tetano
Editor, Senior Moderator
Open Forum Infect Dis
. 2021 Nov 30;9(1)
fab599.
doi: 10.1093/ofid/ofab599. eCollection 2022 Jan.
Trends in Clinical Severity of Hospitalized Patients With Coronavirus Disease 2019-Premier Hospital Dataset, April 2020-April 2021
Geoffrey P Whitfield[SUP] 1 [/SUP], Aaron M Harris[SUP] 1 [/SUP], Sameer S Kadri[SUP] 2 [/SUP], Sara Warner[SUP] 2 [/SUP], Sapna Bamrah Morris[SUP] 1 [/SUP], Jennifer E Giovanni[SUP] 1 [/SUP], Jessica S Rogers-Brown[SUP] 1 [/SUP], Alison F Hinckley[SUP] 3 [/SUP], Lyudmyla Kompaniyets[SUP] 1 [/SUP], Kanta D Sircar[SUP] 1 [/SUP], Hussain R Yusuf[SUP] 1 [/SUP], Emilia H Koumans[SUP] 1 [/SUP], Beth K Schweitzer[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Clinical severity of coronavirus disease 2019 (COVID-19) may vary over time; trends in clinical severity at admission during the pandemic among hospitalized patients in the United States have been incompletely described, so a historical record of severity over time is lacking.
Methods: We classified 466677 hospital admissions for COVID-19 from April 2020 to April 2021 into 4 mutually exclusive severity grades based on indicators present on admission (from most to least severe): Grade 4 included intensive care unit (ICU) admission and invasive mechanical ventilation (IMV); grade 3 included non-IMV ICU and/or noninvasive positive pressure ventilation; grade 2 included diagnosis of acute respiratory failure; and grade 1 included none of the above indicators. Trends were stratified by sex, age, race/ethnicity, and comorbid conditions. We also examined severity in states with high vs low Alpha (B.1.1.7) variant burden.
Results: Severity tended to be lower among women, younger adults, and those with fewer comorbidities compared to their counterparts. The proportion of admissions classified as grade 1 or 2 fluctuated over time, but these less-severe grades comprised a majority (75%-85%) of admissions every month. Grades 3 and 4 consistently made up a minority of admissions (15%-25%), and grade 4 showed consistent decreases in all subgroups, including states with high Alpha variant burden.
Conclusions: Clinical severity among hospitalized patients with COVID-19 has varied over time but has not consistently or markedly worsened over time. The proportion of admissions classified as grade 4 decreased in all subgroups. There was no consistent evidence of worsening severity in states with higher vs lower Alpha prevalence.
Keywords: COVID severity trends; electronic medical records; epidemiology
. 2021 Nov 30;9(1)
fab599.doi: 10.1093/ofid/ofab599. eCollection 2022 Jan.
Trends in Clinical Severity of Hospitalized Patients With Coronavirus Disease 2019-Premier Hospital Dataset, April 2020-April 2021
Geoffrey P Whitfield[SUP] 1 [/SUP], Aaron M Harris[SUP] 1 [/SUP], Sameer S Kadri[SUP] 2 [/SUP], Sara Warner[SUP] 2 [/SUP], Sapna Bamrah Morris[SUP] 1 [/SUP], Jennifer E Giovanni[SUP] 1 [/SUP], Jessica S Rogers-Brown[SUP] 1 [/SUP], Alison F Hinckley[SUP] 3 [/SUP], Lyudmyla Kompaniyets[SUP] 1 [/SUP], Kanta D Sircar[SUP] 1 [/SUP], Hussain R Yusuf[SUP] 1 [/SUP], Emilia H Koumans[SUP] 1 [/SUP], Beth K Schweitzer[SUP] 1 [/SUP]
Affiliations
- PMID: 34988259
- PMCID: PMC8709898
- DOI: 10.1093/ofid/ofab599
Abstract
Background: Clinical severity of coronavirus disease 2019 (COVID-19) may vary over time; trends in clinical severity at admission during the pandemic among hospitalized patients in the United States have been incompletely described, so a historical record of severity over time is lacking.
Methods: We classified 466677 hospital admissions for COVID-19 from April 2020 to April 2021 into 4 mutually exclusive severity grades based on indicators present on admission (from most to least severe): Grade 4 included intensive care unit (ICU) admission and invasive mechanical ventilation (IMV); grade 3 included non-IMV ICU and/or noninvasive positive pressure ventilation; grade 2 included diagnosis of acute respiratory failure; and grade 1 included none of the above indicators. Trends were stratified by sex, age, race/ethnicity, and comorbid conditions. We also examined severity in states with high vs low Alpha (B.1.1.7) variant burden.
Results: Severity tended to be lower among women, younger adults, and those with fewer comorbidities compared to their counterparts. The proportion of admissions classified as grade 1 or 2 fluctuated over time, but these less-severe grades comprised a majority (75%-85%) of admissions every month. Grades 3 and 4 consistently made up a minority of admissions (15%-25%), and grade 4 showed consistent decreases in all subgroups, including states with high Alpha variant burden.
Conclusions: Clinical severity among hospitalized patients with COVID-19 has varied over time but has not consistently or markedly worsened over time. The proportion of admissions classified as grade 4 decreased in all subgroups. There was no consistent evidence of worsening severity in states with higher vs lower Alpha prevalence.
Keywords: COVID severity trends; electronic medical records; epidemiology