Multicenter Study

. 2021 Mar 8;9(1):E181-E188.

doi: 10.9778/cmajo.20200250. Print 2021 Jan-Mar.

Characteristics and outcomes of patients with COVID-19 admitted to hospital and intensive care in the first phase of the pandemic in Canada: a national cohort study

Srinivas Murthy¹, Patrick M Archambault², Anika Atique², François Martin Carrier², Matthew P Cheng², Cassidy Codan², Nick Daneman², William Dechert², Sarah Douglas², Kirsten M Fiest², Robert Fowler², Geraldine Goco², Yusing Gu², Anne-Marie Guerguerian², Richard Hall², Jimmy M Hsu², Ari Joffe², Philippe Jouvet², Laurel Kelly², Michelle E Kho², Rebecca J Kruisselbrink², Deepali Kumar², Demetrios James Kutsogiannis², François Lamontagne², Todd C Lee², Kusum Menon², Heather O'Grady², Katie O'Hearn², Daniel H Ovakim², Scott G Pharand², Tyler Pitre², Riley Reel², Brenda Reeve², Oleksa Rewa², David Richardson², Asgar Rishu², Gyan Sandhu², Shirley Sarfo-Mensah², Ellen Shadowitz², Wendy Sligl², Joshua Solomon², Henry T Stelfox², Ashleigh Swanson², Hubert Tessier-Grenier², Jennifer L Y Tsang², Gordon Wood²; SPRINT-SARI Canada Investigators and the Canadian Critical Care Trials Group

