Clinical Characteristics and Morbidity Associated With Coronavirus Disease 2019 in a Series of Patients in Metropolitan Detroit - PubMed

Review

doi: 10.1001/jamanetworkopen.2020.12270.

Raef A Fadel  ² , Kelly M Malette  ² , Charles Hammond  ² , Hafsa Abdulla  ² , Abigail Entz  ² , Zachary Demertzis  ² , Zachary Hanna  ² , Andrew Failla  ² , Carina Dagher  ² , Zohra Chaudhry  ¹ , Amit Vahia  ¹ , Odaliz Abreu Lanfranco  ¹ , Mayur Ramesh  ¹ , Marcus J Zervos  ^{1   3} , George Alangaden  ^{1   3} , Joseph Miller  ^{1   3   4} , Indira Brar  ^{1   3}

Importance: In late December 2019, an outbreak caused by a novel severe acute respiratory syndrome coronavirus 2 emerged in Wuhan, China. Data on the clinical characteristics and outcomes of infected patients in urban communities in the US are limited.

Objectives: To describe the clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and to perform a comparative analysis of hospitalized and ambulatory patient populations.

Design, setting, and participants: This study is a case series of 463 consecutive patients with COVID-19 evaluated at Henry Ford Health System in metropolitan Detroit, Michigan, from March 9 to March 27, 2020. Data analysis was performed from March to April 2020.

Exposure: Laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection.

Main outcomes and measures: Demographic data, underlying comorbidities, clinical presentation, complications, treatment, and outcomes were collected.

Results: Of 463 patients with COVID-19 (mean [SD] age, 57.5 [16.8] years), 259 (55.9%) were female, and 334 (72.1%) were African American. Most patients (435 [94.0%]) had at least 1 comorbidity, including hypertension (295 patients [63.7%]), chronic kidney disease (182 patients [39.3%]), and diabetes (178 patients [38.4%]). Common symptoms at presentation were cough (347 patients [74.9%]), fever (315 patients [68.0%]), and dyspnea (282 patients [60.9%]). Three hundred fifty-five patients (76.7%) were hospitalized; 141 (39.7%) required intensive care unit management and 114 (80.8%) of those patients required invasive mechanical ventilation. Male sex (odds ratio [OR], 2.0; 95% CI, 1.3-3.2; P = .001), severe obesity (OR, 2.0; 95% CI, 1.4-3.6; P = .02), and chronic kidney disease (OR, 2.0; 95% CI, 1.3-3.3; P = .006) were independently associated with intensive care unit admission. Patients admitted to the intensive care unit had longer length of stay and higher incidence of respiratory failure and acute respiratory distress syndrome requiring invasive mechanical ventilation, acute kidney injury requiring dialysis, shock, and mortality (57 patients [40.4%] vs 15 patients [7.0%]) compared with patients in the general practice unit. Twenty-nine (11.2%) of those discharged from the hospital were readmitted and, overall, 20.0% died within 30 days. Male sex (OR, 1.8; 95% CI, 1.1-3.1; P = .03) and age older than 60 years (OR, 5.3; 95% CI, 2.9-9.7; P < .001) were significantly associated with mortality, whereas African American race was not (OR, 0.98; 95% CI, 0.54-1.8; P = .86).

Conclusions and relevance: In this review of urban metropolitan patients with COVID-19, most were African American with a high prevalence of comorbid conditions and high rates of hospitalization, intensive care unit admission, complications, and mortality due to COVID-19.

1. 1. Del Rio C, Malani PN. COVID-19: new insights on a rapidly changing epidemic. JAMA. 2020;323(14):1339-1340. doi:10.1001/jama.2020.3072 - DOI - PubMed
2. 1. John Hopkins Coronavirus Resource Center COVID-19 map. Published 2020. Accessed March 29, 2020. https://coronavirus.jhu.edu/map.html
3. 1. Centers for Disease Control and Prevention Coronavirus disease 2019 (COVID-19). Accessed April 7, 2020. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
4. 1. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-1242. doi:10.1001/jama.2020.2648 - DOI - PubMed
5. 1. Guan WJ, Ni ZY, Hu Y, et al. ; China Medical Treatment Expert Group for COVID-19 . Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720. doi:10.1056/NEJMoa2002032 - DOI - PMC - PubMed