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      Characteristics, Outcomes, and Trends of Patients With COVID-19–Related Critical Illness at a Learning Health System in the United States

      other
      Author(s): , MD, MSCE, MBE * , , DNP, RN * , , PhD, MPH, , MD, PhD, , MD, , MD, MSCE, , MD, , PharmD, , MD, MSc,   , MD, , MD, , MD, MSCE, , CRNP, , MD, MSHP, , MD, MS, , MD, MS, , MD, , BS, RRT, , MS, , MD, , MBA, MPP, , MD, , MD, , MSc, MPH, , MD, MSHP, , MD, , MD, MSCE, , MD, , MD, PhD, , MD, , MD, , MBBS, , MD, MSCE, , BS, , MD, , MBChB, , MD, MSCE, , CRNP, , MD, , PhD, , MD, , MD, MSCE†, , MD†
      Publication date (Electronic):
      Journal: Annals of Internal Medicine
      Publisher: American College of Physicians

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          Abstract

          In a large health system in the United States, investigators examined whether mortality, receipt of mechanical ventilation, and patient acuity changed over time among adult patients with COVID-19–related critical illness admitted to intensive care units.

          Abstract

          Visual Abstract. COVID-19–Related Critical Illness In a large health system in the United States, investigators examined whether mortality, receipt of mechanical ventilation, and patient acuity changed over time among adult patients with COVID-19–related critical illness admitted to intensive care units.
          Visual Abstract.
          COVID-19–Related Critical Illness

          In a large health system in the United States, investigators examined whether mortality, receipt of mechanical ventilation, and patient acuity changed over time among adult patients with COVID-19–related critical illness admitted to intensive care units.

          Abstract

          Background:

          The coronavirus disease 2019 (COVID-19) pandemic continues to surge in the United States and globally.

          Objective:

          To describe the epidemiology of COVID-19–related critical illness, including trends in outcomes and care delivery.

          Design:

          Single–health system, multihospital retrospective cohort study.

          Setting:

          5 hospitals within the University of Pennsylvania Health System.

          Patients:

          Adults with COVID-19–related critical illness who were admitted to an intensive care unit (ICU) with acute respiratory failure or shock during the initial surge of the pandemic.

          Measurements:

          The primary exposure for outcomes and care delivery trend analyses was longitudinal time during the pandemic. The primary outcome was all-cause 28-day in-hospital mortality. Secondary outcomes were all-cause death at any time, receipt of mechanical ventilation (MV), and readmissions.

          Results:

          Among 468 patients with COVID-19–related critical illness, 319 (68.2%) were treated with MV and 121 (25.9%) with vasopressors. Outcomes were notable for an all-cause 28-day in-hospital mortality rate of 29.9%, a median ICU stay of 8 days (interquartile range [IQR], 3 to 17 days), a median hospital stay of 13 days (IQR, 7 to 25 days), and an all-cause 30-day readmission rate (among nonhospice survivors) of 10.8%. Mortality decreased over time, from 43.5% (95% CI, 31.3% to 53.8%) to 19.2% (CI, 11.6% to 26.7%) between the first and last 15-day periods in the core adjusted model, whereas patient acuity and other factors did not change.

          Limitation:

          Single–health system study; use of, or highly dynamic trends in, other clinical interventions were not evaluated, nor were complications.

          Conclusion:

          Among patients with COVID-19–related critical illness admitted to ICUs of a learning health system in the United States, mortality seemed to decrease over time despite stable patient characteristics. Further studies are necessary to confirm this result and to investigate causal mechanisms.

          Primary Funding Source:

          Agency for Healthcare Research and Quality.

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          Most cited references31

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          • Abstract: found
          • Article: found

          Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

          Dawei Wang, Bo Hu, Fangfang Zhu … (2020)
          In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
          Article 0 comments Cited 10786 times – based on 0 reviews     Review now
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            Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area

            Safiya Richardson, Jamie Hirsch, Mangala Narasimhan … (2020)
            There is limited information describing the presenting characteristics and outcomes of US patients requiring hospitalization for coronavirus disease 2019 (COVID-19).
            Article 0 comments Cited 4643 times – based on 0 reviews     Review now
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              Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy

