ABSTRACT
Background: In March 2020, the COVID-19 outbreak was declared a pandemic by the World Health Organization. Aim: Our objective was to identify risk factors predictive of severe disease and death in France. Methods: In this prospective cohort study, we included patients >= 18 years old with confirmed COVID19, hospitalised in Strasbourg and Mulhouse hospitals (France), in March 2020. We respectively compared patients who developed severe disease (admission to an intensive care unit (ICU) or death) and patients who died, to those who did not, by day 7 after hospitalisation. Results: Among 1,045 patients, 424 (41%) had severe disease, including 335 (32%) who were admitted to ICU, and 115 (11%) who died. Mean age was 66 years (range: 20-100), and 612 (59%) were men. Almost 75% of patients with body mass index (BMI) data (n = 897) had a BMI >= 25 kg/m2 (n = 661). Independent risk factors associated with severe disease were advanced age (odds ratio (OR): 1.1 per 10-year increase;95%CrI (credible interval): 1.0-1.2), male sex (OR: 2.1;95% CrI: 1.5- 2.8), BMI of 25-29.9 kg/m2 (OR: 1.8;95% CrI: 1.2-2.7) or >= 30 (OR: 2.2;95% CrI: 1.5-3.3), dyspnoea (OR: 2.5;95% CrI: 1.8-3.4) and inflammatory parameters (elevated C-reactive protein and neutrophil count, low lymphocyte count). Risk factors associated with death were advanced age (OR: 2.7 per 10-year increase;95% CrI: 2.1-3.4), male sex(OR:1.7;95%CrI:1.1- 2.7), immunosuppression (OR: 3.8;95% CrI: 1.6-7.7), diabetes (OR: 1.7;95% CrI: 1.0-2.7), chronic kidney disease (OR: 2.3;95% CrI: 1.3-3.9), dyspnoea (OR: 2.1;95% CrI: 1.2-3.4) and inflammatory parameters. Conclusions: Overweightedness, obesity, advanced age, male sex, comorbidities, dyspnoea and inflammation are risk factors for severe COVID-19 or death in hospitalised patients. Identifying these features among patients in routine clinical practice might improve COVID-19 management. <comment>Superscript/Subscript Available</comment
ABSTRACT
BACKGROUND: Scant data are currently available about a potential link between comorbid chronic lung diseases (CLD) and the risk and severity of the coronavirus disease 2019 (COVID-19) infection. METHODS: To describe the clinical characteristics of and outcomes for patients with COVID-19 infection, including patients with comorbid respiratory diseases, who have been primarily hospitalized in the pulmonology department of Strasbourg University Hospital, France. In this retrospective, single-center study, we included all confirmed cases of COVID-19 from March 3 to April 15, 2020. We then compared the symptoms, biological and radiological findings, and outcomes for patients with and without CLD. RESULTS: Of the 124 patients that were enrolled, the median age was 62 years, and 75 patients (60%) were male. Overall, 40% of patients (n=50) had preexisting CLD, including chronic obstructive pulmonary disease (COPD) (n=15, 12%) and asthma (n=19, 15%). Twenty-eight patients were transferred to the intensive care unit (ICU), and six patients died in our unit. CLD were not predictive of ICU hospitalization, but a significantly higher total mortality was observed (17.6% vs. 5.5%, P<0.05) in these patients. CONCLUSIONS: Our results suggest the lack of an over-representation of CLD in COVID-19, representing 40% of patients in this cohort and even within a pulmonology department. CLD were not a risk factor for ICU management. However, a tendency to higher global mortality was observed in COVID-19 patients with CLD. Further studies are warranted to determine the risk of COVID-19 for patients with comorbid CLD.