Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug;26(33):2001059.
doi: 10.2807/1560-7917.ES.2021.26.33.2001059.

Determinants for hospitalisations, intensive care unit admission and death among 20,293 reported COVID-19 cases in Portugal, March to April 2020

Vasco Ricoca Peixoto  1   2   3 , André Vieira  1   3 , Pedro Aguiar  1   3 , Paulo Sousa  1   3 , Carlos Carvalho  4 , Daniel Thomas  2   5 , Alexandre Abrantes  1   3 , Carla Nunes  1   3
Affiliations

Determinants for hospitalisations, intensive care unit admission and death among 20,293 reported COVID-19 cases in Portugal, March to April 2020

Vasco Ricoca Peixoto et al. Euro Surveill. 2021 Aug.

Abstract

BackgroundDeterminants of hospitalisation, intensive care unit (ICU) admission and death are still unclear for COVID-19. Few studies have adjusted for confounding for different clinical outcomes including all reported cases within a country.AimWe used routine surveillance data from Portugal to identify risk factors for severe COVID-19 outcomes, and to support risk stratification, public health interventions, and planning of healthcare resources.MethodsWe conducted a retrospective cohort study including 20,293 laboratory-confirmed cases of COVID-19 reported between 1 March and 28 April 2020 through the national epidemiological surveillance system. We calculated absolute risk, relative risk (RR) and adjusted relative risk (aRR) to identify demographic and clinical factors associated with hospitalisation, ICU admission and death using Poisson regressions.ResultsIncreasing age (≥ 60 years) was the major determinant for all outcomes. Age ≥ 90 years was the strongest determinant of hospital admission (aRR: 6.1), and 70-79 years for ICU (aRR: 10.4). Comorbidities of cardiovascular, immunodeficiency, kidney and lung disease (aRR: 4.3, 2.8, 2.4, 2.0, respectively) had stronger associations with ICU admission, while for death they were kidney, cardiovascular and chronic neurological disease (aRR: 2.9, 2.6, 2.0).ConclusionsOlder age was the strongest risk factor for all severe outcomes. These findings from the early stages of the COVID-19 pandemic support risk-stratified public health measures that should prioritise protecting older people. Epidemiological scenarios and clinical guidelines should consider this, even though under-ascertainment should also be considered.

Keywords: COVID-19; death; determinants; hospital admission; intensive care; risk factors.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Illustration of assumptions included in the model for associations between exposures of interest and confounding variables
Figure 2
Figure 2
Adjusted risk for hospital (n = 18,670) and intensive care unit (n = 20,293) admission among COVID-19 cases using a Poisson regression model, Portugal, 1 March–28 April 2020
Figure 3
Figure 3
Adjusted risk reduction for death among COVID-19 cases using a Poisson regression model, Portugal, 1 March–28 April 2020 (n = 20,270)
See this image and copyright information in PMC

References

    1. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-20. 10.1056/NEJMoa2002032 - DOI - PMC - PubMed
    1. Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA. 2020;323(18):1775-6. 10.1001/jama.2020.4683 - DOI - PubMed
    1. Livingston E, Bucher K. Coronavirus Disease 2019 (COVID-19) in Italy. JAMA. 2020;323(14):1335. 10.1001/jama.2020.4344 - DOI - PubMed
    1. Bialek S, Boundy E, Bowen V, Chow N, Cohn A, Dowling N, et al. Severe outcomes among patients with coronavirus disease 2019 (COVID-19) - United States, February 12-March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(12):343-6. 10.15585/mmwr.mm6912e2 - DOI - PMC - PubMed
    1. Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-81. 10.1001/jama.2020.5394 - DOI - PMC - PubMed