228 Epidemiologic Differences in Respiratory Failure Due to COVID-19 in a Large Suburban Health Care System

Study Objective: A subset of patients infected with COVID-19 exhibit respiratory failure requiring intubation The clinical course in patients severely affected by COVID-19 requires a better understanding Our aim is to describe the outcomes of respiratory failure in COVID-19 positive patients and compare them to those COVID-19 negative patients with respiratory failure in a single suburban health care system Methods: We performed a multicenter retrospective cohort study of patients admitted to the Beaumont Health system, an eight-hospital system in southeast Michigan, who underwent COVID-19 testing from 1/1/20-4/6/20 We selected patients with respiratory failure, documentation of mechanical ventilation, and a completed hospital course We abstracted patient demographics, mode of transport to the hospital, residence from where they were transported (home, nursing facility, public) as well as lab data and information on the patient’s hospital course We then dichotomized subjects between positive and negative results for COVID-19 We compiled descriptive statistics between COVID positive and COVID negative patients as well as between those COVID positive patients who survived through hospitalization and those that did not Results: During this study period, 644 subjects received endotracheal intubation, 6 were < 18 years and excluded Of the remainder 411 (64 4%) were COVID positive COVID-19 positive patients were more often obese (BMI 35 2 vs 30 7), African American (69 1% vs 30 8%), and less likely to arrive by ambulance (35 7% vs 71 4%) or arrive from a skilled nursing facility (8 5% vs 17 2%) (all p<0 001) COVID-positive patients had an almost twofold decreased survival compared to COVID-negative patients (36 3% vs 62 6%, OR=0 34, 95% CI 0 24 , 0 48) Of COVID-positive patients, survivors were younger (57 9 vs 64 9 years,p<0 001) and more often AA (39 1% vs 28 1%, OR=1 6, 95% CI 1 1,2 4) Early intubation of COVID + patients was associated with slightly shorter mean mechanical ventilation duration (78 5 vs 111 hours,p=0 09) but no difference in survival (38 5% vs 35 7%, OR=0 89, 95% CI (0 53,1 5)) Consistent with previous studies, COVID+ patients with comorbidities were less likely to survive than those without significant comorbidities [Formula presented] Conclusion: Our study confirms early reports of a higher mortality in patients intubated for severe COVID-19 infection and higher rates of respiratory failure related to COVID-19 in African American patients However, intubated survivors in our hospital system were more often younger and African American More work is needed to clarify what physiological and socioeconomic factors are associated with severe COVID-19 infection and outcome