Analysis of hospitalized COVID 19 patients in the Mount Sinai Health System using electronic medical records (EMR) reveals important prognostic factors for improved clinical outcomes
COVID 19 is a novel threat to human health worldwide. There is an urgent need to understand patient characteristics of having COVID 19 disease and evaluate markers of critical illness and mortality. Objective: To assess association of clinical features on patient outcomes. Design, Setting, and Participants: In this observational case series, patient level data were extracted from electronic medical records for 28,336 patients tested for SARS CoV 2 at the Mount Sinai Health System from 2/24/ to 4/15/2020, including 6,158 laboratory confirmed cases. Exposures: Confirmed COVID 19 diagnosis by RT PCR assay from nasal swabs. Main Outcomes and Measures: Effects of race on positive test rates and mortality were assessed. Among positive cases admitted to the hospital (N 3,273) effects of patient demographics, hospital site and unit, social behavior, vital signs, lab results, and disease comorbidities on discharge and death were estimated. Results: Hispanics (29% and African Americans (25% had disproportionately high positive case rates relative to population base rates (p<2e 16) however, no differences in mortality rates were observed in the hospital. Outcome differed significantly between hospitals (Gray's T=248.9; p<2e 16) reflecting differences in average baseline age and underlying comorbidities. Significant risk factors for mortality included age (HR=1.05 [95% CI, 1.04 1.06] p=1.15e 32) oxygen saturation (HR=0.985 [95% CI, 0.982 0.988] p=1.57e 17) care in ICU areas (HR=1.58 [95% CI, 1.29 1.92] p=7.81e 6) and elevated creatinine (HR=1.75 [95% CI, 1.47 2.10] p=7.48e 10) alanine aminotransferase (ALT) (HR=1.002, [95% CI 1.001 1.003] p=8.86e 5) and body mass index (BMI) (HR=1.02, [95% CI 1.00 1.03] p=1.09e 2) Asthma (HR=0.78 [95% CI, 0.62 0.98] p=0.031) was significantly associated with increased length of hospital stay, but not mortality. Deceased patients were more likely to have elevated markers of inflammation. Baseline age, BMI, oxygen saturation, respiratory rate, white blood cell (WBC) count, creatinine, and ALT were significant prognostic indicators of mortality. Conclusions and Relevance: While race was associated with higher risk of infection, we did not find a racial disparity in inpatient mortality suggesting that outcomes in a single tertiary care health system are comparable across races. We identified clinical features associated with reduced mortality and discharge. These findings could help to identify which COVID 19 patients are at greatest risk and evaluate the impact on survival.
medRxiv