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Mortality by Reaction Type Among Hospitalized COVID-19 Patients: An Analysis of US Electronic Medical Records

Seitz, Stacia N. (2022) Mortality by Reaction Type Among Hospitalized COVID-19 Patients: An Analysis of US Electronic Medical Records. Master's Thesis, University of Pittsburgh. (Unpublished)

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Abstract

Background: Much is still unknown regarding the outcomes of symptomatic and asymptomatic COVID-19 patients.
Objective: To describe COVID-19 patients in a federated electronic medical records (EMR) network in the US and assess mortality according to COVID-19 reaction type.
Methods: This was a retrospective cohort study of COVID-19 patients hospitalized between January 21, 2020 and April 23, 2021 in the TriNetX Dataworks COVID-19 database. All data from the EMR were mapped to standard terminologies (ICD-10, LOINC, RxNorm). Reaction type and risk of mortality were examined by age, sex, race, month of index date, immunosuppressant use, dexamethasone use, and select comorbidities.
Results: There were 12,929 hospitalized COVID-19 patients identified during the study period. Of these, 8,195 patients were symptomatic. The proportion of patients was higher in the symptomatic patient group compared to the asymptomatic patient group for all investigated baseline comorbidities/characteristics, except pregnancy. After adjustment, the mean (standard deviation (SD)) time to death, in days, at day 14 was 7.05 (4.54) and 6.09 (4.76) and at day 28 was 8.28 (7.05) and 7.00 (6.79) for symptomatic and asymptomatic patients, respectively. There was an increased risk of mortality for symptomatic patients compared to asymptomatic patients at both day 14 (hazard ratio (HR)=1.89; 95% confidence interval (CI) 1.44-2.47; p<0.001) and day 28 (HR=1.56; 95% CI 1.26-1.94; p<0.001). The probability of all-cause 14-day mortality was significantly higher in symptomatic patients (9.4%) compared to asymptomatic patients (5.9%) (log rank p<0.001). The probability of all-cause 28-day mortality was also significantly higher in symptomatic patients (25.6%) compared to asymptomatic patients (22.7%) (log rank p=0.001).
Conclusion: In a US-based EMR network of hospitalized COVID-19 patients, we observed an increased risk of mortality and a lower survival probability for symptomatic patients compared to asymptomatic patients at both day 14 and day 28. However, we observed that the average time to death was longer for symptomatic patients at both day 14 and day 28. These findings indicate that clinically, when allocating limited resources and treatment, it is imperative for healthcare providers to more aggressively treat symptomatic hospitalized COVID-19 patients in response to this global public health challenge.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Seitz, Stacia N.sts150@pitt.edusts1500000-0002-9220-5657
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairSekikawa, Akiraakira@pitt.eduakira
Committee MemberGlynn, Nancyepidnwg@pitt.eduepidnwg
Committee MemberArnold, Jonathanarnoldjd@upmc.edu
Committee MemberAsubonteng, Juliusjulius.asubonteng@gilead.com
Date: 6 January 2022
Date Type: Publication
Defense Date: 6 December 2021
Approval Date: 6 January 2022
Submission Date: 15 December 2021
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 52
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: MS - Master of Science
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: coronavirus, COVID-19, COVID-19 symptoms, reaction type, asymptomatic, pandemic
Date Deposited: 06 Jan 2022 15:33
Last Modified: 06 Jan 2022 15:33
URI: http://d-scholarship.pitt.edu/id/eprint/41975

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