Affiliations

¹ Division of Infectious Diseases, Department of Medicine (Lee), McGill University, Montréal, Que.; Ajmera Transplant Centre (Kumar), University Health Network, Toronto, Ont.; Department of Critical Care Medicine (Dechert), Brantford General Hospital, Brantford, Ont.; Department of Medicine (Sandhu), St. Michael's Hospital, Toronto, Ont.; School of Rehabilitation Science (Kho, O'Grady), McMaster University, Hamilton, Ont.; St. Joseph's Healthcare (Kelly), Hamilton, Ont.; Island Health Authority (Ovakim), Victoria, BC; Department of Anesthesiology and Department of Medicine - Critical Care Division (Carrier), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Department of Medicine (Daneman), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Faculté de médecine de l'Université de Montréal (Tessier-Grenier), Université de Montréal, Montréal, Que.; Vancouver Island Health Authority (Wood), Victoria, BC; Department of Medicine (Gu), McGill University, Montréal, Que.; Children's Hospital of Eastern Ontario Research Institute (O'Hearn), Ottawa, Ont.; Department of Community Health Sciences (Stelfox), University of Calgary, Calgary, Alta.; UBC Faculty of Medicine (Douglas), University of British Columbia, and Island Health, Vancouver, BC; Department of Medicine (Fowler), University of Toronto, Toronto, Ont.; Faculty of Medicine (Solomon), McGill University, Montréal, Que.; Department of Pediatrics (Goco) and of Critical Care Medicine (Guerguerian), The Hospital for Sick Children, Toronto, Ont.; Department of Medicine (Hsu), McGill University, Montréal, Que.; Divisions of Infectious Diseases and Medical Microbiology (Cheng), McGill University Health Centre, Montréal, Que.; Department of Medicine (Swanson), University of Victoria, Victoria, BC; Department of Medicine (Hall), Dalhousie University, Halifax, NS; Department of Medicine (Pitre), McMaster University, Hamilton, Ont.; Department of Pediatrics (Jouvet), Sainte-Justine Hospital, Université de Montréal, Montréal, Que.; Ottawa Hospital Research Institute (Pharand), Ottawa, Ont.; Department of Critical Care Medicine (Fiest), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine, University of British Columbia, and Island Health (Reel), Victoria, BC; Department of Medicine (Tsang), McMaster University, Hamilton, Ont., and Niagara Health (Tsang), St. Catharines, Ont.; Grand River Hospital (Kruisselbrink), Kitchener, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Laval, Que.; Department of Medicine (Rishu), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Medicine (Codan), University of Calgary, Calgary, Alta.; Departments of Medicine (Rewa, Sligl), of Critical Care Medicine (Kutsogiannis) and of Pediatrics (Joffe), University of Alberta, Edmonton, Alta.; Department of Medicine (Shadowitz), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Medicine (Sarfo-Mensah), The Ottawa Hospital/Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Lamontagne), Université de Sherbrooke, Sherbrooke, Que.; Department of Pediatrics (Menon), University of Ottawa, Ottawa, Ont.; McGill University Health Centre (Atique), Montréal, Que.; William Osler Health System (Richardson), Toronto, Ont.; Joseph Brant Hospital (Reeve), Burlington, Ont.; Department of Pediatrics (Murthy), University of British Columbia, Vancouver, BC Srinivas.murthy@cw.bc.ca.
² Division of Infectious Diseases, Department of Medicine (Lee), McGill University, Montréal, Que.; Ajmera Transplant Centre (Kumar), University Health Network, Toronto, Ont.; Department of Critical Care Medicine (Dechert), Brantford General Hospital, Brantford, Ont.; Department of Medicine (Sandhu), St. Michael's Hospital, Toronto, Ont.; School of Rehabilitation Science (Kho, O'Grady), McMaster University, Hamilton, Ont.; St. Joseph's Healthcare (Kelly), Hamilton, Ont.; Island Health Authority (Ovakim), Victoria, BC; Department of Anesthesiology and Department of Medicine - Critical Care Division (Carrier), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Department of Medicine (Daneman), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Faculté de médecine de l'Université de Montréal (Tessier-Grenier), Université de Montréal, Montréal, Que.; Vancouver Island Health Authority (Wood), Victoria, BC; Department of Medicine (Gu), McGill University, Montréal, Que.; Children's Hospital of Eastern Ontario Research Institute (O'Hearn), Ottawa, Ont.; Department of Community Health Sciences (Stelfox), University of Calgary, Calgary, Alta.; UBC Faculty of Medicine (Douglas), University of British Columbia, and Island Health, Vancouver, BC; Department of Medicine (Fowler), University of Toronto, Toronto, Ont.; Faculty of Medicine (Solomon), McGill University, Montréal, Que.; Department of Pediatrics (Goco) and of Critical Care Medicine (Guerguerian), The Hospital for Sick Children, Toronto, Ont.; Department of Medicine (Hsu), McGill University, Montréal, Que.; Divisions of Infectious Diseases and Medical Microbiology (Cheng), McGill University Health Centre, Montréal, Que.; Department of Medicine (Swanson), University of Victoria, Victoria, BC; Department of Medicine (Hall), Dalhousie University, Halifax, NS; Department of Medicine (Pitre), McMaster University, Hamilton, Ont.; Department of Pediatrics (Jouvet), Sainte-Justine Hospital, Université de Montréal, Montréal, Que.; Ottawa Hospital Research Institute (Pharand), Ottawa, Ont.; Department of Critical Care Medicine (Fiest), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine, University of British Columbia, and Island Health (Reel), Victoria, BC; Department of Medicine (Tsang), McMaster University, Hamilton, Ont., and Niagara Health (Tsang), St. Catharines, Ont.; Grand River Hospital (Kruisselbrink), Kitchener, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Laval, Que.; Department of Medicine (Rishu), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Medicine (Codan), University of Calgary, Calgary, Alta.; Departments of Medicine (Rewa, Sligl), of Critical Care Medicine (Kutsogiannis) and of Pediatrics (Joffe), University of Alberta, Edmonton, Alta.; Department of Medicine (Shadowitz), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Medicine (Sarfo-Mensah), The Ottawa Hospital/Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Lamontagne), Université de Sherbrooke, Sherbrooke, Que.; Department of Pediatrics (Menon), University of Ottawa, Ottawa, Ont.; McGill University Health Centre (Atique), Montréal, Que.; William Osler Health System (Richardson), Toronto, Ont.; Joseph Brant Hospital (Reeve), Burlington, Ont.; Department of Pediatrics (Murthy), University of British Columbia, Vancouver, BC.

PMID: 33688026
PMCID: PMC8034299
DOI: 10.9778/cmajo.20200250

Multicenter Study

Characteristics and outcomes of patients with COVID-19 admitted to hospital and intensive care in the first phase of the pandemic in Canada: a national cohort study

Srinivas Murthy et al. CMAJ Open. 2021.

. 2021 Mar 8;9(1):E181-E188.

doi: 10.9778/cmajo.20200250. Print 2021 Jan-Mar.

