Characterization and clinical course of 1000 patients with COVID-19 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 (NYC) medical center and describe their clinical course across the emergency department (ED), inpatient wards, and intensive care units (ICUs).

Design

Retrospective manual medical record review.

Setting

NewYork-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC), a quaternary care academic medical center in NYC.

Participants

The first 1000 consecutive patients with laboratory-confirmed COVID-19.

Methods

We identified the first 1000 consecutive patients with a positive RT-SARS-CoV-2 PCR test who first presented to the ED or were hospitalized at NYP/CUIMC between March 1 and April 5, 2020. Patient data was manually abstracted from the electronic medical record.

Main outcome measures

We describe patient characteristics including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition.

Results

Among the first 1000 patients, 150 were ED patients, 614 were admitted without requiring ICU-level care, and 236 were admitted or transferred to the ICU. The most common presenting symptoms were cough (73.2%), fever (72.8%), and dyspnea (63.1%). Hospitalized patients, and ICU patients in particular, most commonly had baseline comorbidities including of hypertension, diabetes, and obesity. ICU patients were older, predominantly male (66.9%), and long lengths of stay (median 23 days; IQR 12 to 32 days); 78.0% developed AKI and 35.2% required dialysis. Notably, for patients who required mechanical ventilation, only 4.4% were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at 3-4 and 9 days. As of April 30, 90 patients remained hospitalized and 211 had died in the hospital.

Conclusions

Hospitalized patients with COVID-19 illness at this medical center faced significant morbidity and mortality, with high rates of AKI, dialysis, and a bimodal distribution in time to intubation from symptom onset.

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