Clinical and virological characteristics of hospitalised COVID-19 patients in a German tertiary care centre during the first wave of the SARS-CoV-2 pandemic: a prospective observational study

Abstract

Purpose Adequate patient allocation is pivotal for optimal resource management in strained healthcare systems, and requires detailed knowledge of clinical and virological disease trajectories. The purpose of this work was to identify risk factors associated with need for invasive mechanical ventilation (IMV), to analyse viral kinetics in patients with and without IMV and to provide a comprehensive description of clinical course. Methods A cohort of 168 hospitalised adult COVID-19 patients enrolled in a prospective observational study at a large European tertiary care centre was analysed. Results Forty-four per cent (71/161) of patients required invasive mechanical ventilation (IMV). Shorter duration of symptoms before admission (aOR 1.22 per day less, 95% CI 1.10–1.37, p < 0.01) and history of hypertension (aOR 5.55, 95% CI 2.00–16.82, p < 0.01) were associated with need for IMV. Patients on IMV had higher maximal concentrations, slower decline rates, and longer shedding of SARS-CoV-2 than non-IMV patients (33 days, IQR 26–46.75, vs 18 days, IQR 16–46.75, respectively, p < 0.01). Median duration of hospitalisation was 9 days (IQR 6–15.5) for non-IMV and 49.5 days (IQR 36.8–82.5) for IMV patients. Conclusions Our results indicate a short duration of symptoms before admission as a risk factor for severe disease that merits further investigation and different viral load kinetics in severely affected patients. Median duration of hospitalisation of IMV patients was longer than described for acute respiratory distress syndrome unrelated to COVID-19.

Enhanced fitness of SARS-CoV-2 variant of concern B.1.1.7, but not B.1.351, in animal models

“…All patients were confirmed by RT-qPCR for COVID-19; serum or plasma were collected between 30 and 40 days post symptom onsets. Further sera were available through a prospective observational cohort study conducted at Charité- Universitätsmedizin Berlin 30 , a prospective observational cohort study on immunogenicity and reactogenicity of COVID-19 vaccines in healthcare workers 31 , and from patients who recovered from mild to moderate COVID-19 for convalescent plasma donation. (https://www.frontiersin.org/articles/10.3389/fimmu.2020.628971/full).…”

A proteomic survival predictor for COVID-19 patients in intensive care

“…The exploratory cohort used for marker identification and model generation consisted of the 50 most severely ill COVID-19 patients out of a cohort of 168 patients with varying disease severity, treated between 15 March and 16 September 2020 at Charité University Hospital, Berlin, Germany (Fig. 1A) [13,18,28]. All 50 patients required intensive care with invasive mechanical ventilation plus additional organ support such as renal replacement therapy (RRT), ECMO, or vasopressors, corresponding to grade 7 on the WHO Ordinal Scale for Clinical Improvement.…”

“…Patients included in this analysis are a sub-cohort of the Pa-COVID-19 study conducted at Charité -Universitätsmedizin Berlin, a prospective observational cohort study on the pathophysiology of COVID-19 as described previously [18,28]. All patients with PCR-confirmed SARS-CoV-2 infection that progressed to critical disease (WHO grade 7, i.e.…”

“…Currently such decisions are often based primarily on patient's age, comorbidities, and established intensive care prognosis models, such as the Sequential Organ Failure Assessment (SOFA) or Acute Physiology and Chronic Health Evaluation (APACHE II), which assess the patient on the basis of a combination of established clinical and laboratory risk parameters [14,15]. The predictive values of both SOFA and APACHE II for the most critical forms of COVID-19 are limited [16][17][18], creating a diagnostic gap and imminent need for reliable predictors, specifically validated in severely ill COVID-19 patients, to guide and tailor efforts in treating these critically ill patients. Indeed, classifying clinical trajectories within more homogeneous groups such as WHO grade 7 patients is considerably more difficult to achieve than a molecular severity classification that distinguishes mild from severe patients; physiological and molecular differences are less pronounced within the same than between different severity groups.…”

“…We studied proteomes of two well characterized cohorts of the most severely ill patients with COVID-19 in two independent health care centers (Charité-Universitätsmedizin, Berlin Germany, and Medical University of Innsbruck, Austria) who gave informed consent to deep clinical and molecular phenotyping [13,18,28], We found 14 protein concentration trajectories that distinguish survivors from non-survivors.…”