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Oxford University Press - PMC COVID-19 Collection logoLink to Oxford University Press - PMC COVID-19 Collection
. 2020 Jul 16:ciaa1012. doi: 10.1093/cid/ciaa1012

Risk Factors for Intensive Care Unit Admission and In-hospital Mortality among Hospitalized Adults Identified through the U.S. Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET)

Lindsay Kim 1,2,#,, Shikha Garg 1,2,#, Alissa O’Halloran 1, Michael Whitaker 1,3, Huong Pham 1, Evan J Anderson 4,5,6, Isaac Armistead 7, Nancy M Bennett 8, Laurie Billing 9, Kathryn Como-Sabetti 10, Mary Hill 11, Sue Kim 12, Maya L Monroe 13, Alison Muse 14, Arthur L Reingold 15, William Schaffner 16, Melissa Sutton 17, H Keipp Talbot 16, Salina M Torres 18, Kimberly Yousey-Hindes 19, Rachel Holstein 1,20, Charisse Cummings 1,21, Lynette Brammer 1, Aron J Hall 1, Alicia M Fry 1, Gayle E Langley 1
PMCID: PMC7454425  PMID: 32674114

Abstract

Background

Currently, the United States has the largest number of reported coronavirus disease 2019 (COVID-19) cases and deaths globally. Using a geographically diverse surveillance network, we describe risk factors for severe outcomes among adults hospitalized with COVID-19.

Methods

We analyzed data from 2,491 adults hospitalized with laboratory-confirmed COVID-19 during March 1–May 2, 2020 identified through the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network comprising 154 acute care hospitals in 74 counties in 13 states. We used multivariable analyses to assess associations between age, sex, race and ethnicity, and underlying conditions with intensive care unit (ICU) admission and in-hospital mortality.

Results

Ninety-two percent of patients had ≥1 underlying condition; 32% required ICU admission; 19% invasive mechanical ventilation; and 17% died. Independent factors associated with ICU admission included ages 50-64, 65-74, 75-84 and ≥85 years versus 18-39 years (adjusted risk ratio (aRR) 1.53, 1.65, 1.84 and 1.43, respectively); male sex (aRR 1.34); obesity (aRR 1.31); immunosuppression (aRR 1.29); and diabetes (aRR 1.13). Independent factors associated with in-hospital mortality included ages 50-64, 65-74, 75-84 and ≥85 years versus 18-39 years (aRR 3.11, 5.77, 7.67 and 10.98, respectively); male sex (aRR 1.30); immunosuppression (aRR 1.39); renal disease (aRR 1.33); chronic lung disease (aRR 1.31); cardiovascular disease (aRR 1.28); neurologic disorders (aRR 1.25); and diabetes (aRR 1.19).

Conclusion

In-hospital mortality increased markedly with increasing age. Aggressive implementation of prevention strategies, including social distancing and rigorous hand hygiene, may benefit the population as a whole, as well as those at highest risk for COVID-19-related complications.

Keywords: COVID-19, SARS-CoV-2, hospitalization, mortality, surveillance


Articles from Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America are provided here courtesy of Oxford University Press

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