              Giacomo Grasselli, Alberto Zangrillo, Alberto Zanella … (2020)
              In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited.
              Article 0 comments Cited 2760 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ann Intern Med
                Journal ID (iso-abbrev): Ann Intern Med
                Journal ID (publisher-id): aim
                Title: Annals of Internal Medicine
                Publisher: American College of Physicians
                ISSN (Print): 0003-4819
                ISSN (Electronic): 1539-3704
                Publication date (Electronic): 19 January 2021
                Electronic Location Identifier: M20-5327
                Affiliations
                [01]University of Pennsylvania Health System, Philadelphia, Pennsylvania (G.L.A., J.J., M.O.H., J.H.A., J.B., C.B., P.J.B., C.L.C., L.M.C., M.F.C., J.M.C., J.D.C., T.C., K.R.C., B.D.F., E.G., J.C.G., S.G., A.H., C.W.H., M.H., P.K., Z.N.K., G.B.K., M.L., N.D.M., M.E.M., D.N., J.L.P., M.B.P., S.C.P., Z.A.Q., J.P.R., J.S., W.D.S., M.J.S., M.G.S., C.P.S., J.K.W., W.W., A.A.W., B.J.A., J.T.G.)
                Author notes
                Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality or the National Institutes of Health.
                Acknowledgment: The authors thank the entire Penn Medicine Critical Care Alliance and Penn Medicine staff—across the spectrum of physicians, nurses, advanced practitioners, respiratory therapists, other allied health professionals, and operations and support staff—and all Penn Medicine patients and their families, who each collaborated and sacrificed in the interest of our community and public health during this generational pandemic. The authors also acknowledge additional key personnel in the preparation of this report, including but not limited to Ari Friedman, MD, PhD; Diane Gorman, MSN; Ann Huffenberger, DBA, RN; Paul Junker, MS; and Venkat Panchanadam, PhD.
                Grant Support: By Agency for Healthcare Research and Quality grant K12HS026372 (to G.L. Anesi) and National Institutes of Health grants K23HL140482 (to B.J. Anderson), K24HL115354 (to J.D. Christie), and R00HL141678 (to M.O. Harhay).

                Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-5327.

