Clinical characteristics and outcomes for 7,995 patients with SARS-CoV-2 infection

Abstract

Severe acute respiratory syndrome virus (SARS-CoV-2) has infected millions of people worldwide. Our goal was to identify risk factors associated with admission and disease severity in patients with SARS-CoV-2.

Design

This was an observational, retrospective study based on real-world data for 7,995 patients with SARS-CoV-2 from a clinical data repository.

Setting

Yale New Haven Health (YNHH) is a five-hospital academic health system serving a diverse patient population with community and teaching facilities in both urban and suburban areas.

Populations

The study included adult patients who had SARS-CoV-2 testing at YNHH between March 1 and April 30, 2020.

Main outcome and performance measures

Primary outcomes were admission and in-hospital mortality for patients with SARS-CoV-2 infection as determined by RT-PCR testing. We also assessed features associated with the need for respiratory support.

Results

Of the 28605 patients tested for SARS-CoV-2, 7995 patients (27.9%) had an infection (median age 52.3 years) and 2154 (26.9%) of these had an associated admission (median age 66.2 years). Of admitted patients, 2152 (99.9%) had a discharge disposition at the end of the study period. Of these, 329 (15.3%) required invasive mechanical ventilation and 305 (14.2%) expired. Increased age and male sex were positively associated with admission and in-hospital mortality (median age 80.7 years), while comorbidities had a much weaker association with the risk of admission or mortality. Black race (OR 1.43, 95%CI 1.14–1.78) and Hispanic ethnicity (OR 1.81, 95%CI 1.50–2.18) were identified as risk factors for admission, but, among discharged patients, age-adjusted in-hospital mortality was not significantly different among racial and ethnic groups.

Conclusions

This observational study identified, among people testing positive for SARS-CoV-2 infection, older age and male sex as the most strongly associated risks for admission and in-hospital mortality in patients with SARS-CoV-2 infection. While minority racial and ethnic groups had increased burden of disease and risk of admission, age-adjusted in-hospital mortality for discharged patients was not significantly different among racial and ethnic groups. Ongoing studies will be needed to continue to evaluate these risks, particularly in the setting of evolving treatment guidelines.

SciScore for 10.1101/2020.07.19.20157305: (What is this?)

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

Table 1: Rigor

Institutional Review Board Statement	IRB: The study was approved by the Yale University Institutional Review Board (protocol #2000027747).
Randomization	not detected.
Blinding	not detected.
Power Analysis	not detected.
Sex as a biological variable	not detected.

Table 2: Resources

No key resources detected.

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: We detected the following sentences addressing limitations in the study:

However, as an observational study based on real-world data, this study also has several limitations. First, while standardized testing protocols were in place, testing was often limited to symptomatic individuals or those with known exposure risks, thus potentially biasing our cohort to those who were symptomatic and sought care. The study was also limited to a single health system, but one that consists of a mixture of academic, urban, and suburban care facilities with a diverse patient population. In addition, while our health system implemented standardized treatment protocols, patients received therapies that were investigational for Covid-19 at the time of the study, and use of these medications may not be similar at all institutions, especially as Covid-19 treatment protocols rapidly evolve as new evidence is obtained. Another limitation is that features associated with risk of admission may not correlate to risk of disease severity, as the decision to admit can be impacted based on discharge options or perceived clinical risks by healthcare providers. Finally, due to the timeline of the current outbreak, this study was limited to the initial admission and only assessed in-hospital mortality. Therefore, additional studies are needed to assess the impact of disease on patients not admitted to the hospital and the long-term effects of SARS-CoV-2 infection. There is an ongoing need to rapidly generate and communicate evidence, while also being cautious that only high-qual...

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.

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