Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

TY - JOUR

T1 - Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

AU - Kartsonaki, Christiana

AU - Baillie, J Kenneth

AU - Barrio, Noelia García

AU - Baruch, Joaquín

AU - Beane, Abigail

AU - Blumberg, Lucille

AU - Bozza, Fernando

AU - Broadley, Tessa

AU - Burrell, Aidan

AU - Carson, Gail

AU - Citarella, Barbara Wanjiru

AU - Dagens, Andrew

AU - Dankwa, Emmanuelle A

AU - Donnelly, Christl A

AU - Dunning, Jake

AU - Elotmani, Loubna

AU - Escher, Martina

AU - Farshait, Nataly

AU - Goffard, Jean-Christophe

AU - Gonçalves, Bronner P

AU - Hall, Matthew

AU - Hashmi, Madiha

AU - Sim Lim Heng, Benedict

AU - Ho, Antonia

AU - Jassat, Waasila

AU - Pedrera Jiménez, Miguel

AU - Laouenan, Cedric

AU - Lissauer, Samantha

AU - Martin-Loeches, Ignacio

AU - Mentré, France

AU - Merson, Laura

AU - Morton, Ben

AU - Munblit, Daniel

AU - Nekliudov, Nikita A

AU - Nichol, Alistair D

AU - Singh Oinam, Budha Charan

AU - Ong, David

AU - Panda, Prasan Kumar

AU - Petrovic, Michele

AU - Pritchard, Mark G

AU - Ramakrishnan, Nagarajan

AU - Ramos, Grazielle Viana

AU - Roger, Claire

AU - Sandulescu, Oana

AU - Semple, Malcolm G

AU - Sharma, Pratima

AU - Sigfrid, Louise

AU - Somers, Emily C

AU - Streinu-Cercel, Anca

AU - Taccone, Fabio

AU - Vecham, Pavan Kumar

AU - Kumar Tirupakuzhi Vijayaraghavan, Bharath

AU - Wei, Jia

AU - Wils, Evert-Jan

AU - Ci Wong, Xin

AU - Horby, Peter

AU - Rojek, Amanda

AU - Olliaro, Piero L

AU - ISARIC Characterization Group

AU - Kobbe, Robin

N1 - © The Author(s) 2023. Published by Oxford University Press on behalf of the International Epidemiological Association.

PY - 2023/4/19

Y1 - 2023/4/19

N2 - BACKGROUND: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients.METHODS: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV).RESULTS: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%.CONCLUSIONS: Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death.

AB - BACKGROUND: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients.METHODS: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV).RESULTS: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%.CONCLUSIONS: Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death.

KW - Humans

KW - Male

KW - Child

KW - Middle Aged

KW - COVID-19/therapy

KW - SARS-CoV-2

KW - Intensive Care Units

KW - Proportional Hazards Models

KW - Risk Factors

KW - Hospitalization

U2 - 10.1093/ije/dyad012

DO - 10.1093/ije/dyad012

M3 - SCORING: Journal article

C2 - 36850054

VL - 52

SP - 355

EP - 376

JO - INT J EPIDEMIOL

JF - INT J EPIDEMIOL

SN - 0300-5771

IS - 2

ER -