美国哥伦比亚大学欧文医学中心Ruijun Chen团队分析了纽约市1000例covid-19患者的特征和临床过程。2020年5月29日，《英国医学杂志》发表了这一成果。

为了分析纽约市一家大型医疗中心covid-19患者的病情，并描述其在急诊室、医院病房和重症监护室的临床过程，研究组在纽约长老会/哥伦比亚大学欧文医学中心进行了一项回顾性手动病历审查。选择2020年3月1日至4月5日到急诊科就诊或住院的前1000名SARS-CoV-2阳性患者。从电子病历中手动提取患者数据。

在前1000名患者中，150名被送往急诊科，其中614名入院（非重症监护室），还有236名被收入重症监护室。最常见的症状是咳嗽（732/1000）、发烧（728/1000）和呼吸困难（631/1000）。医院里的患者，尤其是在重症监护病房接受治疗的患者，通常有包括高血压、糖尿病和肥胖症在内的各种基线合并症。

重症监护病房的患者年龄较大，主要是男性（66.9％），并且住院时间长（中位23天），78.0％患急性肾损伤，35.2％需要透析。症状发作后超过14天才首次插管进行机械通气的患者占4.4％。从症状发作到插管的时间表现为双峰分布，分别于发作后3-4天和发作后9天达到峰值。截至4月30日，仍有90名患者留在医院，另有211人死亡。

总之，因covid-19入院的患者发病和死亡风险较大，急性肾损伤和住院透析的发生率也很高，且插管时间长，从症状发作到插管的时间呈双峰分布。

附：英文原文

Title: Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series

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

Issue&Volume: 2020/05/29

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.

DOI: 10.1136/bmj.m1996

Source: https://www.bmj.com/content/369/bmj.m1996