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Comparative Study
. 2020 Dec;25(48):2000895.
doi: 10.2807/1560-7917.ES.2020.25.48.2000895.

Clinical characteristics and risk factors associated with severe COVID-19: prospective analysis of 1,045 hospitalised cases in North-Eastern France, March 2020

Charlotte Kaeuffer  1 , Coralie Le Hyaric  1   2 , Thibaut Fabacher  2   3 , Joy Mootien  4 , Benjamin Dervieux  5 , Yvon Ruch  1 , Antonin Hugerot  1 , Yves-Jean Zhu  1 , Valentin Pointurier  4 , Raphael Clere-Jehl  6 , Valentin Greigert  7 , Loic Kassegne  8 , Nicolas Lefebvre  1 , Floriane Gallais  9 ; Covid Alsace Study Group  10 ; Nicolas Meyer  11   3 , Yves Hansmann  1 , Olivier Hinschberger  5 , François Danion  1 ; COVID Alsace Study Group
Collaborators, Affiliations
Comparative Study

Clinical characteristics and risk factors associated with severe COVID-19: prospective analysis of 1,045 hospitalised cases in North-Eastern France, March 2020

Charlotte Kaeuffer et al. Euro Surveill. 2020 Dec.

Abstract

BackgroundIn March 2020, the COVID-19 outbreak was declared a pandemic by the World Health Organization.AimOur objective was to identify risk factors predictive of severe disease and death in France.MethodsIn this prospective cohort study, we included patients ≥ 18 years old with confirmed COVID-19, 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.ResultsAmong 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.ConclusionsOverweightedness, 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.

Keywords: COVID-19; coronavirus; death; outcome; risk factors.

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Conflict of interest statement

Conflict of interest: YH reports personal fees from Pfizer, MSD, and Astellas, outside the submitted work. FD declares personal fees from Gilead, outside the submitted work. Other authors: no reported conflict of interest.

COVID-19 Alsace Study group: MO reports personal fees from Canon Medical Systems Europe, BMS, and Bracco Imaging, outside the submitted work. Other authors: no reported conflict of interest.

Figures

Figure 1
Figure 1
Proportions of patients with certain clinical symptoms at admission among patients with non-severe and severe COVID-19 by day 7, North-Eastern France, March 2020 (n=1,045 patients)
Figure 2
Figure 2
Outcome of COVID-19 patients depending on the age and BMI, North-Eastern France, March 2020 (n=1,045 patients)
See this image and copyright information in PMC

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