                Reproducible Research Statement: Study protocol: Not available. Statistical code: Available from Dr. Anesi (e-mail, george.anesi@ 123456pennmedicine.upenn.edu ). Data set: A data set without hospital-level indicators is available from Dr. Anesi (e-mail, george.anesi@ 123456pennmedicine.upenn.edu ).
                Corresponding Author: George L. Anesi, MD, MSCE, MBE, Division of Pulmonary, Allergy, and Critical Care, 3400 Spruce Street, 5037 Gates Building, Philadelphia, PA 19104-6021; e-mail, george.anesi@ 123456pennmedicine.upenn.edu .
                Current Author Addresses: Dr. Anesi: Division of Pulmonary, Allergy, and Critical Care, 3400 Spruce Street, 5037 Gates Building, Philadelphia, PA 19104-6021.
                Ms. Jablonski: Hospital of the University of Pennsylvania, 3400 Spruce Street, 5 Rhoads Building, Philadelphia, PA 19104.
                Drs. Harhay and Courtright: 423 Guardian Drive, 304 Blockley Hall, Philadelphia, PA 19104.
                Drs. Atkins, Cereda, Gordon, Hanson, Kornfield, and Lane-Fall: Hospital of the University of Pennsylvania, 3400 Spruce Street, 6 Dulles Building, Philadelphia, PA 19104.
                Dr. Bajaj: 3546 Route 27, Kendall Park, NJ 08824.
                Drs. Baston, Reilly, Schweickert, and Anderson: Hospital of the University of Pennsylvania, 3400 Spruce Street, 5 Gates Building, Philadelphia, PA 19104.
                Dr. Brennan: Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, Suite 5A, Philadelphia, PA 19104.
                Drs. Candeloro and Fuchs: Hospital of the University of Pennsylvania, 3400 Spruce Street, 9 Founders Building, Philadelphia, PA 19104.
                Drs. Catalano and Kinniry: Penn Medicine Washington Square, 800 Walnut Street, 9th Floor, Philadelphia, PA 19107.
                Dr. Chandler: Hospital of the University of Pennsylvania, 3400 Spruce Street, 3 Gates Building, Philadelphia, PA 19104.
                Dr. Christie: Hospital of the University of Pennsylvania, 3400 Spruce Street, 8 Maloney Building, Philadelphia, PA 19104.
                Ms. Collins and Dr. Pascual: Penn Presbyterian Medical Center, 51 North 39th Street, Medical Office Building, Suite 120, Philadelphia, PA 19104.
                Dr. Greenwood: Hospital of the University of Pennsylvania, Department of Emergency Medicine, 3400 Spruce Street, Philadelphia, PA 19104.
                Mr. Gudowski: Hospital of the University of Pennsylvania, Respiratory Care Services, 3400 Spruce Street, Philadelphia, PA 19104.
                Mr. Hanish: Penn Medicine Corp Information Services, 3930 Chestnut Street, Philadelphia, PA 19104.
                Ms. Heuer and Dr. Scott: Hospital of the University of Pennsylvania, 3400 Spruce Street, 5 Founders Building, Philadelphia, PA 19104.
                Mr. Kruse: Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104.
                Dr. Martin: Penn Medicine University City, 3737 Market Street, 4th Floor, Philadelphia, PA 19104.
                Dr. Mikkelsen: Hospital of the University of Pennsylvania, 3400 Spruce Street, 5042 Gates Building, Philadelphia, PA 19104.
                Dr. Negoianu: Hospital of the University of Pennsylvania, 3400 Spruce Street, 1 Founders Building, Philadelphia, PA 19104.
                Dr. Patel: 540 North Duke Street, Suite 244, Lancaster, PA 17602.
                Dr. Pugliese: Hospital of the University of Pennsylvania, 3400 Spruce Street, 8 Gates Building, Philadelphia, PA 19104.
                Dr. Qasim: Penn Presbyterian Medical Center, 51 North 39th Street, Myrin Building, Philadelphia, PA 19104.
                Mr. Salmon: 3600 Civic Center Boulevard, 7th Floor, 7W-101-30, Philadelphia, PA 19104.
                Dr. Shashaty: Hospital of the University of Pennsylvania, 3400 Spruce Street, 5039 Gates Building, Philadelphia, PA 19104.
                Ms. Sicoutris: Hospital of the University of Pennsylvania, 3400 Spruce Street, 1 Dulles Building, Philadelphia, PA 19104.
                Dr. J.K. Wang: Chester County Hospital, 701 East Marshall Street, West Chester, PA 19380.
                Dr. W. Wang: 423 Guardian Drive, 3 Blockley Hall, Philadelphia, PA 19104.
                Dr. Wani: Penn Medicine University City, 3737 Market Street, 10th Floor, Philadelphia, PA 19104.
                Dr. Gutsche: Penn Presbyterian Medical Center, 51 North 39th Street, 223 Wright-Saunders, Philadelphia, PA 19104.
                Author Contributions: Conception and design: G.L. Anesi, J. Jablonski, M.O. Harhay, C. Baston, L.M. Catalano, J.D. Christie, T. Collins, J.C. Greenwood, N.D. Martin, M.E. Mikkelsen, Z.A. Qasim, W. Wang, B.J. Anderson, J.T. Gutsche.
