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J Gen Intern Med . Risk Factors for Mortality in Patients With COVID-19 in New York City

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  • J Gen Intern Med . Risk Factors for Mortality in Patients With COVID-19 in New York City

    J Gen Intern Med

    . 2020 Jun 30;1-10.
    doi: 10.1007/s11606-020-05983-z. Online ahead of print.
    Risk Factors for Mortality in Patients With COVID-19 in New York City

    Takahisa Mikami 1 2 , Hirotaka Miyashita 1 2 , Takayuki Yamada 1 2 , Matthew Harrington 1 2 , Daniel Steinberg 1 2 , Andrew Dunn 1 3 , Evan Siau 4 5

    AffiliationsExpandFree PMC article


    Background: New York City emerged as an epicenter of the coronavirus disease 2019 (COVID-19) pandemic.
    Objective: To describe the clinical characteristics and risk factors associated with mortality in a large patient population in the USA.
    Design: Retrospective cohort study.
    Participants: 6493 patients who had laboratory-confirmed COVID-19 with clinical outcomes between March 13 and April 17, 2020, who were seen in one of the 8 hospitals and/or over 400 ambulatory practices in the New York City metropolitan area MAIN MEASURES: Clinical characteristics and risk factors associated with in-hospital mortality.
    Key results: A total of 858 of 6493 (13.2%) patients in our total cohort died: 52/2785 (1.9%) ambulatory patients and 806/3708 (21.7%) hospitalized patients. Cox proportional hazard regression modeling showed an increased risk of in-hospital mortality associated with age older than 50 years (hazard ratio [HR] 2.34, CI 1.47-3.71), systolic blood pressure less than 90 mmHg (HR 1.38, CI 1.06-1.80), a respiratory rate greater than 24 per min (HR 1.43, CI 1.13-1.83), peripheral oxygen saturation less than 92% (HR 2.12, CI 1.56-2.88), estimated glomerular filtration rate less than 60 mL/min/1.73m2 (HR 1.80, CI 1.60-2.02), IL-6 greater than 100 pg/mL (HR 1.50, CI 1.12-2.03), D-dimer greater than 2 mcg/mL (HR 1.19, CI 1.02-1.39), and troponin greater than 0.03 ng/mL (HR 1.40, CI 1.23-1.62). Decreased risk of in-hospital mortality was associated with female sex (HR 0.84, CI 0.77-0.90), African American race (HR 0.78 CI 0.65-0.95), and hydroxychloroquine use (HR 0.53, CI 0.41-0.67).
    Conclusions: Among patients with COVID-19, older age, male sex, hypotension, tachypnea, hypoxia, impaired renal function, elevated D-dimer, and elevated troponin were associated with increased in-hospital mortality and hydroxychloroquine use was associated with decreased in-hospital mortality.