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One-third of patients hospitalized at the outset of the COVID-19 coronavirus outbreak in New York City required invasive mechanical ventilation, higher than that reported in China, a retrospective case series found.

Of the first 393 consecutive adults admitted to two New York City hospitals with confirmed COVID-19,

And of those, about 31% had no need for supplemental oxygen during the first 3 hours after presenting to the emergency department, meaning they deteriorated rapidly, reported Parag Goyal, MD, of Weill Cornell Medicine in New York City, and colleagues.

To date, a third of patients requiring mechanical ventilation have been extubated, and in total, 10% of patients have died, the authors wrote in the New England Journal of Medicine.

Notably, the authors said both examined hospitals employed an "early-intubation strategy with limited use of high-flow nasal cannulae" from March 5, the date of the first positive case, to March 27.

"The percentage of patients in our case series who received invasive mechanical ventilation was more than 10 times as high as that in China," the researchers wrote. "The high demand for invasive mechanical ventilation has the potential to overwhelm hospital resources."

Median age of patients was about 62, about 61% were men, only 37% were white, and, notably, 36% were obese. While more than three-quarters of patients presented with cough or fever, and 57% with dyspnea, almost a quarter presented with myalgias or diarrhea, and almost 20% presented with vomiting.

The authors noted that the proportion of patients with gastrointestinal symptoms was considerably higher than those reported in China, though prior research suggested this might be the case. They also cited geographic variation or differential reporting as potential reasons.

Similar to data reported from China, nearly all patients had lymphopenia, though 27% had thrombocytopenia.

From March 5 to April 10, a total of 130 patients developed respiratory failure leading to ventilation. These patients were more likely to be men, to be obese, and to have elevated liver function values and inflammatory markers, such as ferritin, D-dimer, C-reactive protein, and procalcitonin.

The researchers characterized obesity as "common," and a risk factor for mechanical ventilation. The authors also noted that patients receiving mechanical ventilation were more likely to need vasopressor support than those who did not receive mechanical ventilation (95% vs 1.5%, respectively), and reported other complications, such as atrial arrhythmias (17.7% vs 1.9%), as well as new renal replacement therapy (13.3% vs 0.4%).

Citing the number of patients receiving vasopressors and new renal replacement therapy, the authors added, "there is also a need to strengthen stockpiles and supply chains for these resources."

To date, about two-thirds of the total number of patients have been discharged from the hospital, Goyal and colleagues said.

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