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

Kartsonaki, CORCID logo; Baillie, JK; Barrio, NG; Baruch, J; Beane, A; Blumberg, LORCID logo; Bozza, F; Broadley, T; Burrell, A; Carson, G; +49 more...Citarella, BW; Dagens, A; Dankwa, EA; Donnelly, CA; Dunning, J; Elotmani, L; Escher, M; Farshait, N; Goffard, J; Gonçalves, BP; Hall, M; Hashmi, M; Sim Lim Heng, B; Ho, AORCID logo; Jassat, W; Pedrera Jiménez, M; Laouenan, C; Lissauer, S; Martin-Loeches, I; Mentré, F; Merson, L; Morton, BORCID logo; Munblit, DORCID logo; Nekliudov, NA; Nichol, AD; Singh Oinam, BC; Ong, D; Panda, PK; Petrovic, M; Pritchard, MG; Ramakrishnan, N; Ramos, GV; Roger, C; Sandulescu, O; Semple, MG; Sharma, P; Sigfrid, L; Somers, EC; Streinu-Cercel, A; Taccone, F; Vecham, PK; Kumar Tirupakuzhi Vijayaraghavan, B; Wei, J; Wils, E; Ci Wong, X; Horby, PORCID logo; Rojek, A; Olliaro, PL; ISARIC Clinical Characterisation Group and (2023) Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19. International journal of epidemiology, 52 (2). pp. 355-376. ISSN 0300-5771 DOI: 10.1093/ije/dyad012
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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.


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