Risk factors for severity on admission and the disease progression during hospitalisation in a large cohort of patients with COVID-19 in Japan

Abstract

ObjectivesTo investigate the risk factors contributing to severity on admission. Additionally, risk factors of worst severity and fatality were studied. Moreover, factors were compared based on three points: early severity, worst severity and fatality.DesignAn observational cohort study using data entered in a Japan nationwide COVID-19 inpatient registry, COVIREGI-JP.SettingAs of 28 September 2020, 10480 cases from 802 facilities have been registered. Participating facilities cover a wide range of hospitals where patients with COVID-19 are admitted in Japan.ParticipantsParticipants who had a positive test result on any applicable SARS-CoV-2 diagnostic tests were admitted to participating healthcare facilities. A total of 3829 cases were identified from 16 January to 31 May 2020, of which 3376 cases were included in this study.Primary and secondary outcome measuresPrimary outcome was severe or nonsevere on admission, determined by the requirement of mechanical ventilation or oxygen therapy, SpO2 or respiratory rate. Secondary outcome was the worst severity during hospitalisation, judged by the requirement of oxygen and/orinvasive mechanical ventilation/extracorporeal membrane oxygenation.ResultsRisk factors for severity on admission were older age, men, cardiovascular disease, chronic respiratory disease, diabetes, obesity and hypertension. Cerebrovascular disease, liver disease, renal disease or dialysis, solid tumour and hyperlipidaemia did not influence severity on admission; however, it influenced worst severity. Fatality rates for obesity, hypertension and hyperlipidaemia were relatively lower.ConclusionsThis study segregated the comorbidities influencing severity and death. It is possible that risk factors for severity on admission, worst severity and fatality are not consistent and may be propelled by different factors. Specifically, while hypertension, hyperlipidaemia and obesity had major effect on worst severity, their impact was mild on fatality in the Japanese population. Some studies contradict our results; therefore, detailed analyses, considering in-hospital treatments, are needed for validation.Trial registration numberUMIN000039873. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000045453

Treatment and outcome of COVID-19 patients in a specialized hospital during the third wave: advance of age and increased mortality compared with the first/second waves

“…Median duration from the onset of symptoms to admission was 4 days, remarkably shortened from 7 days in our previous study. It was also significantly shorter than 6−7 days reported in a large cohort study in Japan [ 16 ], suggesting rapid deterioration of respiratory condition despite prompt admission from the onset of symptoms. Commonly observed symptoms were fever, cough, and fatigue, in consistent with previous studies [ 3 , 10 , 16 ].…”

“…It was also significantly shorter than 6−7 days reported in a large cohort study in Japan [ 16 ], suggesting rapid deterioration of respiratory condition despite prompt admission from the onset of symptoms. Commonly observed symptoms were fever, cough, and fatigue, in consistent with previous studies [ 3 , 10 , 16 ]. Note that more than 60% of patients with moderate II severity did not complain of dyspnea, suggesting the possibility of asymptomatic hypoxia [ 17 ] and the importance of routine measurement of SpO2 regardless of the complaints of patients.…”

Lifestyle Habits among Pregnant Women in Denmark during the First COVID-19 Lockdown Compared with a Historical Period—A Hospital-Based Cross-Sectional Study

“…During the pandemic, there has been an increased focus on healthy lifestyle, since it has been debated, whether e.g., smoking and obesity could increase the risk of the severity of COVID-19 infection [ 68 , 69 ]. This could potentially increase the existing risk of underreporting unhealthy behaviors [ 64 , 65 , 70 ] during the pandemic compared to before.…”

Impact of regional heterogeneity on the severity of COVID-19

“…When we consider countermeasures against COVID-19, the proportion of patients with severe disease is extremely important [ 4 ]. Mild and/or asymptomatic cases can be easily managed as they need no specific treatment.…”

“…For example, new variants may contribute to the severity of COVID-19 cases [ 6 ]. However, such variants are not the only determinants of severity; age, sex, past medical history, and many other factors have been attributed to the severity of COVID-19 [ 4 , 7 ]. In addition, it is conceivable that there are other factors influencing the severity of COVID-19 aside from such biological aspects.…”