Hospitalised COVID-19 patients of the Mount Sinai Health System: a retrospective observational study using the electronic medical records
Li Li,
Benjamin S Glicksberg,
Zichen Wang,
Amanda Zheutlin,
Yu-Han Kao,
Kristin Ayers,
Susan Gross,
Patricia Kovatch,
Sharon Nirenberg,
Alexander Charney,
Girish Nadkarni,
Jessica K De Freitas,
Paul O’Reilly,
Allan Just,
Carol Horowitz,
Glenn Martin,
Andrea Branch,
Dennis Charney,
David Reich,
William K Oh,
Eric Schadt,
Rong Chen
Affiliations
Li Li
Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
Benjamin S Glicksberg
Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Zichen Wang
Sema4, Stamford, Connecticut, USA
Amanda Zheutlin
Sema4, Stamford, Connecticut, USA
Yu-Han Kao
Sema4, Stamford, Connecticut, USA
Kristin Ayers
Sema4, Stamford, Connecticut, USA
Susan Gross
Sema4, Stamford, Connecticut, USA
Patricia Kovatch
Mount Sinai Data Warehouse, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Sharon Nirenberg
Mount Sinai Data Warehouse, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Alexander Charney
Department of Genetics and Genomic Sciences, The Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Girish Nadkarni
The Hasso Plattner Institute for Digital Health at the Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Jessica K De Freitas
Department of Genetics and Genomic Sciences, The Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Paul O’Reilly
Department of Genetics and Genomic Sciences, The Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Allan Just
Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Carol Horowitz
Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Glenn Martin
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Andrea Branch
Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Dennis Charney
The Office of the Dean, Icahn School of Medicine at Mount Sinai, New York, New York, USA
David Reich
Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
William K Oh
Tisch Cancer Institute and Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Eric Schadt
Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Rong Chen
School of Nursing, Hangzhou Normal University, Hangzhou, China
Objective To assess association of clinical features on COVID-19 patient outcomes.Design Retrospective observational study using electronic medical record data.Setting Five member hospitals from the Mount Sinai Health System in New York City (NYC).Participants 28 336 patients tested for SARS-CoV-2 from 24 February 2020 to 15 April 2020, including 6158 laboratory-confirmed COVID-19 cases.Main outcomes and measures Positive test rates and in-hospital mortality were assessed for different racial groups. Among positive cases admitted to the hospital (N=3273), we estimated HR for both discharge and death across various explanatory variables, including patient demographics, hospital site and unit, smoking status, vital signs, lab results and comorbidities.Results Hispanics (29%) and African Americans (25%) had disproportionately high positive case rates relative to their representation in the overall NYC population (p<0.05); however, no differences in mortality rates were observed in hospitalised patients based on race. Outcomes differed significantly between hospitals (Gray’s T=248.9; p<0.05), reflecting differences in average baseline age and underlying comorbidities. Significant risk factors for mortality included age (HR 1.05, 95% CI 1.04 to 1.06; p=1.15e-32), oxygen saturation (HR 0.985, 95% CI 0.982 to 0.988; p=1.57e-17), care in intensive care unit areas (HR 1.58, 95% CI 1.29 to 1.92; p=7.81e-6) and elevated creatinine (HR 1.75, 95% CI 1.47 to 2.10; p=7.48e-10), white cell count (HR 1.02, 95% CI 1.01 to 1.04; p=8.4e-3) and body mass index (BMI) (HR 1.02, 95% CI 1.00 to 1.03; p=1.09e-2). Deceased patients were more likely to have elevated markers of inflammation.Conclusions While race was associated with higher risk of infection, we did not find racial disparities in inpatient mortality suggesting that outcomes in a single tertiary care health system are comparable across races. In addition, we identified key clinical features associated with reduced mortality and discharge. These findings could help to identify which COVID-19 patients are at greatest risk of a severe infection response and predict survival.
