Comparison of patient characteristics and in-hospital mortality between patients with COVID-19 in 2020 and those with influenza in 2017–2020: a multicenter, retrospective cohort study in Japan

Abstract

Background COVID-19 has worse mortality than influenza in American and European studies, but evidence from the Western Pacific region is scarce. Methods Using a large-scale multicenter inpatient claims data in Japan, we identified individuals hospitalised with COVID-19 in 2020 or influenza in 2017–2020. We compared patient characteristics, supportive care, and in-hospital mortality, with multivariable logistic regression analyses for in-hospital mortality overall, by age group, and among patients with mechanical ventilation. Findings We identified 16,790 COVID-19 patients and 27,870 influenza patients, with the different age distribution (peak at 70–89 years in COVID-19 vs. bimodal peaks at 0–9 and 80–89 years in influenza). On admission, the use of mechanical ventilation was similar in both groups (1·4% vs. 1·4%) but higher in the COVID-19 group (3·3% vs. 2·5%; p<0·0001) during the entire hospitalisation. The crude in-hospital mortality was 5·1% (856/16,790) for COVID-19 and 2·8% (791/27,870) for influenza. Adjusted for potential confounders, the in-hospital mortality was higher for COVID-19 than for influenza (adjusted odds ratio [aOR] 1·83, 95% confidence interval [CI] 1·64–2·04). In age-stratified analyses, the aOR (95%CI) were 0·78 (0·56–1·08) and 2·05 (1·83–2·30) in patients aged 20–69 years and ≥70 years, respectively (p-for-interaction<0·0001). Among patients with mechanical ventilation, the aOR was 0·79 (0·59–1·05). Interpretation Patients hospitalised with COVID-19 in Japan were more likely to die than those with influenza. However, this was mainly driven by findings in older people, and there was no difference once mechanical ventilation was started. Funding Ministry of Health, Labour and Welfare of Japan (21AA2007).

Epidemiology, Clinical Characteristics, and Mortality of Hospitalized Patients with Severe COVID-19 in Uganda, 2020–2021

“…In a large cohort of patients hospitalized with symptomatic COVID-19 in Uganda, most of whom were young adults, we observed a high frequency of severe illness. Despite provision of locallymaximal oxygen-therapy, corticosteroids, and empiric anti-bacterial agents, mortality among the severely ill was substantial, comparable to if not higher than that reported among patients hospitalized with severe COVID-19 in high-income countries (HICs) (13)(14)(15)(16).…”

Is the Pendulum of Antimicrobial Drug Resistance Swinging Back after COVID-19?

“…In addition, patients with severe COVID-19 pneumonia often require mechanical ventilation and multiple catheter insertions, including those for extracorporeal membrane oxygenation (ECMO) [ 5 ]. The length of hospital stay in severe COVID-19 tends to be longer than for other acute infectious diseases such as influenza, exposing the patients to a greater risk of nosocomial infections [ 6 ]. Moreover, despite poor evidence regarding the matter, a significant number of patients is treated with empiric broad-spectrum antibiotic therapy, thus increasing the risk of developing infections caused by multidrug-resistant (MDR) pathogens [ 7 ].…”

Inflammasome activation and pulmonary viral loads define two distinct clinical outcomes in COVID-19

“…Although SARS-CoV-2 and influenza share many similarities, including the transmission, replication, and induction of similar clinical outcomes in humans, COVID-19 can be significantly more severe in nonvaccinated individuals [45][46][47][48] . The mechanisms underlying these differences are unknown, and the revelation that exacerbated inflammasome activation mediates COVID-19 pathology 13,14,16 has led to comparisons of inflammasome activation in COVID-19 patients with other pulmonary viral diseases.…”