Clinical characteristics and factors associated with hospital admission or death in 43 103 adult outpatients with coronavirus disease 2019 managed with the Covidom telesurveillance solution: a prospective cohort study

Abstract

Objectives Studies on coronavirus disease 2019 (COVID-19) have mainly focused on hospitalized patients or those with severe disease. We aim to assess the clinical characteristics, outcomes and factors associated with hospital admission or death in adult outpatients with COVID-19. Methods This is a prospective cohort of outpatients with suspected or confirmed COVID-19, registered in Covidom telesurveillance solution for home monitoring of patients with COVID-19 in the Greater Paris area, from March to August 2020. The primary outcome was clinical worsening, defined as hospitalization or death within 1 month after symptom onset. Results Among 43,103 patients, mean age was 42.9 years (SD=14.3); 93.0% (n=40,081) of patients were < 65 years old and 61.9% (n=26,688) were women. Of these 43,103 patients, 67.5% (n=29,104) completed a medical questionnaire on comorbidities and symptoms. The main reported comorbidities were asthma (12.8%; n=3,685), hypertension (12.3%; n=3,546) and diabetes (4.8%; n=1,385). A small proportion of all eligible patients (4.1% [95% CI: 3.9–4.2]; 1,751/43,103) experienced clinical worsening. The rate of hospitalisation was 4.0% (95% CI: 3.8–4.2; n=1,728) and 0.1% (95% CI: 0.1–0.2; n=64) died. Factors associated with clinical worsening were male sex, older age, obesity and comorbidities such as chronic renal disease or cancer under treatment. Probability of worsening was reduced with anosmia/ageusia. Conclusions Clinical worsening was rare among outpatients. Male sex, older age and comorbidities such as chronic renal disease, active cancers or obesity were independently associated with clinical worsening. However, our cohort may include patients younger and healthier than the general population.

Association of Initial Clinical Characteristics with the Need for the Intensive Care Unit and Hospitalization in Patients Presenting to the Emergency Department with Acute Symptomatic COVID-19

“…[4] A cohort of 43,103 COVID-19 outpatients in France found that dyspnea was associated with an eventual requirement for hospitalization while anosmia or ageusia were associated with a decreased risk for need for hospitalization. [15] The same dyspnea and anosmia/ageusia results were found in a smaller cohort of initial outpatients in Seattle, Washington as well. [16] A meta-analysis encompassing 1813 patients revealed that dyspnea was associated with an increased risk for ICU admission (pooled OR 6.55, 95% CI: 4.28-10.0).…”

Asthma and COVID-19 risk: a systematic review and meta-analysis

“…The sample sizes ranged from 52 [ 12 ] to 417 366 people [ 13 ]. Most of the studies were hospital-based (34 studies) while three were studies [ 14 – 16 ] in the community and fourteen had a mixed setting [ 16 – 28 ]. Studies originate from 21 countries spread on all 5 continents – Europe (n=17), North America (n=13), Asia (n=12), South America (n=5), Africa (n=2) and Australia (n=2).…”

“…Scores on the NOS ranged between 6 [ 16 , 29 ] to 9 (maximum 9), with a higher score indicating a high quality. All studies scored 7 or above and were of high quality.…”

Lower Rate of Daily Smokers With Symptomatic COVID-19: A Monocentric Self-Report of Smoking Habit Study

“…Another study covering the clinical characteristics and factors associated with hospital admission or death in 43,103 adult outpatients described a lower rate of worsening amongst patients who reported being current smokers. The current tobacco use odds ratio was 0.67 [0.47–0.95] for clinical worsening association ( 22 ).…”