Authors

Affiliations

¹ Division of Infectious Diseases, Department of Medicine (Lee), McGill University, Montréal, Que.; Ajmera Transplant Centre (Kumar), University Health Network, Toronto, Ont.; Department of Critical Care Medicine (Dechert), Brantford General Hospital, Brantford, Ont.; Department of Medicine (Sandhu), St. Michael's Hospital, Toronto, Ont.; School of Rehabilitation Science (Kho, O'Grady), McMaster University, Hamilton, Ont.; St. Joseph's Healthcare (Kelly), Hamilton, Ont.; Island Health Authority (Ovakim), Victoria, BC; Department of Anesthesiology and Department of Medicine - Critical Care Division (Carrier), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Department of Medicine (Daneman), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Faculté de médecine de l'Université de Montréal (Tessier-Grenier), Université de Montréal, Montréal, Que.; Vancouver Island Health Authority (Wood), Victoria, BC; Department of Medicine (Gu), McGill University, Montréal, Que.; Children's Hospital of Eastern Ontario Research Institute (O'Hearn), Ottawa, Ont.; Department of Community Health Sciences (Stelfox), University of Calgary, Calgary, Alta.; UBC Faculty of Medicine (Douglas), University of British Columbia, and Island Health, Vancouver, BC; Department of Medicine (Fowler), University of Toronto, Toronto, Ont.; Faculty of Medicine (Solomon), McGill University, Montréal, Que.; Department of Pediatrics (Goco) and of Critical Care Medicine (Guerguerian), The Hospital for Sick Children, Toronto, Ont.; Department of Medicine (Hsu), McGill University, Montréal, Que.; Divisions of Infectious Diseases and Medical Microbiology (Cheng), McGill University Health Centre, Montréal, Que.; Department of Medicine (Swanson), University of Victoria, Victoria, BC; Department of Medicine (Hall), Dalhousie University, Halifax, NS; Department of Medicine (Pitre), McMaster University, Hamilton, Ont.; Department of Pediatrics (Jouvet), Sainte-Justine Hospital, Université de Montréal, Montréal, Que.; Ottawa Hospital Research Institute (Pharand), Ottawa, Ont.; Department of Critical Care Medicine (Fiest), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine, University of British Columbia, and Island Health (Reel), Victoria, BC; Department of Medicine (Tsang), McMaster University, Hamilton, Ont., and Niagara Health (Tsang), St. Catharines, Ont.; Grand River Hospital (Kruisselbrink), Kitchener, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Laval, Que.; Department of Medicine (Rishu), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Medicine (Codan), University of Calgary, Calgary, Alta.; Departments of Medicine (Rewa, Sligl), of Critical Care Medicine (Kutsogiannis) and of Pediatrics (Joffe), University of Alberta, Edmonton, Alta.; Department of Medicine (Shadowitz), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Medicine (Sarfo-Mensah), The Ottawa Hospital/Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Lamontagne), Université de Sherbrooke, Sherbrooke, Que.; Department of Pediatrics (Menon), University of Ottawa, Ottawa, Ont.; McGill University Health Centre (Atique), Montréal, Que.; William Osler Health System (Richardson), Toronto, Ont.; Joseph Brant Hospital (Reeve), Burlington, Ont.; Department of Pediatrics (Murthy), University of British Columbia, Vancouver, BC Srinivas.murthy@cw.bc.ca.
² Division of Infectious Diseases, Department of Medicine (Lee), McGill University, Montréal, Que.; Ajmera Transplant Centre (Kumar), University Health Network, Toronto, Ont.; Department of Critical Care Medicine (Dechert), Brantford General Hospital, Brantford, Ont.; Department of Medicine (Sandhu), St. Michael's Hospital, Toronto, Ont.; School of Rehabilitation Science (Kho, O'Grady), McMaster University, Hamilton, Ont.; St. Joseph's Healthcare (Kelly), Hamilton, Ont.; Island Health Authority (Ovakim), Victoria, BC; Department of Anesthesiology and Department of Medicine - Critical Care Division (Carrier), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Department of Medicine (Daneman), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Faculté de médecine de l'Université de Montréal (Tessier-Grenier), Université de Montréal, Montréal, Que.; Vancouver Island Health Authority (Wood), Victoria, BC; Department of Medicine (Gu), McGill University, Montréal, Que.; Children's Hospital of Eastern Ontario Research Institute (O'Hearn), Ottawa, Ont.; Department of Community Health Sciences (Stelfox), University of Calgary, Calgary, Alta.; UBC Faculty of Medicine (Douglas), University of British Columbia, and Island Health, Vancouver, BC; Department of Medicine (Fowler), University of Toronto, Toronto, Ont.; Faculty of Medicine (Solomon), McGill University, Montréal, Que.; Department of Pediatrics (Goco) and of Critical Care Medicine (Guerguerian), The Hospital for Sick Children, Toronto, Ont.; Department of Medicine (Hsu), McGill University, Montréal, Que.; Divisions of Infectious Diseases and Medical Microbiology (Cheng), McGill University Health Centre, Montréal, Que.; Department of Medicine (Swanson), University of Victoria, Victoria, BC; Department of Medicine (Hall), Dalhousie University, Halifax, NS; Department of Medicine (Pitre), McMaster University, Hamilton, Ont.; Department of Pediatrics (Jouvet), Sainte-Justine Hospital, Université de Montréal, Montréal, Que.; Ottawa Hospital Research Institute (Pharand), Ottawa, Ont.; Department of Critical Care Medicine (Fiest), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine, University of British Columbia, and Island Health (Reel), Victoria, BC; Department of Medicine (Tsang), McMaster University, Hamilton, Ont., and Niagara Health (Tsang), St. Catharines, Ont.; Grand River Hospital (Kruisselbrink), Kitchener, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Laval, Que.; Department of Medicine (Rishu), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Medicine (Codan), University of Calgary, Calgary, Alta.; Departments of Medicine (Rewa, Sligl), of Critical Care Medicine (Kutsogiannis) and of Pediatrics (Joffe), University of Alberta, Edmonton, Alta.; Department of Medicine (Shadowitz), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Medicine (Sarfo-Mensah), The Ottawa Hospital/Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Lamontagne), Université de Sherbrooke, Sherbrooke, Que.; Department of Pediatrics (Menon), University of Ottawa, Ottawa, Ont.; McGill University Health Centre (Atique), Montréal, Que.; William Osler Health System (Richardson), Toronto, Ont.; Joseph Brant Hospital (Reeve), Burlington, Ont.; Department of Pediatrics (Murthy), University of British Columbia, Vancouver, BC.

