Risk factors for severity on admission and the disease progression during hospitalization in a large cohort of COVID-19 patients in Japan

Abstract

Objectives: To investigate the risk factors contributing to severity on admission. Additionally, risk factors on worst severity and fatality were studied. Moreover, factors were compared based on three points: early severity, worst severity, and fatality. Design: A observational cohort study utilizing data entered in a Japan nationwide COVID-19 inpatient registry, COVIREGI-JP. Setting: As of August 31, 2020, 7,546 cases from 780 facilities have been registered. Participating facilities cover a wide range of hospitals where COVID-19 patients are admitted in Japan. Participants: Participants who had a positive test result on any applicable SARS-CoV-2 diagnostic tests, and were admitted to participating healthcare facilities. A total of 3,829 cases were identified from January 16 to May 31, 2020, of which 3,376 cases were included in this study. Primary and secondary outcoe measures: Primary outcome was severe or non-severe on admission, determined by the requirement of mechanical ventilation or oxygen therapy, SpO2, or respiratory rate. Secondary outcome was the worst severity during hospitalization, judged by the requirement of oxygen and/or IMV/ECMO. Results: Risk factors for severity on admission were older age, male, cardiovascular disease, chronic respiratory disease, diabetes, obesity, and hypertension. Cerebrovascular disease, liver disease, renal disease or dialysis, solid tumor, and hyperlipidemia did not influence severity on admission ; however it influenced worst severity. Fatality rates for obesity, hypertension, and hyperlipidemia were relatively lower. Conclusions: This study segregated the comorbidities driving severity and death. It is possible that risk factors for severity on admission, worst severity, and fatality are not consistent and may be propelled by different factors. Specifically, while hypertension, hyperlipidemia, and obesity had major effect on worst severity, their impact was mild on fatality in the Japanese population. Some studies contradict our results; therefore, detailed analyses, considering in-hospital treatments, are needed for validation. Trial registration: UMIN000039873. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000045453

Clinical features of nursing and healthcare-associated pneumonia due to COVID-19

“…The present results revealed differences in patient background, clinical findings, disease severity, and clinical outcomes between NHCAP and CAP due to COVID-19. The median age and frequency of comorbid illness, which are associated with greater severity of COVID-19 [ 10 ], were significantly higher in patients with NHCAP than those with CAP ( p < 0.0001). Rates of ICU stay and in-hospital mortality were also significantly higher in patients with NHCAP than those with CAP.…”

“…Within Group D, 16 patients were receiving regular endovascular treatment with anti-cancer drugs as an outpatient and 28 patients were receiving dialysis. A large Japanese cohort study demonstrated that patients with solid tumors or receiving dialysis experienced more-severe COVID-19 [ 10 ]. Among patients with NHCAP, the mortality rate was highest at 37.5% in patients with recent cancer treatment, followed by elderly or disabled people who were receiving nursing care with performance status scores of 3 or 4 (Group C, 24.3%), residents of an extended care facility or long-term care health facility (Group A, 23.0%), patients receiving dialysis (13.6%), and patients with mental disorders who were hospitalized in a medical institution for the treatment of mental illness (9.4%).…”

“…SARS-CoV-2 causes frequent outbreaks in facilities such as welfare facilities for persons with disabilities, long-term care health facilities, and mental hospitals that meet the criteria for NHCAP. Older age and comorbid illness are relevant to both worse severity and fatal outcome in patients with COVID-19 [ 10 ]. In addition, several studies demonstrated increased risks of SARS-CoV-2 infection, disease severity, and mortality in persons with mental disorders [ [11] , [12] , [13] , [14] ].…”

Obesity and Infection: What Have We Learned From the COVID-19 Pandemic

“…Terada et al conducted a cohort study of 3,376 patients, categorizing them into two groups based on the severity of the infection at the time of admission: 2,199 cases (65.1%) were nonsevere, and 1,181 cases (34.9%) were severe, and observed that obesity had a major effect on the severity of symptoms (OR 1.75; 95% CI 1.26-2.45, p = 0.001) (54).…”