Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series

  1. Michael G Argenziano
  2. Samuel L Bruce
  3. Cody L Slater
  4. Jonathan R Tiao
  5. Matthew R Baldwin
  6. R Graham Barr
  7. Bernard P Chang
  8. Katherine H Chau
  9. Justin J Choi
  10. Nicholas Gavin
  11. Parag Goyal
  12. Angela M Mills
  13. Ashmi A Patel
  14. Marie-Laure S Romney
  15. Monika M Safford
  16. Neil W Schluger
  17. Soumitra Sengupta
  18. Magdalena E Sobieszczyk
  19. Jason E Zucker
  20. Paul A Asadourian
  21. Fletcher M Bell
  22. Rebekah Boyd
  23. Matthew F Cohen
  24. MacAlistair I Colquhoun
  25. Lucy A Colville
  26. Joseph H de Jonge
  27. Lyle B Dershowitz
  28. Shirin A Dey
  29. Katherine A Eiseman
  30. Zachary P Girvin
  31. Daniella T Goni
  32. Amro A Harb
  33. Nicholas Herzik
  34. Sarah Householder
  35. Lara E Karaaslan
  36. Heather Lee
  37. Evan Lieberman
  38. Andrew Ling
  39. Ree Lu
  40. Arthur Y Shou
  41. Alexander C Sisti
  42. Zachary E Snow
  43. Colin P Sperring
  44. Yuqing Xiong
  45. Henry W Zhou
  46. Karthik Natarajan
  47. George Hripcsak
  48. Ruijun Chen

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Abstract

Objective

To characterize patients with coronavirus disease 2019 (covid-19) in a large New York City medical center and describe their clinical course across the emergency department, hospital wards, and intensive care units.

Design

Retrospective manual medical record review.

Setting

NewYork-Presbyterian/Columbia University Irving Medical Center, a quaternary care academic medical center in New York City.

Participants

The first 1000 consecutive patients with a positive result on the reverse transcriptase polymerase chain reaction assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who presented to the emergency department or were admitted to hospital between 1 March and 5 April 2020. Patient data were manually abstracted from electronic medical records.

Main outcome measures

Characterization of patients, including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition.

Results

Of the first 1000 patients, 150 presented to the emergency department, 614 were admitted to hospital (not intensive care units), and 236 were admitted or transferred to intensive care units. The most common presenting symptoms were cough (732/1000), fever (728/1000), and dyspnea (631/1000). Patients in hospital, particularly those treated in intensive care units, often had baseline comorbidities including hypertension, diabetes, and obesity. Patients admitted to intensive care units were older, predominantly male (158/236, 66.9%), and had long lengths of stay (median 23 days, interquartile range 12-32 days); 78.0% (184/236) developed acute kidney injury and 35.2% (83/236) needed dialysis. Only 4.4% (6/136) of patients who required mechanical ventilation were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at three to four days, and at nine days. As of 30 April, 90 patients remained in hospital and 211 had died in hospital.

Conclusions

Patients admitted to hospital with covid-19 at this medical center faced major morbidity and mortality, with high rates of acute kidney injury and inpatient dialysis, prolonged intubations, and a bimodal distribution of time to intubation from symptom onset.

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    SciScore for 10.1101/2020.04.20.20072116: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    17 NYP/CUIMC includes Milstein Hospital, which includes 6 ICUs, and Milstein Heart Center, which includes an additional coronary and cardiothoracic ICU, for a total of 117 adult ICU beds.
    Milstein Heart Center
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1136/bmj.m1996
  3. Version published to 10.1101/2020.04.20.20072116v2 on medRxiv
  4. Version published to 10.1101/2020.04.20.20072116v1 on medRxiv