Clinical outcomes and characteristics of patients hospitalized for Influenza or COVID-19 in Germany

Ludwig, Marion; Jacob, Josephine; Basedow, Frederike; Andersohn, Frank; Walker, Jochen

doi:10.1016/j.ijid.2020.11.204

Cited by 86 publications

(128 citation statements)

References 31 publications

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“…Symptoms of COVID-19 appear very similar to FLU, especially in the early phase of infection, and therefore, FLU represents an optimal comparator for COVID-19. To date, clinical features and outcomes in critically ill patients with FLU and COVID-19 are not widely described [35][36][37][38]. Therefore, in the present study, we contributed to the comparison between FLU and COVID-19 and we found that in critically ill patients requiring ICU admission male sex, age > 65 and higher lymphocytes counts were associated with COVID-19, whereas CKD and COPD were related to FLU, respectively.…”

Section: Discussionmentioning

confidence: 74%

Comparison of clinical features and outcomes in COVID-19 and influenza pneumonia patients requiring intensive care unit admission

et al. 2021

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Background Little is known in distinguishing clinical features and outcomes between coronavirus disease-19 (COVID-19) and influenza (FLU). Materials/methods Retrospective, single-centre study including patients with COVID-19 or FLU pneumonia admitted to the Intensive care Unit (ICU) of Policlinico Umberto I (Rome). Aims were: (1) to assess clinical features and differences of patients with COVID-19 and FLU, (2) to identify clinical and/or laboratory factors associated with FLU or COVID-19 and (3) to evaluate 30-day mortality, bacterial superinfections, thrombotic events and invasive pulmonary aspergillosis (IPA) in patients with FLU versus COVID-19. Results Overall, 74 patients were included (19, 25.7%, FLU and 55, 74.3%, COVID-19), median age 67 years (58–76). COVID-19 patients were more male (p = 0.013), with a lower percentage of COPD (Chronic Obstructive Pulmonary Disease) and chronic kidney disease (CKD) (p = 0.001 and p = 0.037, respectively) than FLU. SOFA score was higher (p = 0.020) and lymphocytes were significantly lower in FLU than in COVID-19 [395.5 vs 770.0 cells/mmc, p = 0.005]. At multivariable analysis, male sex (OR 6.1, p < 0.002), age > 65 years (OR 2.4, p = 0.024) and lymphocyte count > 725 cells/mmc at ICU admission (OR 5.1, p = 0.024) were significantly associated with COVID-19, whereas CKD and COPD were associated with FLU (OR 0.1 and OR 0.16, p = 0.020 and p < 0.001, respectively). No differences in mortality, bacterial superinfections and thrombotic events were observed, whereas IPA was mostly associated with FLU (31.5% vs 3.6%, p = 0.0029). Conclusions In critically ill patients, male sex, age > 65 years and lymphocytes > 725 cells/mmc are related to COVID-19. FLU is associated with a significantly higher risk of IPA than COVID-19.

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Section: Discussionmentioning

confidence: 74%

Comparison of clinical features and outcomes in COVID-19 and influenza pneumonia patients requiring intensive care unit admission

et al. 2021

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“…Six studies initially identified in preprint were subsequently excluded since they had not been peer-reviewed and published by 28 th January 2021; additionally, one study that was initially included based on preprint was subsequently removed since the peer-reviewed version did not meet our study's inclusion criteria. In total, 59 studies [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] were selected for the qualitative synthesis, of which 39[ [23] , [24] , [25] , …”

Section: Resultsmentioning

confidence: 99%

COPD and the risk of poor outcomes in COVID-19: A systematic review and meta-analysis

et al. 2021

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Background Patients with chronic obstructive pulmonary disease (COPD) are highly susceptible from respiratory exacerbations from viral respiratory tract infections. However, it is unclear whether they are at increased risk of COVID-19 pneumonia or COVID-19-related mortality. We aimed to determine whether COPD is a risk factor for adverse COVID-19 outcomes including hospitalization, severe COVID-19, or death. Methods Following the PRISMA guidelines, we performed a systematic review of COVID-19 clinical studies published between November 1 st , 2019 and January 28 th , 2021 (PROSPERO ID: CRD42020191491). We included studies that quantified the number of COPD patients, and reported at least one of the following outcomes stratified by COPD status: hospitalization; severe COVID-19; ICU admission; mechanical ventilation; acute respiratory distress syndrome; or mortality. We meta-analyzed the results of individual studies to determine the odds ratio (OR) of these outcomes in patients with COPD compared to those without COPD. Findings Fifty-nine studies met the inclusion criteria, and underwent data extraction. Most studies were retrospective cohort studies/case series of hospitalized patients. Only four studies examined the effects of COPD on COVID-19 outcomes as their primary endpoint. In aggregate, COPD was associated with increased odds of hospitalization (OR 4.23, 95% confidence interval [CI] 3.65–4.90), ICU admission (OR 1.35, 95% CI 1.02–1.78), and mortality (OR 2.47, 95% CI 2.18–2.79). Interpretation Having a clinical diagnosis of COPD significantly increases the odds of poor clinical outcomes in patients with COVID-19. COPD patients should thus be considered a high-risk group, and targeted for preventative measures and aggressive treatment for COVID-19 including vaccination.

