Clinical management of hospitalized COVID-19 patients in the United States

Abstract

Abstract Objective The objective of this study was to characterize hospitalized COVID-19 patients and describe their real-world treatment patterns and outcomes over time. Methods Adult patients hospitalized 5/1/2020–12/31/2020 with a discharge diagnosis of COVID-19 were identified from the Premier Healthcare Database. Patient and hospital characteristics, treatments, baseline severity based on oxygen support, length of stay (LOS), ICU utilization and mortality were examined. Results The study included 295 657 patients (847 hospitals), with median age(IQR) of 66(54-77) years. Majority were male, white, and over 65. Approximately 85% had no supplemental oxygen charges (NSOc) or low-flow oxygen (LFO) at baseline, while 75% received no more than NSOc or LFO as maximal oxygen support at any time during hospitalization. Remdesivir (RDV) and corticosteroid treatment utilization increased over time. By December, 50% were receiving RDV and 80% were receiving corticosteroids. A higher proportion initiated COVID-19 treatments within two days of hospitalization in December vs May (RDV: 87% vs 40%; corticosteroids: 93% vs 62%; convalescent plasma: 68% vs 26%). There was a shift toward initiating RDV in patients on NSOc or LFO (68.0% (May) vs. 83.1% (December)). Median LOS decreased over time. Overall mortality was 13.5% and it was highest for severe patients (invasive mechanical ventilation/ECMO (IMV/ECMO):53.7%, high-flow oxygen/non-invasive ventilation (HFO/NIV):32.2%, LFO:11.7%, NSOc:7.3%). ICU use decreased, while mortality decreased for NSOc and LFO. Conclusions Clinical management of COVID-19 is rapidly evolving. This large observational study found that use of evidence-based treatments increased from May to December 2020, while improvement in outcomes occurred over this time-period.