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Abstract

Background:

The COVID-19 pandemic has caused substantial morbidity and mortality.

Objective:

To describe monthly clinical trends among adults hospitalized with COVID-19.

Design:

Pooled cross-sectional study.

Setting:

99 counties in 14 states participating in the Coronavirus Disease 2019–Associated Hospitalization Surveillance Network (COVID-NET).

Patients:

U.S. adults (aged ≥18 years) hospitalized with laboratory-confirmed COVID-19 during 1 March to 31 December 2020.

Measurements:

Monthly hospitalizations, intensive care unit (ICU) admissions, and in-hospital death rates per 100 000 persons in the population; monthly trends in weighted percentages of interventions, including ICU admission, mechanical ventilation, and vasopressor use, among an age- and site-stratified random sample of hospitalized case patients.

Results:

Among 116 743 hospitalized adults with COVID-19, the median age was 62 years, 50.7% were male, and 40.8% were non-Hispanic White. Monthly rates of hospitalization (105.3 per 100 000 persons), ICU admission (20.2 per 100 000 persons), and death (11.7 per 100 000 persons) peaked during December 2020. Rates of all 3 outcomes were highest among adults aged 65 years or older, males, and Hispanic or non-Hispanic Black persons. Among 18 508 sampled hospitalized adults, use of remdesivir and systemic corticosteroids increased from 1.7% and 18.9%, respectively, in March to 53.8% and 74.2%, respectively, in December. Frequency of ICU admission, mechanical ventilation, and vasopressor use decreased from March (37.8%, 27.8%, and 22.7%, respectively) to December (20.5%, 12.3%, and 12.8%, respectively); use of noninvasive respiratory support increased from March to December.

Limitation:

COVID-NET covers approximately 10% of the U.S. population; findings may not be generalizable to the entire country.

Conclusion:

Rates of COVID-19–associated hospitalization, ICU admission, and death were highest in December 2020, corresponding with the third peak of the U.S. pandemic. The frequency of intensive interventions for management of hospitalized patients decreased over time. These data provide a longitudinal assessment of clinical trends among adults hospitalized with COVID-19 before widespread implementation of COVID-19 vaccines.

Primary Funding Source:

Centers for Disease Control and Prevention.

中文翻译：

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2020 年 3 月至 2020 年 12 月因 COVID-19 住院的美国成年人的临床趋势

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抽象的

背景：

COVID-19 大流行已导致大量发病率和死亡率。

客观的：

描述 COVID-19 住院成人的每月临床趋势。

设计：

汇总横断面研究。

环境：

14 个州的 99 个县参与了 2019 年冠状病毒病相关住院监测网络 (COVID-NET)。

耐心：

2020 年 3 月 1 日至 12 月 31 日期间因实验室确诊的 COVID-19 住院的美国成年人（年龄≥18 岁）。

测量：

每月住院人数、重症监护病房 (ICU) 入院人数和每 10 万人中的住院死亡率；在按年龄和地点分层的住院病例患者随机样本中，干预措施加权百分比的月度趋势，包括 ICU 入院、机械通气和血管加压药使用。

结果：

在 116743 名 COVID-19 住院成人中，中位年龄为 62 岁，50.7% 为男性，40.8% 为非西班牙裔白人。每月住院率（每 10 万人 105.3 人）、ICU 入院率（每 10 万人 20.2 人）和死亡率（每 10 万人 11.7 人）在 2020 年 12 月达到峰值。所有 3 种结局的发生率在 65 岁或以上的成年人中最高、男性和西班牙裔或非西班牙裔黑人。在抽样的 18508 名住院成人中，瑞德西韦和全身性皮质类固醇的使用率分别从 3 月份的 1.7% 和 18.9% 增加到 12 月份的 53.8% 和 74.2%。从 3 月（分别为 37.8%、27.8% 和 22.7%）到 12 月（分别为 20.5%、12.3% 和 12.8%），入住 ICU 的频率、机械通气和血管加压药使用率下降；

局限性：

COVID-NET 覆盖了大约 10% 的美国人口；调查结果可能无法推广到整个国家。

结论：

2020 年 12 月，与 COVID-19 相关的住院率、ICU 入院率和死亡率最高，与美国大流行的第三个高峰相对应。住院患者管理的强化干预频率随着时间的推移而减少。这些数据提供了在广泛实施 COVID-19 疫苗之前对 COVID-19 住院成人临床趋势的纵向评估。

主要资金来源：

疾病预防与控制中心。