Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series
Authors: Argenziano Michael G , Bruce Samuel L , Slater Cody L , Tiao Jonathan R , Baldwin Matthew R , Barr R Graham , Chang Bernard P , Chau Katherine H , Choi Justin J , Gavin Nicholas , Goyal Parag , Mills Angela M , Patel Ashmi A , Romney Marie-Laure S , Safford Monika M , Schluger Neil W , Sengupta Soumitra , Sobieszczyk Magdalena E , Zucker Jason E , Asadourian Paul A , Bell Fletcher M , Boyd Rebekah , Cohen Matthew F , Colquhoun MacAlistair I , Colville Lucy A , de Jonge Joseph H , Dershowitz Lyle B , Dey Shirin A , Eiseman Katherine A , Girvin Zachary P , Goni Daniella T , Harb Amro A , Herzik Nicholas , Householder Sarah , Karaaslan Lara E , Lee Heather , Lieberman Evan , Ling Andrew , Lu Ree , Shou Arthur Y , Sisti Alexander C , Snow Zachary E , Sperring Colin P , Xiong Yuqing , Zhou Henry W , Natarajan Karthik , Hripcsak George , Chen Ruijun 
Published: May 2020

Abstract

Objective
To characterize patients with coronavirus disease 2019 (covid-19) in a large New York City medical center and describe their clinical course across the emergency department, hospital wards, and intensive care units.

Design
Retrospective manual medical record review.

Setting
NewYork-Presbyterian/Columbia University Irving Medical Center, a quaternary care academic medical center in New York City.

Participants
The first 1000 consecutive patients with a positive result on the reverse transcriptase polymerase chain reaction assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who presented to the emergency department or were admitted to hospital between 1 March and 5 April 2020. Patient data were manually abstracted from electronic medical records.

Main outcome measures
Characterization of patients, including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition.

Results
Of the first 1000 patients, 150 presented to the emergency department, 614 were admitted to hospital (not intensive care units), and 236 were admitted or transferred to intensive care units. The most common presenting symptoms were cough (732/1000), fever (728/1000), and dyspnea (631/1000). Patients in hospital, particularly those treated in intensive care units, often had baseline comorbidities including hypertension, diabetes, and obesity. Patients admitted to intensive care units were older, predominantly male (158/236, 66.9%), and had long lengths of stay (median 23 days, interquartile range 12-32 days); 78.0% (184/236) developed acute kidney injury and 35.2% (83/236) needed dialysis. Only 4.4% (6/136) of patients who required mechanical ventilation were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at three to four days, and at nine days. As of 30 April, 90 patients remained in hospital and 211 had died in hospital.

Conclusions
Patients admitted to hospital with covid-19 at this medical center faced major morbidity and mortality, with high rates of acute kidney injury and inpatient dialysis, prolonged intubations, and a bimodal distribution of time to intubation from symptom onset.