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. 2020 Sep 29;9(10):3148.
doi: 10.3390/jcm9103148.

Trajectories of Hospitalization in COVID-19 Patients: An Observational Study in France

Pierre-Yves Boëlle  1 , Tristan Delory  1   2 , Xavier Maynadier  1 , Cécile Janssen  2 , Renaud Piarroux  1 , Marie Pichenot  3 , Xavier Lemaire  4 , Nicolas Baclet  5 , Pierre Weyrich  5 , Hugues Melliez  6 , Agnès Meybeck  7 , Jean-Philippe Lanoix  8   9 , Olivier Robineau  1   7
Affiliations

Trajectories of Hospitalization in COVID-19 Patients: An Observational Study in France

Pierre-Yves Boëlle et al. J Clin Med. .

Abstract

Describing the characteristics of COVID-19 patients in the hospital is of importance to assist in the management of hospital capacity in the future. Here, we analyze the trajectories of 1321 patients admitted to hospitals in northern and eastern France. We found that the time from onset to hospitalization decreased with age, from 7.3 days in the 20-65 year-olds to 4.5 in the >80 year-olds (p < 0.0001). Overall, the length of stay in the hospital was 15.9 days, and the death rate was 20%. One patient out of four was admitted to the intensive care unit (ICU) for approximately one month. The characteristics of trajectories changed with age: fewer older patients were admitted to the ICU and the death rate was larger in the elderly. Admission shortly after onset was associated with increased mortality (odds-ratio (OR) = 1.8, Confidence Interval (CI) 95% [1.3, 2.6]) as well as male sex (OR = 2.1, CI 95% [1.5, 2.9]). Time from admission within the hospital to the transfer to ICU was short. The age- and sex-adjusted mortality rate decreased over the course of the epidemic, suggesting improvement in care over time. In the SARS-CoV-2 epidemic, the urgent need for ICU at admission and the prolonged length of stay in ICU are a challenge for bed management and organization of care.

Keywords: COVID-19; ICU; hospital mortality; hospital trajectories; length of stay; mixture model.

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Conflict of interest statement

O.R. has been involved as a consultant and expert witness in Company Gilead, ViiV, and MSD. The other authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Daily admissions in the hospital (top left) and the ICU (bottom left) and overall occupation in the hospital (top right) and the ICU (bottom right) during the COVID-19 epidemic. The vertical black line is the date of the lockdown (17 March). ICU=Intensive Care Unit.
Figure 2
Figure 2
Time from onset to hospitalization according to age. The lines correspond to the two components of the mixture analysis: slow progressor (red), rapid progressor (blue). Histogram is shown in pink.
Figure 3
Figure 3
Summary of patient trajectories from onset to admission. Time flows from left to right. Onset (S) are slow progressors, Onset (Q) are quick progressors. The width of the branches is proportional to the percentage of patients. Branches end at the average length of stay in each ward. Left side: All patients, right side, top to bottom, age groups: 18–65 years old, 65–80 years old, >80 years old.
Figure 4
Figure 4
Mortality rate (red) and mean age (blue) at date of hospital admission. Mortality rate was corrected for censoring (shaded area is 95% confidence interval).
See this image and copyright information in PMC

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