Laboratory findings associated with severe illness and mortality among hospitalized individuals with coronavirus disease 2019 in Eastern Massachusetts

Importance

The coronavirus disease 2019 (COVID-19) pandemic has placed unprecedented stress on health systems across the world, and reliable estimates of risk for adverse hospital outcomes are needed.

Objective

To quantify admission laboratory and comorbidity features associated with critical illness and mortality risk across 6 Eastern Massachusetts hospitals.

Design

Retrospective cohort study using hospital course, prior diagnoses, and laboratory values.

Setting

Emergency department and inpatient settings from 2 academic medical centers and 4 community hospitals.

Participants

All individuals with hospital admission and positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by PCR testing across these 6 hospitals through June 5, 2020.

Exposure

Coronavirus 2 (SARS-CoV-2).

Main Outcome Measures

Severe illness defined by ICU admission, mechanical ventilation, or death.

Results

Among 2,511 hospitalized individuals who tested positive for SARS-CoV-2 (of whom 50.9% were male, 53.9% white, and 27.0% Hispanic, with mean age 62.6 years), 215 (8.6%) were admitted to the ICU, 164 (6.5%) required mechanical ventilation, and 292 (11.6%) died. L1-regression models developed in 3 of these hospitals yielded area under ROC curve (AUC) of 0.807 for severe illness and 0.847 for mortality in the 3 held-out hospitals. In total, 212/292 (78%) of the deaths occurred in the highest-risk mortality quintile.

Conclusions and Relevance

In this cohort, specific admission laboratory studies in concert with sociodemographic features and prior diagnosis facilitated risk stratification among individuals hospitalized for COVID-19.

Funding

1R56MH115187-01

Trial Registration

None

Key Points