In-Hospital COVID-19 Mortality Fell During the First 6 Months of the Pandemic

[Argirios Argiriou]

Journal Watch
March 18, 2021

In-Hospital COVID-19 Mortality Fell During the First 6 Months of the Pandemic in the U.S. — But Remains Unacceptably High
Carlos del Rio, MD, reviewing Nguyen NT et al. JAMA Netw Open 2021 Mar 1

Among nearly 200,000 patients hospitalized with COVID-19, mortality declined from 22.1% in March to 6.5% in August of 2020.

While <20% of patients with SARS-CoV-2 infection require hospitalization, the large total number of infected individuals has resulted in thousands of hospital admissions. Investigators used a U.S. clinical database to describe the characteristics and outcomes of 192,550 adults (52.5% men, 43.3% white) hospitalized with COVID-19 at 555 medical centers between March 1 and August 31, 2020.

The most common comorbidities were hypertension (61.5%), diabetes (38.4%), and obesity (27.4%). In-hospital mortality was 13.6% overall, rising with age (from 1.4% [age range, 18–29] to 26.6% [≥80]) and falling with calendar month (from 22.1% [March] to 6.5% [August]). Almost 30% of the cohort was admitted to the intensive care unit (ICU); of these patients, 47.2% died and 10.5% were transferred to hospice during the index hospitalization. Median length of stay was 15 days (median cost, $39,825) for those admitted to the ICU and 6 days (median cost, $10,520) for those not requiring ICU admission.

COMMENT
At the beginning of the pandemic, almost 1 in 4 U.S. patients admitted to the hospital with COVID-19 died, but the rate fell to 1 in 16 within 6 months. The study does not report changes in mortality among those admitted to the ICU, but that rate probably also declined significantly. What caused this decrease? Likely factors include wider SARS-CoV-2 testing and better awareness, clinicians' learning curves for managing patients, better therapies, and the decreasing median age of hospitalized patients. Still, in-hospital COVID-19–associated mortality remains unacceptably high, fueled by the ongoing critical need for better antivirals and therapies.

EDITOR DISCLOSURES AT TIME OF PUBLICATION
Disclosures for Carlos del Rio, MD, at time of publication
Consultant/Advisory Board   Infectious Diseases Society of America
Grant/Research Support   NIH/National Institute of Allergy and Infectious Diseases; NIH/National Institute on Drug Abuse
Editorial Boards   Clinical Infectious Diseases; JAIDS: Journal of Acquired Immune Deficiency Syndromes
Leadership Positions in Professional Societies   International Antiviral Society–USA (Board of Directors); American Conference for the Treatment of HIV (Board of Directors)
CITATION(S):
Nguyen NT et al. Outcomes and mortality among adults hospitalized with COVID-19 at US medical centers. JAMA Netw Open 2021 Mar 1; 4:e210417. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος