Background: There are limited data on risk factors for serious outcomes and death from COVID-19 among patients representative of the U.S. population.

Objectives: To determine risk factors for critical care, ventilation, and death among hospitalized patients with COVID-19.

Methods: This was a retrospective cohort study that used data from Optum’s longitudinal COVID-19 electronic health record (EHR) database derived from a network of healthcare provider organizations across the U.S. The study included patients confirmed with COVID-19 infection (presence of ICD-10-CM code U07.1 and/or positive SARS-CoV-2 test) between January 2020 and November 2020. The association between baseline characteristics and clinical variables during hospitalization with serious outcomes (critical care, mechanical ventilation, and death) was evaluated using odds ratios (OR) and 95% confidence intervals (CI) from logistic regression models, adjusted for demographic variables.

Results: Among 56,996 hospitalized COVID-19 patients (49.5% male and 72.4% ≥ 50 years), 11,967 received critical care, 9,136 received mechanical ventilation, and 8,526 died. The median duration of hospitalization overall was 6 days (IQR: 4, 11). The duration was longer among patients that experienced an outcome: 11 days (IQR: 6, 19) for critical care, 15 days (IQR: 8, 24) for mechanical ventilation, and 10 days (IQR: 5, 17) for death. Dyspnea and hypoxemia were the most prevalent symptoms and both were associated with serious outcomes in adjusted models. Additionally, temperature, C-reactive protein, ferritin, lactate dehydrogenase, D-dimer, and oxygen saturation measured during hospitalization were significant predictors of serious outcomes as were several in-hospital diagnoses. The strongest associations were observed for acute respiratory failure (critical care: OR, 6.30; 95% CI, 5.99-6.63; ventilation: OR, 8.55; 95% CI, 8.02-9.11; death: OR, 3.36; 95% CI, 3.17-3.55) and sepsis (critical care: OR, 4.59; 95% CI, 4.39-4.81; ventilation: OR, 5.26; 95% CI, 5.00-5.53; death: OR, 4.14; 95% CI, 3.92-4.38). Treatment with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers during hospitalization were inversely associated with death (OR, 0.57; 95% CI, 0.54-0.61).

Conclusions: We identified several clinical characteristics associated with receipt of critical care, mechanical ventilation, and death among COVID-19 patients. As more is learned about COVID-19, future studies should focus on identifying the etiologic factors for severe COVID-19 disease.