Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Christiana Kartsonaki, J. Kenneth Baillie, Noelia García Barrio, Joaquín Baruch, Abigail Beane, Lucille Blumberg, Fernando Bozza, Tessa Broadley, Aidan Burrell, Gail Carson, Barbara Wanjiru Citarella, Andrew Dagens, Emmanuelle A. Dankwa, Christl A. Donnelly, Jake Dunning, Loubna Elotmani, Martina Escher, Nataly Farshait, Jean Christophe Goffard, Bronner P. GonçalvesMatthew Hall, Madiha Hashmi, Benedict Sim Lim Heng, Antonia Ho, Waasila Jassat, Miguel Pedrera Jiménez, Cedric Laouenan, Samantha Lissauer, Ignacio Martin-Loeches, France Mentré, Laura Merson, Ben Morton, Daniel Munblit, Nikita A. Nekliudov, Alistair D. Nichol, Budha Charan Singh Oinam, David Ong, Prasan Kumar Panda, Michele Petrovic, Mark G. Pritchard, Nagarajan Ramakrishnan, Grazielle Viana Ramos, Claire Roger, Oana Sandulescu, Malcolm G. Semple, Pratima Sharma, Louise Sigfrid, Emily C. Somers, Anca Streinu-Cercel, Fabio Taccone, Pavan Kumar Vecham, Bharath Kumar Tirupakuzhi Vijayaraghavan, Jia Wei, Evert Jan Wils, Xin Ci Wong, Peter Horby, Amanda Rojek, Piero L. Olliaro, ISARIC Clinical Characterisation Group

Research output: Contribution to journalArticleResearchpeer-review

20 Citations (Scopus)

Abstract

Background: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world’s largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a ~30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death.

Original languageEnglish
Pages (from-to)355-376
Number of pages22
JournalInternational Journal of Epidemiology
Volume52
Issue number2
DOIs
Publication statusPublished - Apr 2023

Keywords

  • co-morbidities
  • cohort study
  • COVID-19
  • risk of death
  • SARS-CoV-2
  • symptoms
  • treatments

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