Characteristics and predictors of hospitalization and death in the first 11 122 cases with a positive RT-PCR test for SARS-CoV-2 in Denmark: a nationwide cohort

Reilev, Mette; Kristensen, Kasper Bruun; Pottegård, Anton; Lund, Lars; Hallas, Jesper; Ernst, Martin; Christiansen, Christian Fynbo; Sørensen, Henrik Toft; Johansen, Nanna Borup; Brun, Nikolai C.; Voldstedlund, Marianne; Støvring, Henrik; Thomsen, Marianne Kragh; Christensen, Steffen; Gubbels, Sophie; Krause, Tyra Grove; Mølbak, Kåre; Thomsen, Reimar W.

doi:10.1093/ije/dyaa140

Cited by 240 publications

(319 citation statements)

References 18 publications

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“…Previous studies have reported widely varying overall COVID-19 mortality rates, e.g., 1.4% among 1,099 cases in Wuhan, China (14), and 7.2% among 22,512 in Italy (15). In our study, the overall 30-day COVID-19 mortality was 6.1% and males over 60 years of age were overrepresented, which is well in line with previous data from COVID-19 patients from Denmark (16). Importantly, mortality rates are very different among in- and outpatients.…”

Section: Discussionsupporting

confidence: 91%

Thirty-Day Mortality and Morbidity in COVID-19 Positive vs. COVID-19 Negative Individuals and vs. Individuals Tested for Influenza A/B: A Population-Based Study

et al. 2020

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Background: As of October 2020, COVID-19 has caused 1,000,000 deaths worldwide. However, large-scale studies of COVID-19 mortality and new-onset comorbidity compared to individuals tested negative for COVID-19 and individuals tested for influenza A/B are lacking. We investigated COVID-19 30-day mortality and new-onset comorbidity compared to individuals with negative COVID-19 test results and individuals tested for influenza A/B.Methods and findings: This population-based cohort study utilized electronic health records covering roughly half (n = 2,647,229) of Denmark's population, with nationwide linkage of microbiology test results and death records. All individuals ≥18 years tested for COVID-19 and individuals tested for influenza A/B were followed from 11/2017 to 06/2020. Main outcome was 30-day mortality after a test for either COVID-19 or influenza. Secondary outcomes were major comorbidity diagnoses 30-days after the test for either COVID-19 or influenza A/B. In total, 224,639 individuals were tested for COVID-19. To enhance comparability, we stratified the population for in- and outpatient status at the time of testing. Among inpatients positive for COVID-19, 356 of 1,657 (21%) died within 30 days, which was a 3.0 to 3.1-fold increased 30-day mortality rate, when compared to influenza and COVID-19-negative inpatients (all p < 0.001). For outpatients, 128 of 6,263 (2%) COVID-19-positive patients died within 30 days, which was a 5.5 to 6.9-fold increased mortality rate compared to individuals tested negative for COVID-19 or individuals tested positive or negative for influenza, respectively (all p < 0.001). Compared to hospitalized patients with influenza A/B, new-onset ischemic stroke, diabetes and nephropathy occurred more frequently in inpatients with COVID-19 (all p < 0.05).Conclusions: In this population-based study comparing COVID-19 positive with COVID-19 negative individuals and individuals tested for influenza, COVID-19 was associated with increased rates of major systemic and vascular comorbidity and substantially higher mortality. Results should be interpreted with caution because of differences in test strategies for COVID-19 and influenza, use of aggregated data, the limited 30-day follow-up and the possibility for changing mortality rates as the pandemic unfolds. However, the true COVID-19 mortality may even be higher than the stated 3.0 to 5.5-fold increase, owing to more extensive testing for COVID-19.

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Section: Discussionsupporting

confidence: 91%

Thirty-Day Mortality and Morbidity in COVID-19 Positive vs. COVID-19 Negative Individuals and vs. Individuals Tested for Influenza A/B: A Population-Based Study

et al. 2020

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“…The evidence for an association between air pollution and mortality starting at slightly lower nitrogen dioxide levels in the present study could stem from an association between air pollution and severe COVID-19, mediated by a high chronic disease prevalence existing already at relatively low levels of nitrogen dioxide exposure. Evidence is clear that a higher prevalence of comorbidities may lead to a more clinically severe form of COVID-19 and to a higher mortality from the disease (Onder et al, 2020;Reilev et al, 2020;Ssentongo et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Associations between mortality from COVID-19 in two Italian regions and outdoor air pollution as assessed through tropospheric nitrogen dioxide

