Clinical outcome, risk assessment, and seasonal variation in hospitalized COVID-19 patients—Results from the CORONA Germany study

Geßler, Nele; Gunawardene, Melanie; Wohlmuth, Peter; Arnold, Dirk; Behr, Jüergen; Gloeckner, Christian; Herrlinger, Klaus; Hoelting, Thomas; Pape, Ulrich‐Frank; Schreiber, Ruediger; Stang, Axel; Wesseler, Claas; Willems, Stephan; Arms, Charlotte; Herborn, Christoph U.

doi:10.1371/journal.pone.0252867

Cited by 18 publications

(23 citation statements)

References 15 publications

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“…As shown by our study group, in-hospital mortality showed temporal variation during the year 2020 in the "CORONA Germany" cohort, mostly influenced by age [22]. Also, we assume seasonality of COVID-19 to be noteworthy, as discussed before [22]. Interestingly, incidences of clinically manifest cardiovascular events showed two peaks in our study coinciding with the two waves of infection in Germany.…”

Section: Blood Pressuresupporting

confidence: 69%

“…Lastly, it needs to be considered that the time span covered by this study is wide and includes different waves of COVID-19 infections, burdens on the health care system and the learning curve of this new disease. As shown by our study group, in-hospital mortality showed temporal variation during the year 2020 in the "CORONA Germany" cohort, mostly influenced by age [22]. Also, we assume seasonality of COVID-19 to be noteworthy, as discussed before [22].…”

Section: Blood Pressuresupporting

confidence: 56%

“…This number of patients is too low to draw any conclusions. However, three of these four patients suffered from advanced respiratory failure due to COVID-19 and are therefore considered to be at high risk for poor outcome [22]. The one patient suffering from a STEMI and ventricular fibrillation survived after successful resuscitation and percutaneous coronary intervention demonstrating the better prognostic outcome of this entity.…”

Section: Atrial Fibrillationmentioning

confidence: 98%

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Prognostic Impact of Acute Cardiovascular Events in COVID-19 Hospitalized Patients—Results from the CORONA Germany Study

Gunawardene

Geßler

Wohlmuth

et al. 2021

JCM

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Background: Acute myocardial injury (AMJ), assessed by elevated levels of cardiac troponin, is associated with fatal outcome in coronavirus disease 2019 (COVID-19). However, the role of acute cardiovascular (CV) events defined by clinical manifestation rather than sole elevations of biomarkers is unclear in hospitalized COVID-19 patients. Objective: The aim of this study was to investigate acute clinically manifest CV events in hospitalized COVID-19 patients. Methods: From 1 March 2020 to 5 January 2021, we conducted a multicenter, prospective, epidemiological cohort study at six hospitals from Hamburg, Germany (a portion of the state-wide 45-center CORONA Germany cohort study) enrolling all hospitalized COVID-19 patients. Primary endpoint was occurrence of a clinically manifest CV-event. Results: In total, 132 CV-events occurred in 92 of 414 (22.2%) patients in the Hamburg-cohort: cardiogenic shock in 10 (2.4%), cardiopulmonary resuscitation in 12 (2.9%), acute coronary syndrome in 11 (2.7%), de-novo arrhythmia in 31 (7.5%), acute heart-failure in 43 (10.3%), myocarditis in 2 (0.5%), pulmonary-embolism in 11 (2.7%), thrombosis in 9 (2.2%) and stroke in 3 (0.7%). In the Hamburg-cohort, mortality was 46% (42/92) for patients with a CV-event and 33% (27/83) for patients with only AMJ without CV-event (OR 1.7, CI: (0.94–3.2), p = 0.077). Mortality was higher in patients with CV-events (Odds ratio(OR): 4.8, 95%-confidence-interval(CI): [2.9–8]). Age (OR 1.1, CI: (0.66–1.86)), atrial fibrillation (AF) on baseline-ECG (OR 3.4, CI: (1.74–6.8)), systolic blood-pressure (OR 0.7, CI: (0.53–0.96)), potassium (OR 1.3, CI: (0.99–1.73)) and C-reactive-protein (1.4, CI (1.04–1.76)) were associated with CV-events. Conclusion: Hospitalized COVID-19 patients with clinical manifestation of acute cardiovascular events show an almost five-fold increased mortality. In this regard, the emergence of arrhythmias is a major determinant.

