RT Journal Article SR Electronic T1 Hospitalised COVID-19 patients of the Mount Sinai Health System: a retrospective observational study using the electronic medical records JF BMJ Open JO BMJ Open FD British Medical Journal Publishing Group SP e040441 DO 10.1136/bmjopen-2020-040441 VO 10 IS 10 A1 Zichen Wang A1 Amanda Zheutlin A1 Yu-Han Kao A1 Kristin Ayers A1 Susan Gross A1 Patricia Kovatch A1 Sharon Nirenberg A1 Alexander Charney A1 Girish Nadkarni A1 Jessica K De Freitas A1 Paul O’Reilly A1 Allan Just A1 Carol Horowitz A1 Glenn Martin A1 Andrea Branch A1 Benjamin S Glicksberg A1 Dennis Charney A1 David Reich A1 William K Oh A1 Eric Schadt A1 Rong Chen A1 Li Li YR 2020 UL http://bmjopen.bmj.com/content/10/10/e040441.abstract AB Objective To assess association of clinical features on COVID-19 patient outcomes.Design Retrospective observational study using electronic medical record data.Setting Five member hospitals from the Mount Sinai Health System in New York City (NYC).Participants 28 336 patients tested for SARS-CoV-2 from 24 February 2020 to 15 April 2020, including 6158 laboratory-confirmed COVID-19 cases.Main outcomes and measures Positive test rates and in-hospital mortality were assessed for different racial groups. Among positive cases admitted to the hospital (N=3273), we estimated HR for both discharge and death across various explanatory variables, including patient demographics, hospital site and unit, smoking status, vital signs, lab results and comorbidities.Results Hispanics (29%) and African Americans (25%) had disproportionately high positive case rates relative to their representation in the overall NYC population (p<0.05); however, no differences in mortality rates were observed in hospitalised patients based on race. Outcomes differed significantly between hospitals (Gray’s T=248.9; p<0.05), reflecting differences in average baseline age and underlying comorbidities. Significant risk factors for mortality included age (HR 1.05, 95% CI 1.04 to 1.06; p=1.15e-32), oxygen saturation (HR 0.985, 95% CI 0.982 to 0.988; p=1.57e-17), care in intensive care unit areas (HR 1.58, 95% CI 1.29 to 1.92; p=7.81e-6) and elevated creatinine (HR 1.75, 95% CI 1.47 to 2.10; p=7.48e-10), white cell count (HR 1.02, 95% CI 1.01 to 1.04; p=8.4e-3) and body mass index (BMI) (HR 1.02, 95% CI 1.00 to 1.03; p=1.09e-2). Deceased patients were more likely to have elevated markers of inflammation.Conclusions While race was associated with higher risk of infection, we did not find racial disparities in inpatient mortality suggesting that outcomes in a single tertiary care health system are comparable across races. In addition, we identified key clinical features associated with reduced mortality and discharge. These findings could help to identify which COVID-19 patients are at greatest risk of a severe infection response and predict survival.