Investigators who studied hospital admissions for COVID-19 at an integrated health care system in California found that adults across all age groups required inpatient care, not just the elderly, according to a new report in the Journal of the American Medical Association.

The report provides details of the clinical manifestation of the disease and characteristics of patients hospitalized with it, including clinical presentation and underlying health problems. As with other recent studies, the new investigation found hypertension, diabetes, and chronic kidney disease to be common underlying health problems.

Of 377 adult patients admitted to a Kaiser Permanente Northern California (KPNC) hospital from March 1, 2020 to March 31, 2020 after testing positive for SARS-CoV-2, the novel coronavirus that causes COVID-19, 264 (70%) were treated on a general ward or intermediate-care unit and 113 (30%) received treatment in an intensive care unit (ICU), Laura C. Myers, MD, MPH, and colleagues at KPNC’s Division of Research and Systems Research Initiative in Oakland reported. Patients had a median age of 61 years, and 212 (56.2%) were men. Hypertension was the most common comorbidity (164 patients, 43.5%), followed by diabetes (118 patients, 31.3%) and chronic kidney disease (48 patients, 12.7%).

None of the 166 patients who underwent testing for influenza A/B or respiratory syncytial virus (44% of the entire cohort) tested positive for these pathogens. Chest radiographs revealed bilateral infiltrations in 239 patients (63.4%). In all, 110 patients (29.2%) required invasive mechanical ventilation.


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Although patients aged 60 to 69 years represented the most common age group hospitalized (93 patients, 24.6%) and admitted to an ICU (31 patients, 27.4%), adults of all ages were admitted. Among all hospitalized patients, 172 patients (45.6%) were aged 59 years or less and 205 (54.4%) were aged 60 years or more, according to the investigators.

Of 321 patients with discharge dispositions, 50 (15.6%) died in the hospital, Dr Myers and her team reported. Of 253 patients treated on a ward with discharge dispositions, 16 (6.3%) died. Of 68 patients treated in an ICU with discharge dispositions, 34 (50%) died.

The chief system in the emergency department was shortness of breath (185 patients, 49.1%), fever (127 patients, 33.7%), and cough (120 (31.8%).

“Unlike previous studies, adults across age groups, not just elderly individuals, required inpatient care, with persons aged 60 to 69 years most commonly hospitalized,” Dr Myers and her coauthors wrote. “These findings underscore the importance of public health interventions that prevent transmission for the entire public to mitigate hospital surges.”

The study follows an April 22 online report in JAMA in which investigators described their findings from a study of 5700 patients with COVID-19 admitted to 12 Northwell Health system hospitals in the New York City area. The study included all sequentially hospitalized patients from March 1 to April 4.

Of the 5700 patients, 60.3% were male and 39.7% were female. Patients had a median age of 63 years. The most common comorbidities were hypertension, obesity, and diabetes, which were present in 56.6%, 41.7%, and 33.8% of patients. In addition, 5% had CKD and 3.5% had end-stage kidney disease. At triage, 30.7% of patients were febrile, 27.8% received supplemental oxygen, and 17.3% had a respiratory rate greater than 24 breaths/minute.

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The investigators, led by Karina W. Davidson, PhD, of Northwell Health in New York City,   assessed outcomes for 2634 patients who were discharged or had died at the study end point. During hospitalization, 21% died, 14.2% received treatment in an ICU, 12.2% received invasive mechanical ventilation, and 3.2% received renal replacement therapy.

References

Myers LC, Parodi SM, Escobar GJ, Liu VX. Characteristics of hospitalized adults with COVID-19 in an integrated health care system in California [published online April 24, 2020]. JAMA.  doi: 10.1001/jama.2020.7202

Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area [published online April 22, 2020]. JAMA. doi:10.1001/jama.2020.6775