PMID: 33688026
PMCID: PMC8034299
DOI: 10.9778/cmajo.20200250

Abstract

Background: Clinical data on patients admitted to hospital with coronavirus disease 2019 (COVID-19) provide clinicians and public health officials with information to guide practice and policy. The aims of this study were to describe patients with COVID-19 admitted to hospital and intensive care, and to investigate predictors of outcome to characterize severe acute respiratory infection.

Methods: This observational cohort study used Canadian data from 32 selected hospitals included in a global multisite cohort between Jan. 24 and July 7, 2020. Adult and pediatric patients with a confirmed diagnosis of COVID-19 who received care in an intensive care unit (ICU) and a sampling of up to the first 60 patients receiving care on hospital wards were included. We performed descriptive analyses of characteristics, interventions and outcomes. The primary analyses examined in-hospital mortality, with secondary analyses of the length of hospital and ICU stay.

Results: Between January and July 2020, among 811 patients admitted to hospital with a diagnosis of COVID-19, the median age was 64 (interquartile range [IQR] 53-75) years, 495 (61.0%) were men, 46 (5.7%) were health care workers, 9 (1.1%) were pregnant, 26 (3.2%) were younger than 18 years and 9 (1.1%) were younger than 5 years. The median time from symptom onset to hospital admission was 7 (IQR 3-10) days. The most common symptoms on admission were fever, shortness of breath, cough and malaise. Diabetes, hypertension and cardiac, kidney and respiratory disease were the most common comorbidities. Among all patients, 328 received care in an ICU, admitted a median of 0 (IQR 0-1) days after hospital admission. Critically ill patients received treatment with invasive mechanical ventilation (88.8%), renal replacement therapy (14.9%) and extracorporeal membrane oxygenation (4.0%); 26.2% died. Among those receiving mechanical ventilation, 31.2% died. Age was an influential predictor of mortality (odds ratio per additional year of life 1.06, 95% confidence interval 1.03-1.09).

Interpretation: Patients admitted to hospital with COVID-19 commonly had fever, respiratory symptoms and comorbid conditions. Increasing age was associated with the development of critical illness and death; however, most critically ill patients in Canada, including those requiring mechanical ventilation, survived and were discharged from hospital.

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Conflict of interest statement

Competing interests: See the end of the article. Competing interests: Todd Lee reports salary support from Fonds de recherche du Québec – Santé. Deepali Kumar reports grants and personal fees from Roche. Michelle Kho reports grants from Canada Research Chairs. Matthew Cheng reports grants from the McGill Interdisciplinary Initiative in Infection and Immunity and personal fees from GEn1E Lifesciences (as a member of the scientific advisory board) and personal fees from nplex biosciences (as a member of the scientific advisory board). Philippe Jouvet reports consulting for Mallinckrodt Pharmaceuticals and grants to his institution from VitalTracer and Evolucare. Patrick Archambault is a co-investigator in the Canadian Institutes of Health Research (CIHR)–funded Canadian COVID-19 Emergency Department Rapid Response Network (https://canadiancovid19ednetwork.org). No other competing interests were declared.

Figures

**Figure 1:**
Presenting symptoms seen on admission among 811 patients admitted to hospital with coronavirus disease 2019.

**Figure 2:**
Presenting comorbidities at admission among 811 patients admitted to hospital with coronavirus disease 2019.

**Figure 3:**
Time-to-event analysis for mortality. Shaded bars represent 95% confidence intervals.

See this image and copyright information in PMC

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Characteristics and outcomes of patients with COVID-19 admitted to hospital and intensive care in the first phase of the pandemic in Canada: a national cohort study

Affiliations

Characteristics and outcomes of patients with COVID-19 admitted to hospital and intensive care in the first phase of the pandemic in Canada: a national cohort study

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