Characteristics and outcomes of an international cohort of 400,000 hospitalised patients with Covid-19

Abstract

Background: Policymakers need robust data to respond to the COVID-19 pandemic. We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, the world's largest international, standardised cohort of hospitalised patients. Methods: The dataset analysed includes COVID-19 patients hospitalised between January 2020 and May 2021. We investigated how symptoms on admission, comorbidities, risk factors, and treatments varied by age, sex, and other characteristics. We used Cox proportional hazards models to investigate associations between demographics, symptoms, comorbidities, and other factors with risk of death, admission to intensive care unit (ICU), and invasive mechanical ventilation (IMV). Findings: 439,922 patients with laboratory-confirmed (91.7%) or clinically-diagnosed (8.3%) SARS-CoV-2 infection from 49 countries were enrolled. Age (adjusted hazard ratio [HR] per 10 years 1.49 [95% CI 1.49-1.50]) and male sex (1.26 [1.24-1.28]) were associated with a higher risk of death. Rates of admission to ICU and use of IMV increased with age up to age 60, then dropped. Symptoms, comorbidities, and treatments varied by age and had varied associations with clinical outcomes. Tuberculosis was associated with an 86% higher risk of death, and HIV with an 87% higher risk of death. Case fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients. Interpretation: The size of our international database and the standardized data collection method makes this study a reliable and comprehensive international description of COVID-19 clinical features. This is a viable model to be applied to future epidemics.

People in intensive care with COVID ‐19: demographic and clinical features during the first, second, and third pandemic waves in Australia

“…At the same time, clinical practice has rapidly advanced with growing experience and the publication of several key trials. 1 , 2 , 3 The impact of these changes on patients admitted to intensive care units (ICUs) in Australia has not been examined in detail.…”

Factors associated with adverse outcomes among patients hospitalized at a COVID-19 treatment center run by Médecins sans Frontières in Herat, Afghanistan

“…The distribution of symptoms within our cohort was similar to that of other cohorts with the most common symptoms at presentation including cough, shortness of breath, fever, headache, and chest pain. 13,42,[45][46][47][48] Of note is the gradual change in the proportion of patients presenting with fever, which decreased from 82% during the first wave to 24% during the fourth wave, in line with other contexts. 49 One large multicenter retrospective analysis on 21,461 unvaccinated Spanish COVID patients for example found that while fever was reported by 70-74% of patients during waves 1 and 2, this number decreased to 58.3% in successive waves.…”

“…One large-scale multicenter observational study including almost half a million hospitalized COVID-19 patients from 49 different countries for example, showed a mortality of 20%. 45 A further multicenter observational study conducted in the United Kingdom with over 20.000 hospitalized COVID-19 patients, documented a mortality rate of 32%. 46…”

“…One large-scale multicenter observational study including almost half a million hospitalized COVID-19 patients from 49 different countries for example, showed a mortality of 20%. 45 A further multicenter observational study conducted in the United Kingdom with over 20.000 hospitalized COVID-19 patients, documented a mortality rate of 32%. 46 Regarding predictive factors for an unfavorable outcome, we identified gender, higher age, O2 flow at admission, lymphopenia, anemia and an O2 saturation of under 94% as variables associated with adverse outcome.…”

“…A total of 1113 patients were included in this study with a median age of 60 years (IQR: 47-70 years) and a slightly higher proportion of females, which is comparable with other cohorts throughout the globe, even though an inverse gender distribution is more common elsewhere. 13,[41][42][43][44][45][46] The proportion of patients classified as severe or critical at admission increased from 46 to 100% over the course of the four waves. This is explained by the limited bed capacity and resulting variation in rigor in the application of the admission criteria.…”