Impact on disease mortality of clinical, biological, and virological characteristics at hospital admission and overtime in COVID‐19 patients

Abstract

Little is known on the association between clinical factors and coronavirus disease 2019 (COVID‐19) more than 15 days after diagnosis. We conducted a multicentric prospective cohort of COVID‐19 hospitalized patients to describe clinical, biological, and virological characteristics at hospital admission and over time, according to mortality up to Day 60 after admission. For the analysis of risk factors of survival, analyses assessing associations between mortality and demographic characteristics or comorbidities were performed using a Cox regression model. Between January 24 and March 15, 2020, 246 patients with reverse‐transcriptase polymerase chain reactions virologically confirmed COVID‐19 were enrolled. In multivariate analysis, mortality at Day 60 ( n = 42 patients, 17.1% [95% confidence interval, 12.6–22.4]) was associated with older age (adjusted hazard ratio [aHR] for age ≥ 65 years: 5.22 [2.56–10.63, p < .001]), gender (aHR for male: 2.97 [1.47–5.99, p = .002]), chronic pulmonary disease (aHR: 4.84 [2.32–10.07, p < .001]), obesity (aHR: 3.32 [1.70–6.52, p < .001]), and diabetes (aHR: 1.98 [1.01–3.89, p = .048]). The median nasopharyngeal viral load at admission was 6.4 log 10 copies/ml and was associated with mortality regardless of clinical risk factors. Viral load decreased with time elapsed since symptoms onset. Our study confirmed that mortality was associated with clinical characteristics at admission. The viral load at admission was significantly lower in patients admitted late after the onset of symptoms in both dead and alive patients. Our results could improve earlier identification of patients with increased risk of mortality and adapted management.

The first wave of the COVID-19 pandemic in Spain: characterisation of cases and risk factors for severe outcomes, as at 27 April 2020

“…Some of these comorbidities were found to be associated with disease severity. As in previous studies, diabetes was associated with an increased risk of hospitalisation and death [44]. Chronic renal disease was not associated with ICU admission, though it was the comorbidity with the highest risk of death and its association with mortality has been highlighted elsewhere [45].…”

“…Remarkably, 22.9% of the cases were HCWs, a fraction substantially higher than that reported in China (3.8%) [44] and Italy (12.2%) [11], and probably one of the highest in Europe. The high proportion of HCW cases may reflect the testing strategy among essential workers, although the lack of personal protective equipment, especially during the first weeks of the COVID-19 epidemic, may have contributed to such a high rate of infection [48].…”

CD177, a specific marker of neutrophil activation, is a hallmark of COVID-19 severity and death

“…Patient characteristics from the French COVID cohort enrolled in this analysis are shown in Table 1. All patients from this cohort were stratified as severe according to criteria of the French COVID cohort (clinicaltrials.gov NCT04262921) 23 , with 53 (87%) hospitalized in an ICU (either initially or after clinical worsening or death) and eight not. The median age was 60 years ([interquartile range (IQR)], [50-69]) and 80% were male.…”

“…We used a systems immunology approach to identify host factors that were significantly associated with the time to illness onset, severity of the disease (ICU or transfer to ICU), and mortality of COVID-19 patients enrolled in the multicentric French COVID cohort 23 . In addition to the depletion of T cells and mobilization of B cells, neutrophil activation, and severe inflammation, we show upregulation of CD177 gene expression and protein levels in the blood of COVID-19 patients in both the COVID-19 cohort and a “confirmatory” cohort, i.e., Swiss cohort, relative to healthy subjects.…”

Nasopharyngeal and serological anti SARS-CoV-2 IgG/IgA responses in COVID-19 patients

“…The NPS and plasma samples for the four COVID-19 patients are part of patients included in one of the participating center (i.e., Hôpital Bichat, APHP, Paris, France) of the French COVID cohort assessing hospitalized patients with a virologically-confirmed COVID-19 (NCT04262921) [17]. This study was conducted with the understanding and the consent of each participant or its surrogate.…”