. SETTING Single academic medical center in New York City and Long Island. PARTICIPANTS 5279 patients with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection between 1 March 2020 and 8 April 2020. The final date of follow up was 5 May 2020. MAIN OUTCOME MEASURES Outcomes were admission to hospital, critical illness (intensive care, mechanical ventilation, discharge to hospice care, or death), and discharge to hospice care or death. Predictors included patient characteristics, medical history, vital signs, and laboratory results. Multivariable logistic regression was conducted to identify risk factors for adverse outcomes, and competing risk survival analysis for mortality. RESULTS Of 11 544 people tested for SARS-Cov-2, 5566 (48.2%) were positive. After exclusions, 5279 were included. 2741 of these 5279 (51.9%) were admitted to hospital, of whom 1904 (69.5%) were discharged alive without hospice care and 665 (24.3%) were discharged to hospice care or died. Of 647 (23.6%) patients requiring mechanical ventilation, 391 (60.4%) died and 170 (26.2%) were extubated or discharged. The strongest risk for hospital admission was associated with age, with an odds ratio of >2 for all age groups older than 44 years and 37.9 (95% confidence interval 26.1 to 56.0) for ages 75 years and older. Other risks were heart failure (4.4, 2.6 to 8.0), male sex (2.8, 2.4 to 3.2), chronic kidney disease (2.6, 1.9 to 3.6), and any increase in body mass index (BMI) (eg, for BMI >40: 2.5, 1.8 to 3.4). The strongest risks for critical illness besides age were associated with heart failure (1.9, 1.4 to 2.5), BMI >40 (1.5, 1.0 to 2.2), and male sex (1.5, 1.3 to 1.8). Admission oxygen saturation of <88% (3.7, 2.8 to 4.8), troponin level >1 (4.8, 2.1 to 10.9), C reactive protein level >200 (5.1, 2.8 to 9.2), and D-dimer level >2500 (3.9, 2.6 to 6.0) were, however, more strongly associated with critical illness than age or comorbidities. Risk of critical illness decreased significantly over the study period. Similar associations were found for mortality alone. CONCLUSIONS Age and comorbidities were found to be strong predictors of hospital admission and to a lesser extent of critical illness and mortality in people with covid-19; however, impairment of oxygen on admission and markers of inflammation were most strongly associated with critical illness and mortality. Outcomes seem to be improving over time, potentially suggesting improvements in care.

中文翻译：

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2019 年纽约市 5279 名冠状病毒病患者入院和重症相关因素：前瞻性队列研究。

目的 描述美国因冠状病毒病 2019 (covid-19) 入院的患者的结局，以及与疾病严重程度相关的临床和实验室特征。设计前瞻性队列研究。设置 在纽约市和长岛的单一学术医疗中心。参与者 2020 年 3 月 1 日至 2020 年 4 月 8 日期间 5279 名实验室确诊的严重急性呼吸系统综合症冠状病毒 2 (SARS-Cov-2) 感染患者。随访的最终日期为 2020 年 5 月 5 日。 主要结局指标 结局为入院、危重病（重症监护、机械通气、出院至临终关怀或死亡），以及出院至临终关怀或死亡。预测因素包括患者特征、病史、生命体征和实验室结果。进行多变量逻辑回归以确定不良结果的风险因素，以及死亡率的竞争风险生存分析。结果 在接受 SARS-Cov-2 检测的 11544 人中，5566 人（48.2%）呈阳性。排除后，5279 人被包括在内。这 5279 人中有 2741 人（51.9%）入院，其中 1904 人（69.5%）在没有临终关怀的情况下活着出院，665 人（24.3%）出院接受临终关怀或死亡。在需要机械通气的 647 名 (23.6%) 患者中，391 名 (60.4%) 死亡，170 名 (26.2%) 拔管或出院。住院的最大风险与年龄相关，44 岁以上的所有年龄组的比值比 >2，75 岁及以上的比值比为 37.9（95% 置信区间 26.1 至 56.0）。其他风险包括心力衰竭（4.4、2.6 至 8.0）、男性（2.8、2.4 至 3.2）、慢性肾病（2.6、1.9 至 3.6），以及体重指数 (BMI) 的任何增加（例如，对于 BMI > 40：2.5、1.8 至 3.4）。除年龄外，危重疾病的最大风险与心力衰竭（1.9、1.4 至 2.5）、BMI > 40（1.5、1.0 至 2.2）和男性（1.5、1.3 至 1.8）有关。入院血氧饱和度<88% (3.7, 2.8 to 4.8), 肌钙蛋白水平 >1 (4.8, 2.1 to 10.9), C反应蛋白水平 >200 (5.1, 2.8 to 9.2), D-二聚体水平 >2500 (3.9) , 2.6 至 6.0) 然而，与年龄或合并症相比，与危重疾病的相关性更强。在研究期间，危重疾病的风险显着降低。仅在死亡率方面也发现了类似的关联。结论 年龄和合并症被发现是 Covid-19 患者入院的强有力预测因素，并且在较小程度上是严重疾病和死亡率的预测因素；然而，入院时氧气受损和炎症标志物与危重疾病和死亡率的相关性最强。随着时间的推移，结果似乎在改善，这可能表明护理有所改善。