Authors: Christiana Kartsonaki, Ayodhia Pitaloka Pasaribu J Kenneth Baillie, Noelia García Barrio, Joaquín Baruch, Abigail Beane, Lucille Blumberg, Fernando Bozza, Tessa Broadley, Aidan Burrell, Gail Carson, Barbara Wanjiru Citarella, Andrew Dagens, Emmanuelle A Dankwa, Christl A Donnelly, Jake Dunning, Loubna Elotmani, Martina Escher, Nataly Farshait, Jean-Christophe Goffard, Bronner P Gonçalves, Matthew Hall, Madiha Hashmi, Benedict Sim Lim Heng, Antonia Ho, Waasila Jassat, Miguel Pedrera Jiménez, Cedric Laouenan, Samantha Lissauer, Ignacio Martin-Loeches, France Mentré, Laura Merson, Ben Morton, Daniel Munblit, Nikita A Nekliudov, Alistair D Nichol, Budha Charan Singh Oinam, David Ong, Prasan Kumar Panda, Michele Petrovic, Mark G Pritchard, Nagarajan Ramakrishnan, Grazielle Viana Ramos, Claire Roger, Oana Sandulescu, Malcolm G Semple, Pratima Sharma, Louise Sigfrid, Emily C Somers, Anca Streinu-Cercel, Fabio Taccone, Pavan Kumar Vecham, Bharath Kumar Tirupakuzhi Vijayaraghavan, Jia Wei, Evert-Jan Wils, Xin Ci Wong, Peter Horby, Amanda Rojek, and Piero L Olliaro
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.
Keywords: COVID-19, SARS-CoV-2, cohort study, risk of death, co-morbidities, symptoms, treatments
DOI: 10.1093/ije/dyad012
Published: 19 April 2023