Evolution of Care and Outcomes Across Surges in Hospitalized Patients with Coronavirus Disease 2019

Patrick J. O'Hayer; Alexi Vasbinder; Elizabeth Anderson; Tonimarie Catalan; Brayden Bitterman; Ibrahim Khaleel; Grace Erne; Annika Tekumulla; Caroline Tilley; Feriel Presswalla; Namratha Nelapudi; Jiazi Chen; Medha Tripathi; Matthew Rochlen; Loni Rambo; Noor Sulaiman; Pennelope Blakely; Yiyuan Huang; Lili Zhao; Rodica Pop-Busui; Salim S. Hayek

doi:10.1016/j.amjmed.2022.08.035

Evolution of Care and Outcomes Across Surges in Hospitalized Patients with Coronavirus Disease 2019

Patrick J. O'Hayer, Alexi Vasbinder, Elizabeth Anderson, Tonimarie Catalan, Brayden Bitterman, Ibrahim Khaleel, Grace Erne, Annika Tekumulla, Caroline Tilley, Feriel Presswalla, Namratha Nelapudi, Jiazi Chen, Medha Tripathi, Matthew Rochlen, Loni Rambo, Noor Sulaiman, Pennelope Blakely, Yiyuan Huang, Lili Zhao, Rodica Pop-BusuiSalim S. Hayek^*

^*Corresponding author for this work

Preventive Medicine

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has unfolded in distinct surges. Understanding how surges differ may reveal important insights into the evolution of the pandemic and improve patient care. Methods: We leveraged the Michigan Medicine COVID-19 Cohort, a prospective observational study at an academic tertiary medical center that systematically enrolled 2309 consecutive patients hospitalized for COVID-19, comprising 5 distinct surges. Results: As the pandemic evolved, patients hospitalized for COVID-19 tended to have a lower burden of comorbidities and a lower inflammatory burden as measured by admission levels of C-reactive protein, ferritin, lactate dehydrogenase, and D-dimer. Use of hydroxychloroquine and azithromycin decreased substantially after Surge 1, while use of corticosteroids and remdesivir markedly increased (P <.001 for all). In-hospital mortality significantly decreased from 18.3% in Surge 1 to 5.3% in Surge 5 (P <.001). The need for mechanical ventilation significantly decreased from 42.5% in Surge 1 to 7.0% in Surge 5 (P <.001), while the need for renal replacement therapy decreased from 14.4% in Surge 1 to 2.3% in Surge 5 (P <.001). Differences in patient characteristics, treatments, and inflammatory markers accounted only partially for the differences in outcomes between surges. Conclusions: The COVID-19 pandemic has evolved significantly with respect to hospitalized patient populations and therapeutic approaches, and clinical outcomes have substantially improved. Hospitalization after the first surge was independently associated with improved outcomes, even after controlling for relevant clinical covariates.

Original language	English (US)
Pages (from-to)	63-71.e1
Journal	American journal of medicine
Volume	136
Issue number	1
DOIs	https://doi.org/10.1016/j.amjmed.2022.08.035
State	Published - Jan 2023

Funding

Funding: AV is supported by a National Heart, Lung, and Blood Institute (NHLBI)-funded postdoctoral fellowship (T32HL007853). SSH is funded by NHLBI 1R01HL153384-01, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) 1R01DK12801201A1, U01-DK119083-03S1, and the Frankel Cardiovascular Center COVID-19: Impact Research Ignitor (U-M G024231) award. RPB is supported by National Institutes of Health (NIH)/NIDDK-1-R01-DK-107956-01, NIH U01 DK119083, the Juvenile Diabetes Research Foundation 5-COE-2019-861-S-B, and by a Pilot and Feasibility Grant from the Michigan Diabetes Research Center (NIH Grant P30-DK020572). The authors acknowledge the University of Michigan Medical School Research Data Warehouse and DataDirect for providing data aggregation, management, and distribution services in support of the research reported in this publication. The authors are grateful to the services of the Microbiome Core supported by U2CDK110768, especially Chris Blair; the Michigan Clinical Research Unit including Wrenn Woodard and Dexter Hobdy, and the University of Michigan Medical School Central Biorepository for providing biospecimen storage, management, and distribution services in support of the research reported in the publication. We would like to acknowledge the following individuals for contributing to data collection: Tariq Azam, Chelsea Meloche, Rafey Feroze, Kishan J. Padalia, Danny Perry, Abbas Bitar, Erinleigh Michaud, and Peiyao Zhao. The authors acknowledge the University of Michigan Medical School Research Data Warehouse and DataDirect for providing data aggregation, management, and distribution services in support of the research reported in this publication. The authors are grateful to the services of the Microbiome Core supported by U2CDK110768, especially Chris Blair; the Michigan Clinical Research Unit including Wrenn Woodard and Dexter Hobdy, and the University of Michigan Medical School Central Biorepository for providing biospecimen storage, management, and distribution services in support of the research reported in the publication. We would like to acknowledge the following individuals for contributing to data collection: Tariq Azam, Chelsea Meloche, Rafey Feroze, Kishan J. Padalia, Danny Perry, Abbas Bitar, Erinleigh Michaud, and Peiyao Zhao.

