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Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Kartsonaki C 1 , Baillie JK 2 , Barrio NG 3 , Baruch J 4 , Beane A 5 , Blumberg L 6 Show all authors , Bozza F 7 , Broadley T 8 , Burrell A 8 , Carson G 4 , Citarella BW 4 , Dagens A 4 , Dankwa EA 9 , Donnelly CA 9 , Dunning J 4 , Elotmani L 10 , Escher M 4 , Farshait N 11 , Goffard JC 12 , Gonçalves BP 4 , Hall M 13 , Hashmi M 14 , Sim Lim Heng B 15 , Ho A 16 , Jassat W 6 , Pedrera Jiménez M 3 , Laouenan C 17 , Lissauer S 18 , Martin-Loeches I 19 , Mentré F 17 , Merson L 4 , Morton B 20 , Munblit D 21 , Nekliudov NA 22 , Nichol AD 23 , Singh Oinam BC 24 , Ong D 25 , Panda PK 24 , Petrovic M 11 , Pritchard MG 4 , Ramakrishnan N 26 , Ramos GV 7 , Roger C 10 , Sandulescu O 27 , Semple MG 28 , Sharma P 29 , Sigfrid L 4 , Somers EC 29 , Streinu-Cercel A 27 , Taccone F 12 , Vecham PK 26 , Kumar Tirupakuzhi Vijayaraghavan B 30 , Wei J 13 , Wils EJ 25 , Ci Wong X 31 , Horby P 4 , Rojek A 4 , Olliaro PL 4 , ISARIC Clinical Characterisation Group

Affiliations 

  • 1 Medical Research Council (MRC) Population Health Research Unit, Clinical Trials Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  • 2 Roslin Institute, University of Edinburgh, Edinburgh, UK
  • 3 Hospital 12 de Octubre, Madrid, Spain
  • 4 International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) Global Support Centre, Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
  • 5 Critical Care Asia, Bangkok, Thailand
  • 6 National Institute for Communicable Diseases, Johannesburg, South Africa
  • 7 National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation (INI-FIOCRUZ), Ministry of Health, and D'Or Institute of Research and Education (IDOR), Rio de Janeiro, São Paulo, Brazil
  • 8 Monash University, Clayton, Melbourne, Australia
  • 9 Department of Statistics, University of Oxford, Oxford, UK
  • 10 CHU Caremeau, Nîmes, France
  • 11 Humber River Hospital, Toronto, Canada
  • 12 Cliniques Universitaires de Bruxelles (CUB) Hopital Erasme, Anderlecht, Belgium
  • 13 Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
  • 14 Critical Care Asia and Ziauddin University, Karachi, Pakistan
  • 15 Hospital Sungai Buloh, Ministry of Health, Sungai Buloh, Malaysia
  • 16 Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow, UK Department of Infectious Diseases, Queen Elizabeth University Hospital, Glasgow, UK
  • 17 Un iversité de Paris, France, Infection, Antimicrobials, Modelling, Evolution (IAME), INSERM, Paris, France
  • 18 Malawi-Liverpool Wellcome Trust, Blantyre, Malawi
  • 19 St James's Hospital, Dublin, Ireland
  • 20 Liverpool School of Tropical Medicine, Liverpool, UK
  • 21 Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
  • 22 Sechenov University, Moscow, Russia
  • 23 Irish Critical Care Critical Clinical Trials Network, Dublin, Ireland
  • 24 All India Institute of Medical Sciences (AIIMS), Rishikesh, India
  • 25 Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands
  • 26 Apollo Hospitals Chennai, Chennai, India
  • 27 Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  • 28 Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
  • 29 University of Michigan Schools of Medicine & Public Health, Ann Arbor, Michigan, USA
  • 30 Department of Critical Care Medicine, Apollo Hospitals, Chennai, India
  • 31 National Institutes of Health (NIH), Ministry of Health, Shah Alam, Malaysia
Int J Epidemiol, 2023 Apr 19;52(2):355-376.
PMID: 36850054 DOI: 10.1093/ije/dyad012

Abstract

BACKGROUND: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients.

METHODS: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV).

RESULTS: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%.

CONCLUSIONS: Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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