Clinical characteristics and risk factors associated with severe COVID-19: prospective analysis of 1,045 hospitalised cases in North-Eastern France, March 2020

Abstract

Background In March 2020, the COVID-19 outbreak was declared a pandemic by the World Health Organization. Aim Our objective was to identify risk factors predictive of severe disease and death in France. Methods In this prospective cohort study, we included patients ≥ 18 years old with confirmed COVID-19, hospitalised in Strasbourg and Mulhouse hospitals (France), in March 2020. We respectively compared patients who developed severe disease (admission to an intensive care unit (ICU) or death) and patients who died, to those who did not, by day 7 after hospitalisation. Results Among 1,045 patients, 424 (41%) had severe disease, including 335 (32%) who were admitted to ICU, and 115 (11%) who died. Mean age was 66 years (range: 20–100), and 612 (59%) were men. Almost 75% of patients with body mass index (BMI) data (n = 897) had a BMI ≥ 25 kg/m2 (n = 661). Independent risk factors associated with severe disease were advanced age (odds ratio (OR): 1.1 per 10-year increase; 95% CrI (credible interval): 1.0–1.2), male sex (OR: 2.1; 95% CrI: 1.5–2.8), BMI of 25–29.9 kg/m2 (OR: 1.8; 95% CrI: 1.2–2.7) or ≥ 30 (OR: 2.2; 95% CrI: 1.5–3.3), dyspnoea (OR: 2.5; 95% CrI: 1.8–3.4) and inflammatory parameters (elevated C-reactive protein and neutrophil count, low lymphocyte count). Risk factors associated with death were advanced age (OR: 2.7 per 10-year increase; 95% CrI: 2.1–3.4), male sex (OR: 1.7; 95% CrI: 1.1–2.7), immunosuppression (OR: 3.8; 95% CrI: 1.6–7.7), diabetes (OR: 1.7; 95% CrI: 1.0–2.7), chronic kidney disease (OR: 2.3; 95% CrI: 1.3–3.9), dyspnoea (OR: 2.1; 95% CrI: 1.2–3.4) and inflammatory parameters. Conclusions Overweightedness, obesity, advanced age, male sex, comorbidities, dyspnoea and inflammation are risk factors for severe COVID-19 or death in hospitalised patients. Identifying these features among patients in routine clinical practice might improve COVID-19 management.

Epidemiology, outcomes, and utilization of intensive care unit resources for critically ill COVID-19 patients in Libya: A prospective multi-center cohort study

“…Another multicenter study in Spain and Andorra [26] of 960 patients reported a mortality rate of 31% (203). Another multicenter prospective study in France [27] of 335 critically ill patients reported a mortality rate of 7.76% (26). In a single-center study in Sweden of 260 participants, mortality was found in 60 of those admitted to the ICU [28].…”

Possible Role of Corollary Discharge in Lack of Dyspnea in Patients With COVID-19 Disease

“…In a retrospective study, dyspnea and tightness in the chest were much more common in deceased patients (Chen et al, 2020). Moreover, it was one of the associated predictors of severe disease and death (Kaeuffer et al, 2020).…”

“…Dyspnea is the main experience related to the avoidance of survival threats; it is a multidimensional construct of breathing sensations with qualitative, quantitative, and descriptive components (Abernethy and Wheeler, 2008;Parshall et al, 2012;Kaeuffer et al, 2020). The pathophysiological mechanisms, rather than pain, are complex and can coexist (Nishino, 2011).…”

Epidemiological Risk Factors for Acquiring Severe COVID-19: Prospective Cohort Study

“…Several reports from retrospective cohort studies in France 13 and China 14 demonstrated that being male was significantly associated with severe COVID-19. On the contrary, our study revealed females were associated with a 1.07-times increased risk of severe COVID-19 despite more males being hospitalized.…”