Keywords

Azithromycin
COVID-19
Corticosteroids
Dexamethasone
Hydroxychloroquine
Outcomes
Remdesivir
Surge
Tocilizumab

ASJC Scopus subject areas

General Medicine

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10.1016/j.amjmed.2022.08.035

Cite this

O'Hayer, P. J., Vasbinder, A., Anderson, E., Catalan, T., Bitterman, B., Khaleel, I., Erne, G., Tekumulla, A., Tilley, C., Presswalla, F., Nelapudi, N., Chen, J., Tripathi, M., Rochlen, M., Rambo, L., Sulaiman, N., Blakely, P., Huang, Y., Zhao, L., ... Hayek, S. S. (2023). Evolution of Care and Outcomes Across Surges in Hospitalized Patients with Coronavirus Disease 2019. American journal of medicine, 136(1), 63-71.e1. https://doi.org/10.1016/j.amjmed.2022.08.035

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abstract = "Background: The coronavirus disease 2019 (COVID-19) pandemic has unfolded in distinct surges. Understanding how surges differ may reveal important insights into the evolution of the pandemic and improve patient care. Methods: We leveraged the Michigan Medicine COVID-19 Cohort, a prospective observational study at an academic tertiary medical center that systematically enrolled 2309 consecutive patients hospitalized for COVID-19, comprising 5 distinct surges. Results: As the pandemic evolved, patients hospitalized for COVID-19 tended to have a lower burden of comorbidities and a lower inflammatory burden as measured by admission levels of C-reactive protein, ferritin, lactate dehydrogenase, and D-dimer. Use of hydroxychloroquine and azithromycin decreased substantially after Surge 1, while use of corticosteroids and remdesivir markedly increased (P <.001 for all). In-hospital mortality significantly decreased from 18.3% in Surge 1 to 5.3% in Surge 5 (P <.001). The need for mechanical ventilation significantly decreased from 42.5% in Surge 1 to 7.0% in Surge 5 (P <.001), while the need for renal replacement therapy decreased from 14.4% in Surge 1 to 2.3% in Surge 5 (P <.001). Differences in patient characteristics, treatments, and inflammatory markers accounted only partially for the differences in outcomes between surges. Conclusions: The COVID-19 pandemic has evolved significantly with respect to hospitalized patient populations and therapeutic approaches, and clinical outcomes have substantially improved. Hospitalization after the first surge was independently associated with improved outcomes, even after controlling for relevant clinical covariates.",

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O'Hayer, PJ, Vasbinder, A, Anderson, E, Catalan, T, Bitterman, B, Khaleel, I, Erne, G, Tekumulla, A, Tilley, C, Presswalla, F, Nelapudi, N, Chen, J, Tripathi, M, Rochlen, M, Rambo, L, Sulaiman, N, Blakely, P, Huang, Y, Zhao, L, Pop-Busui, R & Hayek, SS 2023, 'Evolution of Care and Outcomes Across Surges in Hospitalized Patients with Coronavirus Disease 2019', American journal of medicine, vol. 136, no. 1, pp. 63-71.e1. https://doi.org/10.1016/j.amjmed.2022.08.035

TY - JOUR

T1 - Evolution of Care and Outcomes Across Surges in Hospitalized Patients with Coronavirus Disease 2019

AU - O'Hayer, Patrick J.

