Clinical course and factors associated with outcomes among 1904 patients hospitalized with COVID-19 in Germany: an observational study

Abstract

Objectives In Germany the coronavirus disease 2019 (COVID-19) pandemic situation is unique among large European countries in that incidence and case fatality rate are distinctly lower. We describe the clinical course and examine factors associated with outcomes among patients hospitalized with COVID-19 in Germany. Methods In this retrospective cohort study we included patients with COVID-19 admitted to a national network of German hospitals between February 12 and June 12, 2020. We examined demographic characteristics, comorbidities and clinical outcomes. Results We included 1904 patients with a median age of 73 years, 48.5% (924/1904) of whom were female. The mortality rate was 17% (317/1835; 95% confidence interval (95%CI) 16–19), the rate of admission to the intensive care unit (ICU) was 21% (399/1860; 95%CI 20–23), and the rate of invasive mechanical ventilation was 14% (250/1850: 95%CI 12–15). The most prominent risk factors for death were male sex (hazard ratio (HR) 1.45; 95%CI 1.15–1.83), pre-existing lung disease (HR 1.61; 95%CI 1.20–2.16), and increased patient age (HR 4.11 (95%CI 2.57–6.58) for age >79 years versus <60 years). Among patients admitted to the ICU, the mortality rate was 29% (109/374; 95%CI 25–34) and higher in ventilated (33% [77/235; 95%CI 27–39]) than in non-ventilated ICU patients (23%, 32/139; 95%CI 16–30; p < 0.05). Conclusions In this nationwide series of patients hospitalized with COVID-19 in Germany, in-hospital and ICU mortality rates were substantial. The most prominent risk factors for death were male sex, pre-existing lung disease, and greater patient age.

Patients’ treatment limitations as predictive factor for mortality in COVID-19: Results from hospitalized patients of a hotspot region for SARS-CoV-2 infections

“…Interestingly, in the study by Nachtigall and co-workers [3] the proportion of patients with at least one comorbidity was only about half as large as in our cohort. Differences in comorbidities between studies were also re ected in the CCI.…”

“…In the total population of hospitalized patients, mortality was 27.2%, similar to that of the prospective observational UK cohort study [4] but higher than in German cohorts (22% and 16.6%), [3,20] although the distributions of age and sex in our study and the previous two studies from Germany were not much different. [3,20] In the PRECOVID study from Spain, [5] An important recent observation was that in patients admitted to hospital with COVID-19, outcomes were better predicted by frailty than by age or comorbidity. [21] These factors are closely related to treatment limitations that might affect mortality risk by limiting the scope of interventions.…”

“…Corresponding odds ratios are visualized in Figure 2. With regard to age and sex, the present population was similar to cohorts of SARS-CoV-2 patients from Germany [3,20] showing a median age of 72 and 73 years, respectively, and a slightly higher percentage of males (51.8 and 51.5%, respectively). In line with these studies and ndings in other European regions and countries, [4,5,10,11] we observed that most patients had a least one major comorbidity.…”

“…[2] In Europe, the region of Lombardy, northern Spain, eastern France and the United Kingdom experienced high incidence rates of SARS-CoV-2 infections during the rst wave, showing in-hospital mortality rates from 17 to 39%. [3][4][5][6] Especially in the region of Lombardy, de cits in health-care resources became overt but systematic analyses of this chapter of COVID-19 management are currently not available. In Germany, according to the Robert-Koch-Institute, [7] 341,223 SARS-CoV-2 infections have been counted until October 15, 2020, while shortages of health-care resources have not been reported.…”

Letalität und Risikofaktoren für einen schweren Verlauf der COVID-19-Pneumonie

“…In beiden Ländern waren ausreichend Krankenhauskapazitäten inklusive geschultes Personal und Intensiv‑/Beatmungsbetten verfügbar. Unter diesen optimalen Versorgungsbedingungen wurden in Deutschland die klinischen Daten von fast 12.000 hospitalisierten Patienten gesammelt und in 2 Studien veröffentlicht [ 1 , 2 ]. Die deutschen COVID-19-Daten können nun mit deutschen und österreichischen CAP-Studiendaten aus den vorangegangenen Jahren verglichen werden (Tab.…”