Factors associated with hospitalization and critical illness among 4,103 patients with Covid-19 disease in New York City

VIEW OR DOWNLOAD PRE-PRINT STUDY (PDF)

Abstract

Background: Little is known about factors associated with hospitalization and critical illness in Covid-19 positive patients.

Methods: We conducted a cross-sectional analysis of all patients with laboratory-confirmed Covid-19 treated at an academic health system in New York City between March 1, 2020 and April 2, 2020, with follow up through April 7, 2020. Primary outcomes were hospitalization and critical illness (intensive care, mechanical ventilation, hospice and/or death). We conducted multivariable logistic regression to identify risk factors for adverse outcomes, and maximum information gain decision tree classifications to identify key splitters.

Results: Among 4,103 Covid-19 patients, 1,999 (48.7%) were hospitalized, of whom 981/1,999 (49.1%) have been discharged, and 292/1,999 (14.6%) have died or been discharged to hospice. Of 445 patients requiring mechanical ventilation, 162/445 (36.4%) have died. Strongest hospitalization risks were age ≥75 years (OR 66.8, 95% CI, 44.7-102.6), age 65-74 (OR 10.9, 95% CI, 8.35-14.34), BMI>40 (OR 6.2, 95% CI, 4.2-9.3), and heart failure (OR 4.3 95% CI, 1.9-11.2). Strongest critical illness risks were admission oxygen saturation <88% (OR 6.99, 95% CI 4.5-11.0), d-dimer>2500 (OR 6.9, 95% CI, 3.2-15.2), ferritin >2500 (OR 6.9, 95% CI, 3.2-15.2), and C-reactive protein (CRP) >200 (OR 5.78, 95% CI, 2.6-13.8). In the decision tree for admission, the most important features were age >65 and obesity; for critical illness, the most important was SpO2<88, followed by procalcitonin >0.5, troponin <0.1 (protective), age >64 and CRP>200.

Conclusions: Age and comorbidities are powerful predictors of hospitalization; however, admission oxygen impairment and markers of inflammation are most strongly associated with critical illness.

VIEW OR DOWNLOAD PRE-PRINT STUDY (PDF)

Corresponding author: Leora Horwitz, MD, MHS 227 E. 30th St. #633 New York, NY 10016 Leora.horwitz@nyulangone.org (646) 501-2685

Authors: Christopher M. Petrilli, MD1,2Simon A. Jones, PhD3,4Jie Yang, MPH, MS4Harish Rajagopalan2Luke O’Donnell, MD1Yelena Chernyak2Katie A. Tobin, MPA2Robert J. Cerfolio, MD2,5Fritz Francois, MD2,6Leora I. Horwitz, MD, MHS1,3,4

Affiliations: 1Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU Grossman School of Medicine, New York, NY 2NYU Langone Health, New York, NY 3Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, New York, NY 4Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY 5Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, New York, NY 6Division of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, New York, NY Corresponding author: Leora Horwitz, MD, MHS 227 E. 30th St. #633 New York, NY 10016 Leora.horwitz@nyulangone.org(646) 501-2685