Hospitalised COVID-19 patients of the Mount Sinai Health System: a retrospective observational study using the electronic medical records

  1. Zichen Wang
  2. Amanda Zheutlin
  3. Yu-Han Kao
  4. Kristin Ayers
  5. Susan Gross
  6. Patricia Kovatch
  7. Sharon Nirenberg
  8. Alexander Charney
  9. Girish Nadkarni
  10. Jessica K De Freitas
  11. Paul O’Reilly
  12. Allan Just
  13. Carol Horowitz
  14. Glenn Martin
  15. Andrea Branch
  16. Benjamin S Glicksberg
  17. Dennis Charney
  18. David Reich
  19. William K Oh
  20. Eric Schadt
  21. Rong Chen
  22. Li Li

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Abstract

To assess association of clinical features on COVID-19 patient outcomes.

Design

Retrospective observational study using electronic medical record data.

Setting

Five member hospitals from the Mount Sinai Health System in New York City (NYC).

Participants

28 336 patients tested for SARS-CoV-2 from 24 February 2020 to 15 April 2020, including 6158 laboratory-confirmed COVID-19 cases.

Main outcomes and measures

Positive test rates and in-hospital mortality were assessed for different racial groups. Among positive cases admitted to the hospital (N=3273), we estimated HR for both discharge and death across various explanatory variables, including patient demographics, hospital site and unit, smoking status, vital signs, lab results and comorbidities.

Results

Hispanics (29%) and African Americans (25%) had disproportionately high positive case rates relative to their representation in the overall NYC population (p<0.05); however, no differences in mortality rates were observed in hospitalised patients based on race. Outcomes differed significantly between hospitals (Gray’s T=248.9; p<0.05), reflecting differences in average baseline age and underlying comorbidities. Significant risk factors for mortality included age (HR 1.05, 95% CI 1.04 to 1.06; p=1.15e-32), oxygen saturation (HR 0.985, 95% CI 0.982 to 0.988; p=1.57e-17), care in intensive care unit areas (HR 1.58, 95% CI 1.29 to 1.92; p=7.81e-6) and elevated creatinine (HR 1.75, 95% CI 1.47 to 2.10; p=7.48e-10), white cell count (HR 1.02, 95% CI 1.01 to 1.04; p=8.4e-3) and body mass index (BMI) (HR 1.02, 95% CI 1.00 to 1.03; p=1.09e-2). Deceased patients were more likely to have elevated markers of inflammation.

Conclusions

While race was associated with higher risk of infection, we did not find racial disparities in inpatient mortality suggesting that outcomes in a single tertiary care health system are comparable across races. In addition, we identified key clinical features associated with reduced mortality and discharge. These findings could help to identify which COVID-19 patients are at greatest risk of a severe infection response and predict survival.

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  1. Version published to 10.1136/bmjopen-2020-040441
  2. ScreenIT

    SciScore for 10.1101/2020.04.28.20075788: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: Electronic Medical Record data and processing: This study utilized the de-identified EMR data and was exempted from the Mount Sinai Institutional Review Board due to the COVID-19 pandemic.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    In total, the background population was composed of 1.6 million people, with 48.1% white, 21.6% African American/Black, 15.3% other, 8.5% Asian/Pacific Islander and 6.4% Hispanic/Latinos (Table 1).
    Islander
    suggested: (Islander, RRID:SCR_007758)

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Positive case rate differences may also in part be due to limitations on number of available tests in high case density places. According to testing rates made available by NY State (https://github.com/nychealth/coronavirus-data) combined with population estimates15, 3.5 residents in Brooklyn and 2.7 residents in Queens per 100 have been tested, while 4.2 per 100 have been tested in Staten Island, for example. Test availability may have resulted in biasing testing among those residents to individuals more likely to be positive, thus artificially raising the positive rate by testing fewer individuals seen as less likely to be positive (e.g., asymptomatic individuals). Fewer tests also reduce the ability to track and contain the virus, so this may contribute to higher case rates, as well. While we are encouraged to report no in-hospital differences in mortality by race, the burden of mortality will remain disproportionately held by African American and Hispanic individuals until rates of infection can be targeted and reduced. We also found that where patients were treated affected their risk for mortality. Patients admitted to hospitals in Brooklyn or Queens were at higher risk than those at one of the Manhattan hospitals. The outer boroughs have consistently higher rates of comorbidities relevant to COVID-19 infection compared to Manhattan18. We found that average age in patients admitted in Brooklyn or Mount Sinai Queens was higher and oxygen saturation is lower than those in...

    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

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  3. Version published to 10.1101/2020.04.28.20075788v1 on medRxiv