AU - Vasbinder, Alexi

AU - Anderson, Elizabeth

AU - Catalan, Tonimarie

AU - Bitterman, Brayden

AU - Khaleel, Ibrahim

AU - Erne, Grace

AU - Tekumulla, Annika

AU - Tilley, Caroline

AU - Presswalla, Feriel

AU - Nelapudi, Namratha

AU - Chen, Jiazi

AU - Tripathi, Medha

AU - Rochlen, Matthew

AU - Rambo, Loni

AU - Sulaiman, Noor

AU - Blakely, Pennelope

AU - Huang, Yiyuan

AU - Zhao, Lili

AU - Pop-Busui, Rodica

AU - Hayek, Salim S.

PY - 2023/1

Y1 - 2023/1

N2 - Background: The coronavirus disease 2019 (COVID-19) pandemic has unfolded in distinct surges. Understanding how surges differ may reveal important insights into the evolution of the pandemic and improve patient care. Methods: We leveraged the Michigan Medicine COVID-19 Cohort, a prospective observational study at an academic tertiary medical center that systematically enrolled 2309 consecutive patients hospitalized for COVID-19, comprising 5 distinct surges. Results: As the pandemic evolved, patients hospitalized for COVID-19 tended to have a lower burden of comorbidities and a lower inflammatory burden as measured by admission levels of C-reactive protein, ferritin, lactate dehydrogenase, and D-dimer. Use of hydroxychloroquine and azithromycin decreased substantially after Surge 1, while use of corticosteroids and remdesivir markedly increased (P <.001 for all). In-hospital mortality significantly decreased from 18.3% in Surge 1 to 5.3% in Surge 5 (P <.001). The need for mechanical ventilation significantly decreased from 42.5% in Surge 1 to 7.0% in Surge 5 (P <.001), while the need for renal replacement therapy decreased from 14.4% in Surge 1 to 2.3% in Surge 5 (P <.001). Differences in patient characteristics, treatments, and inflammatory markers accounted only partially for the differences in outcomes between surges. Conclusions: The COVID-19 pandemic has evolved significantly with respect to hospitalized patient populations and therapeutic approaches, and clinical outcomes have substantially improved. Hospitalization after the first surge was independently associated with improved outcomes, even after controlling for relevant clinical covariates.

AB - Background: The coronavirus disease 2019 (COVID-19) pandemic has unfolded in distinct surges. Understanding how surges differ may reveal important insights into the evolution of the pandemic and improve patient care. Methods: We leveraged the Michigan Medicine COVID-19 Cohort, a prospective observational study at an academic tertiary medical center that systematically enrolled 2309 consecutive patients hospitalized for COVID-19, comprising 5 distinct surges. Results: As the pandemic evolved, patients hospitalized for COVID-19 tended to have a lower burden of comorbidities and a lower inflammatory burden as measured by admission levels of C-reactive protein, ferritin, lactate dehydrogenase, and D-dimer. Use of hydroxychloroquine and azithromycin decreased substantially after Surge 1, while use of corticosteroids and remdesivir markedly increased (P <.001 for all). In-hospital mortality significantly decreased from 18.3% in Surge 1 to 5.3% in Surge 5 (P <.001). The need for mechanical ventilation significantly decreased from 42.5% in Surge 1 to 7.0% in Surge 5 (P <.001), while the need for renal replacement therapy decreased from 14.4% in Surge 1 to 2.3% in Surge 5 (P <.001). Differences in patient characteristics, treatments, and inflammatory markers accounted only partially for the differences in outcomes between surges. Conclusions: The COVID-19 pandemic has evolved significantly with respect to hospitalized patient populations and therapeutic approaches, and clinical outcomes have substantially improved. Hospitalization after the first surge was independently associated with improved outcomes, even after controlling for relevant clinical covariates.

KW - Azithromycin

KW - COVID-19

KW - Corticosteroids

KW - Dexamethasone

KW - Hydroxychloroquine

KW - Outcomes

KW - Remdesivir

KW - Surge

KW - Tocilizumab

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Evolution of Care and Outcomes Across Surges in Hospitalized Patients with Coronavirus Disease 2019

Abstract

Funding

Keywords

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