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“…Interestingly, the odd phenomenon of low COPD rates among patients seems unique to COVID-19 ( Table 1 ), as well as SARS and MERS [3] , [4] , [5] , [6] , [7] , [8] . In contrast, the prevalence of COPD and other pulmonary diseases were often higher than other medical comorbidities among patients with influenza or respiratory syncytial virus infections at about 20-40% [9] , [10] , [11] , [12] , [13] , [14] . Deciphering why host susceptible factors vary in response to different respiratory viral infections would also be an area of research interest.…”

Section: Consequences Of the Hypothesismentioning

confidence: 88%

“…Importantly, their causative agents, SARS-CoV-1 and MERS-CoV, also mainly target the alveolar epithelial cells in the lower respiratory tract to cause diseases [82] , [101] , [102] . In contrast, COPD is more prevalent among patients infected with influenza and respiratory syncytial viruses at 20-40% of cases [9] , [10] , [11] , [12] , [13] , [14] , higher than the general population at 10-15% [17] , [18] . Notably, influenza and respiratory syncytial viruses primarily cause upper respiratory tract diseases [103] , [104] , [105] , [106] .…”

Section: Hypothesismentioning

confidence: 91%

“…The same phenomenon can be observed in other pathogenic human coronaviruses that cause severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), where COPD was rarely found (i.e., 0.4-2%) as medical comorbidity among patients [3] , [4] , [5] , [6] , [7] , [8] . In contrast, the prevalence of COPD is often higher than other comorbidities at 20-40% among patients with other common respiratory viral infections, such as influenza and respiratory syncytial viruses [9] , [10] , [11] , [12] , [13] , [14] . Fig 1.…”

Section: Introductionmentioning

confidence: 98%

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Diseased lungs may hinder COVID-19 development: A possible reason for the low prevalence of COPD in COVID-19 patients

Yong

2021

Medical Hypotheses

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Presently, it remains unclear why the prevalence of lung diseases, namely chronic obstructive pulmonary disease (COPD), is much lower than other medical comorbidities and the general population among patients with coronavirus disease 2019 (COVID-19). If COVID-19 is a respiratory disease, why is COPD not the leading risk factor for contracting COVID-19? The same odd phenomenon was also observed with other pathogenic human coronaviruses causing severe acute respiratory distress syndrome (SARS) and Middle East respiratory syndrome (MERS), but not other respiratory viral infections such as influenza and respiratory syncytial viruses. One commonly proposed reason for the low COPD rates among COVID-19 patients is the usage of inhaled corticosteroids or bronchodilators that may protect against COVID-19. However, another possible reason not discussed elsewhere is that lungs in a diseased state may not be conducive for the severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) to establish COVID-19. For one, COPD causes mucous plugging in large and small airways, which may hinder SARS-CoV-2 from reaching deeper parts of the lungs (i.e., alveoli). Thus, SARS-CoV-2 may only localize to the upper respiratory tract of persons with COPD, causing mild or asymptomatic infections requiring no hospital attention. Even if SARS-CoV-2 reaches the alveoli, cells therein are probably under a heavy burden of endoplasmic reticulum (ER) stress and extensively damaged where it may not support efficient viral replication. As a result, limited SARS-CoV-2 virions would be produced in diseased lungs, preventing the development of COVID-19.

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Clinical outcomes and characteristics of patients hospitalized for Influenza or COVID-19 in Germany

Cited by 86 publications

References 31 publications

Comparison of clinical features and outcomes in COVID-19 and influenza pneumonia patients requiring intensive care unit admission

Comparison of clinical features and outcomes in COVID-19 and influenza pneumonia patients requiring intensive care unit admission

COPD and the risk of poor outcomes in COVID-19: A systematic review and meta-analysis

Diseased lungs may hinder COVID-19 development: A possible reason for the low prevalence of COPD in COVID-19 patients

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