Filippini

Rothman

Cocchio

et al. 2021

Science of The Total Environment

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After the appearance of COVID-19 in China last December 2019, Italy was the first European country to be severely affected by the outbreak. The first diagnosis in Italy was on February 20, 2020, followed by the establishment of a light and a tight lockdown on February 23 and on March 8, 2020, respectively. The virus spread rapidly, particularly in the North of the country in the ‘Padan Plain’ area, known as one of the most polluted regions in Europe. Air pollution has been recently hypothesized to enhance the clinical severity of SARS-CoV-2 infection, acting through adverse effects on immunity, induction of respiratory and other chronic disease, upregulation of viral receptor ACE-2, and possible pathogen transportation as a virus carrier. We investigated the association between air pollution and subsequent COVID-19 mortality rates within two Italian regions (Veneto and Emilia-Romagna). We estimated ground-level nitrogen dioxide through its tropospheric levels using data available from the Sentinel satellites of the European Space Agency Copernicus program before the lockdown. We then examined COVID-19 mortality rates in relation to the nitrogen dioxide levels at three 14-day lag points after the lockdown, namely March 8, 22 and April 5. Using a multivariable negative binomial regression model, we found an association between nitrogen dioxide and COVID-19 mortality. Although ecological data provide only weak evidence, these findings indicate an association between air pollution levels and COVID-19 severity.

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“…21 Despite these strengths, the study had several limitations. The threshold for SARS-CoV-2 20 Importantly, our results did not change after restriction to patients tested after the policy guidelines changed and the country was locked down on 13 March 2020. Any bias should be minimal as use of ACE-I/ ARB was not expected to influence the threshold for testing, which followed national guidelines.…”

Section: Strengths and Limitations Of The Studymentioning

confidence: 60%

“…The unique personal identification number assigned at birth or on immigration allows individual-level linkage of data and complete follow-up. 19 As previously described, 20 data on all individuals tested for SARS-CoV-2 RNA by reverse transcriptase PCR (RT-PCR) were obtained from the Danish Microbiology Database 21 and linked to regularly updated data from the Danish National Patient Registry, 22 the Civil Registration System, 23 the National Prescription Database 24 and the Danish Register of Causes of Deaths. 25…”

Section: Design and Settingmentioning

confidence: 99%

SARS-CoV-2 infection and adverse outcomes in users of ACE inhibitors and angiotensin-receptor blockers: a nationwide case-control and cohort analysis

Christiansen

Pottegård

Heide-Jørgensen

et al. 2020

Thorax

Self Cite

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ObjectiveTo examine the impact of ACE inhibitor (ACE-I)/angiotensin receptor blocker (ARB) use on rate of SARS-CoV-2 infection and adverse outcomes.MethodsThis nationwide case-control and cohort study included all individuals in Denmark tested for SARS-CoV-2 RNA with PCR from 27 February 2020 to 26 July 2020. We estimated confounder-adjusted ORs for a positive test among all SARS-CoV-2 tested, and inverse probability of treatment weighted 30-day risk and risk ratios (RRs) of hospitalisation, intensive care unit (ICU) admission and mortality comparing current ACE-I/ARB use with calcium channel blocker (CCB) use and with non-use.ResultsThe study included 13 501 SARS-CoV-2 PCR-positive and 1 088 695 PCR-negative individuals. Users of ACE-I/ARB had a marginally increased rate of a positive PCR when compared with CCB users (aOR 1.17, 95% CI 1.00 to 1.37), but not when compared with non-users (aOR 1.00 95% CI 0.92 to 1.09).Among PCR-positive individuals, 1466 (11%) were ACE-I/ARB users. The weighted risk of hospitalisation was 36.5% in ACE-I/ARB users and 43.3% in CCB users (RR 0.84, 95% CI 0.70 to 1.02). The risk of ICU admission was 6.3% in ACE-I/ARB users and 5.4% in CCB users (RR 1.17, 95% CI 0.64 to 2.16), while the 30-day mortality was 12.3% in ACE-I/ARB users and 13.9% in CCB users (RR 0.89, 95% CI 0.61 to 1.30). The associations were similar when ACE-I/ARB users were compared with non-users.ConclusionsACE-I/ARB use was associated neither with a consistently increased rate nor with adverse outcomes of SARS-CoV-2 infection. Our findings support the current recommendation of continuing use of ACE-Is/ARBs during the SARS-CoV-2 pandemic.Trial registration numberEUPAS34887

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Characteristics and predictors of hospitalization and death in the first 11 122 cases with a positive RT-PCR test for SARS-CoV-2 in Denmark: a nationwide cohort

Cited by 240 publications

References 18 publications

Thirty-Day Mortality and Morbidity in COVID-19 Positive vs. COVID-19 Negative Individuals and vs. Individuals Tested for Influenza A/B: A Population-Based Study

Thirty-Day Mortality and Morbidity in COVID-19 Positive vs. COVID-19 Negative Individuals and vs. Individuals Tested for Influenza A/B: A Population-Based Study

Associations between mortality from COVID-19 in two Italian regions and outdoor air pollution as assessed through tropospheric nitrogen dioxide

SARS-CoV-2 infection and adverse outcomes in users of ACE inhibitors and angiotensin-receptor blockers: a nationwide case-control and cohort analysis

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