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?:abstract
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There is limited data on longitudinal outcomes for COVID-19 hospitalizations that account for transitions between clinical states over time. Using electronic health record data from a St. Louis-region hospital network, we performed multi-state analyses to examine longitudinal transitions and outcomes among hospitalized adults with laboratory-confirmed COVID-19 with respect to fifteen mutually-exclusive clinical states. Between March 15 and July 25, 2020, 1,577 patients were hospitalized with COVID-19 (49.9% male, median age 63 years [IQR 50, 75], 58.8% Black). Overall, 34.1% (95% confidence interval [CI] 26.4%, 41.8%) had an ICU admission and 12.3% (CI 8.5%, 16.1%) received invasive mechanical ventilation (IMV). The risk of decompensation peaked immediately after admission, discharges peaked around day 3 to 5, and deaths plateaued between days 7 and 16. At 28 days, 12.6% (CI 9.6%, 15.6%) of patients had died (4.2% [CI 3.2%, 5.2%] received IMV) and 80.8% (CI 75.4%, 86.1%) were discharged. Among those receiving IMV, 39.1% (CI 32.0%, 46.2%) remained intubated after 14 days; after 28 days, 37.6% (CI 30.4%, 44.7%) had died and only 37.7% (CI 30.6%, 44.7%) were discharged. Multi-state methods offer granular characterizations of the clinical course of COVID-19 and provide essential information for guiding both clinical decision-making and public health planning.
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