                Analysis and interpretation of the data: G.L. Anesi, M.O. Harhay, L.M. Catalano, M.F. Cereda, J.M. Chandler, J.D. Christie, K.R. Courtright, B.D. Fuchs, E. Gordon, S. Gudowski, A. Hanish, G.B. Kruse, M. Lane-Fall, M.E. Mikkelsen, D. Negoianu, S.C. Pugliese, J.P. Reilly, M.J. Scott, W. Wang, B.J. Anderson.
                Drafting of the article: G.L. Anesi, J. Jablonski, M.O. Harhay, M.F. Cereda, J.M. Chandler, E. Gordon, S. Gudowski, M.E. Mikkelsen, Z.A. Qasim, M.J. Scott, C.P. Sicoutris, A.A. Wani, B.J. Anderson, J.T. Gutsche.
                Critical revision for important intellectual content: G.L. Anesi, J. Jablonski, M.O. Harhay, J.H. Atkins, C.L. Candeloro, L.M. Catalano, M.F. Cereda, J.M. Chandler, J.D. Christie, K.R. Courtright, B.D. Fuchs, E. Gordon J.C. Greenwood, S. Gudowski, M. Lane-Fall, N.D. Martin, M.E. Mikkelsen, J.L. Pascual, S.C. Pugliese, Z.A. Qasim, J.P. Reilly, W.D. Schweickert, M.J. Scott, M.G.S. Shashaty, J.K. Wang, W. Wang, A.A. Wani, B.J. Anderson.
                Final approval of the article: G.L. Anesi, J. Jablonski, M.O. Harhay, J.H. Atkins, J. Bajaj, C. Baston, P.J. Brennan, C.L. Candeloro, L.M. Catalano, M.F. Cereda, J.M. Chandler, J.D. Christie, T. Collins, K.R. Courtright, B.D. Fuchs, E. Gordon, J.C. Greenwood, S. Gudowski, A. Hanish, C.W. Hanson, M. Heuer, P. Kinniry, Z.N. Kornfield, G.B. Kruse, M. Lane-Fall, N.D. Martin, M.E. Mikkelsen, D. Negoianu, J.L. Pascual, M.B.Patel, S.C. Pugliese, Z.A. Qasim, J.P. Reilly, J. Salmon, W.D. Schweickert, M.J. Scott, M.G.S. Shashaty, C.P. Sicoutris, J.K. Wang, W. Wang, A.A. Wani, B.J. Anderson, J.T. Gutsche.
                Provision of study materials or patients: L.M. Catalano, J.C. Greenwood, Z.N. Kornfield, N.D. Martin, M.E. Mikkelsen, M.B. Patel.
                Statistical expertise: G.L. Anesi, M.O. Harhay, M.E. Mikkelsen, W. Wang, B.J. Anderson.
                Administrative, technical, or logistic support: J. Jablonski, J. Bajaj, C. Baston, P.J. Brennan, L.M. Catalano, J.M. Chandler, B.D. Fuchs, C.W. Hanson, M. Heuer, Z.N. Kornfield, G.B. Kruse, N.D. Martin, M.E. Mikkelsen, J.L. Pascual, M.J. Scott, J.T. Gutsche.
                Collection and assembly of data: G.L. Anesi, J. Jablonski, M.O. Harhay, L.M. Catalano, A. Hanish, P. Kinniry, Z.N. Kornfield, G.B. Kruse, M.E. Mikkelsen, D. Negoianu, J.L. Pascual, M.B. Patel, J. Salmon, B.J. Anderson.
                Author information
                https://orcid.org/0000-0003-4585-0714
                https://orcid.org/0000-0002-0553-674X
                https://orcid.org/0000-0003-0124-1415
                https://orcid.org/0000-0002-2435-7413
                https://orcid.org/0000-0003-0519-218X
                https://orcid.org/0000-0003-3572-9857
                https://orcid.org/0000-0003-2337-557X
                https://orcid.org/0000-0002-6258-5898
                https://orcid.org/0000-0001-7050-0017
                https://orcid.org/0000-0002-2157-0825
                https://orcid.org/0000-0002-1613-7912
                https://orcid.org/0000-0003-3643-3505
                https://orcid.org/0000-0002-8766-3418
                https://orcid.org/0000-0002-4791-2889
                Article
                Publisher ID: aim-olf-M205327
                DOI: 10.7326/M20-5327
                PMC ID: 7901669
                PubMed ID: 33460330
                SO-VID: f7af2b42-d1b0-4f5e-88db-ca8a1d5de9ee
                Copyright statement: Copyright @ 2021
                License:

                This article is made available via the PMC Open Access Subset for unrestricted re-use for research, analyses, and text and data mining through PubMed Central. Acknowledgement of the original source shall include a notice similar to the following: "© 2020 American College of Physicians. Some rights reserved. This work permits non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited." These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                Categories
                Subject: Original Research
                Compound subject: 9715, Patients
                Compound subject: 1957, Intensive care units
                Compound subject: 3122457, COVID-19
                Compound subject: 10438, Critical care
                Compound subject: 9933, Ventilators
                Compound subject: 11361, Electronic medical records
                Compound subject: 8693, Oxygen
                Compound subject: 3453, Multiple sclerosis
                Compound subject: 362, Hospitalizations
                Compound subject: 3122776, Vasopressors
                Compound subject: early, Currently Online First
                Compound subject: coronavirus, Coronavirus Disease 2019 (COVID-19)
                Compound subject: hospital, Hospital Medicine
                Compound subject: poc-eligible, POC Eligible

                Data availability:

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