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Section: Blood Pressuresupporting

confidence: 69%

Section: Blood Pressuresupporting

confidence: 56%

Section: Atrial Fibrillationmentioning

confidence: 98%

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Prognostic Impact of Acute Cardiovascular Events in COVID-19 Hospitalized Patients—Results from the CORONA Germany Study

Gunawardene

Geßler

Wohlmuth

et al. 2021

JCM

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“…In Germany, the first wave was smaller and led to fewer hospitalizations than the second, while the peaks in hospitalizations between the waves were more similar in Sweden. Despite this, the highest mortality in both studies was seen in the initial peak of the first wave 26 . Another study examined raw case fatality ratio (CFR) in 53 countries or regions and showed decreased mortality in the second wave in 43 of them, including in Sweden.…”

Section: Discussionmentioning

confidence: 76%

Temporal trends in hospitalizations and 30-day mortality in older patients during the COVID pandemic from March 2020 to July 2021

García-Ptacek

Annetorp

et al. 2021

Preprint

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Importance: Previous reports have suggested reductions in mortality risk from COVID-19 throughout the first wave of the COVID-19 pandemic. Mortality changes later in the pandemic and pandemic effects on other types of geriatric hospitalizations are less studied. Objectives: To describe the changes in hospitalizations and 30-day mortality in Stockholm for patients 70+ receiving inpatient geriatric care for COVID-19 and other causes. Design: Observational study. For patients 70 or older, we present the incidence of 30-day mortality from COVID-19 in the Stockholm region, in relationship to geriatric hospitalizations and 30-day mortality after admission for COVID-19 and other causes. Setting: Hospitalizations for patients 70+ from geriatric clinics in Stockholm, Sweden hospitalized for COVID-19 or other causes between March 2020 and July 31, 2021, were included. Participants: The total number of geriatric hospitalizations for patients 70+ was 5,320 for COVID-19 and 32,243 for non-COVID-19 causes, corresponding to 4,565 individual COVID-19 patients and 19,308 non-COVID-19 patients. Exposure(s): The date of hospital admission to a geriatric clinic. Main Outcome(s) and Measure(s): 30-day mortality after admission. Results: In patients with COVID-19, the 30-day mortality rate was highest at the beginning of the first wave (29% in March-April 2020), decreased as the first wave subsided (7% July-August), increased again in the second wave (17% November-December), but failed to increase as much in the third wave (11-13% March-July 2021). In non-COVID-19 geriatric patients during the same period, the 30-day mortality presented a similar trend, but with a smaller magnitude of variation (5 to 10%). The number of persons 70 or older testing positive for COVID-19 in Stockholm reached two peaks in 2020 (April and December), fell in January 2021 and then increased again in March-April 2021. Conclusions and Relevance: During the first and second waves, hospital admissions and 30-day mortality after geriatric hospitalization for COVID-19 increased in periods of high community transmission, although the mortality peak was lower in wave 2 than in wave 1. The mortality for non-COVID geriatric cases was lower and more stable but also showed an increase with the pandemic peaks.

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“…However, the recent COVID-19 pandemic resulted in many people with an acute infectious illness being in need for palliative care. Mortality is highest among male patients, people of old age and people with chronic or malignant diseases [ 3 , 4 ]. Most people die because of respiratory failure, myocardial damage or failure [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Palliative care in COVID-19

Janssen

2021

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of review The purpose of this paper is (1) to provide insight in the palliative care needs of patients with COVID-19; (2) to highlight the challenges of COVID-19 for palliative care; and (3) to highlight developments in COVID-19 palliative care. Recent findings Patients with serious COVID-19 have palliative care needs in all domains: physical, psychological, social and spiritual. COVID-19 palliative care is confronted with many challenges, including: the uncertain prognosis, resource limitations, challenges regarding advance care planning, lack of guidance, limited multidisciplinary collaboration, need for remote communication, restrictions in family visits, and burden for clinicians. Palliative care responded with many developments: development of services; integration of palliative care with other services; tools to support advance care planning, (remote) communication with patients and families, or spiritual care; and care for team members. Summary Palliative care has an important role in this pandemic. Palliative care rapidly developed services and opportunities were found to support patients, families and clinicians. Further developments are warranted to face future demands of a pandemic, including integrated palliative care and education in palliative care skills across all specialties. Intervention studies are needed to enable evidence-based recommendations for palliative care in COVID-19.

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Clinical outcome, risk assessment, and seasonal variation in hospitalized COVID-19 patients—Results from the CORONA Germany study

Cited by 18 publications

References 15 publications

Prognostic Impact of Acute Cardiovascular Events in COVID-19 Hospitalized Patients—Results from the CORONA Germany Study

Prognostic Impact of Acute Cardiovascular Events in COVID-19 Hospitalized Patients—Results from the CORONA Germany Study

Temporal trends in hospitalizations and 30-day mortality in older patients during the COVID pandemic from March 2020 to July 2021

Palliative care in COVID-19

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