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Abstract

Background

In March 2020, the COVID-19 outbreak was declared a pandemic by the World Health Organization.

Aim

Our objective was to identify risk factors predictive of severe disease and death in France.

Methods

In 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.

Results

Among 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.

Conclusions

Overweightedness, 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.

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2020-12-03
2024-11-21
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2020.25.48.2000895
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References

  1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. , China Novel Coronavirus Investigating and Research Team. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33.  https://doi.org/10.1056/NEJMoa2001017  PMID: 31978945 
  2. World Health Organization (WHO). WHO Director-General’s opening remarks at the media briefing on COVID-19. Geneva: WHO; 13 March 2020. [Accessed 19 Apr 2020]. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-mission-briefing-on-covid-19---13-march-2020
  3. European Centre for Disease Prevention and Control (ECDC). COVID-19 situation update for the EU/EEA and the UK, as of 3 August 2020. Stockholm: ECDC; [Accessed 3 Aug 2020]. Available from: https://www.ecdc.europa.eu/en/cases-2019-ncov-eueea
  4. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.  https://doi.org/10.1016/S0140-6736(20)30183-5  PMID: 31986264 
  5. Guan W-J, Ni Z-Y, Hu Y, Liang W-H, Ou C-Q, He J-X, et al. , China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-20.  https://doi.org/10.1056/NEJMoa2002032  PMID: 32109013 
  6. Bai Y, Yao L, Wei T, Tian F, Jin D-Y, Chen L, et al. Presumed Asymptomatic Carrier Transmission of COVID-19. JAMA. 2020;323(14):1406-7.  https://doi.org/10.1001/jama.2020.2565  PMID: 32083643 
  7. Wilder-Smith A, Chiew CJ, Lee VJ. Can we contain the COVID-19 outbreak with the same measures as for SARS? Lancet Infect Dis. 2020;20(5):e102-7.  https://doi.org/10.1016/S1473-3099(20)30129-8  PMID: 32145768 
  8. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-43.  https://doi.org/10.1001/jamainternmed.2020.0994  PMID: 32167524 
  9. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62.  https://doi.org/10.1016/S0140-6736(20)30566-3  PMID: 32171076 
  10. Peiris JSM, Yuen KY, Osterhaus ADME, Stöhr K. The severe acute respiratory syndrome. N Engl J Med. 2003;349(25):2431-41.  https://doi.org/10.1056/NEJMra032498  PMID: 14681510 
  11. Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al. Remdesivir for the Treatment of Covid-19 - Preliminary Report. N Engl J Med. 2020;NEJMoa2007764.  https://doi.org/10.1056/NEJMoa2007764 
  12. World Health Organization (WHO). Real-time-rt-pcr-assays-for-the-detection-of-sars-cov-2-institut-pasteur-paris. Geneva: WHO. [Accessed 20 Apr 2020]. Available from: https://www.who.int/docs/default-source/coronaviruse/real-time-rt-pcr-assays-for-the-detection-of-sars-cov-2-institut-pasteur-paris.pdf?sfvrsn=3662fcb6_2
  13. World Health Organization (WHO). Obesity. Geneva: WHO. [Accessed 24 Jul 2020]. Available from: https://www.who.int/topics/obesity/en/
  14. Marques A, Peralta M, Naia A, Loureiro N, de Matos MG. Prevalence of adult overweight and obesity in 20 European countries, 2014. Eur J Public Health. 2018;28(2):295-300.  https://doi.org/10.1093/eurpub/ckx143  PMID: 29036436 
  15. Louie JK, Acosta M, Winter K, Jean C, Gavali S, Schechter R, et al. , California Pandemic (H1N1) Working Group. Factors associated with death or hospitalization due to pandemic 2009 influenza A(H1N1) infection in California. JAMA. 2009;302(17):1896-902.  https://doi.org/10.1001/jama.2009.1583  PMID: 19887665 
  16. Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, et al. , LICORN and the Lille COVID-19 and Obesity study group. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity (Silver Spring). 2020;28(7):1195-9.  https://doi.org/10.1002/oby.22831  PMID: 32271993 
  17. Kass DA, Duggal P, Cingolani O. Obesity could shift severe COVID-19 disease to younger ages. Lancet. 2020;395(10236):1544-5.  https://doi.org/10.1016/S0140-6736(20)31024-2  PMID: 32380044 
  18. Lighter J, Phillips M, Hochman S, Sterling S, Johnson D, Francois F, et al. Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission. Clin Infect Dis. 2020;71(15):896-7.  https://doi.org/10.1093/cid/ciaa415  PMID: 32271368 
  19. Peters U, Suratt BT, Bates JHT, Dixon AE. Beyond BMI: Obesity and Lung Disease. Chest. 2018;153(3):702-9.  https://doi.org/10.1016/j.chest.2017.07.010  PMID: 28728934 
  20. Huttunen R, Syrjänen J. Obesity and the outcome of infection. Lancet Infect Dis. 2010;10(7):442-3.  https://doi.org/10.1016/S1473-3099(10)70103-1  PMID: 20610324 
  21. Martí A, Marcos A, Martínez JA. Obesity and immune function relationships. Obes Rev. 2001;2(2):131-40.  https://doi.org/10.1046/j.1467-789x.2001.00025.x  PMID: 12119664 
  22. Kim L, Garg S, O’Halloran A, Whitaker M, Pham H, Anderson EJ, et al. Risk Factors for Intensive Care Unit Admission and In-hospital Mortality among Hospitalized Adults Identified through the U.S. Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET). Clin Infect Dis. 2020;ciaa1012.  https://doi.org/10.1093/cid/ciaa1012  PMID: 32674114 
  23. Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. , COVID-19 Lombardy ICU Network. 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.  https://doi.org/10.1001/jama.2020.5394  PMID: 32250385 
  24. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9.  https://doi.org/10.1001/jama.2020.1585  PMID: 32031570 
  25. Vestergaard LS, Nielsen J, Richter L, Schmid D, Bustos N, Braeye T, et al. , ECDC Public Health Emergency Team for COVID-19. Excess all-cause mortality during the COVID-19 pandemic in Europe - preliminary pooled estimates from the EuroMOMO network, March to April 2020. Euro Surveill. 2020;25(26):2001214.  https://doi.org/10.2807/1560-7917.ES.2020.25.26.2001214  PMID: 32643601 
  26. Yan CH, Faraji F, Prajapati DP, Ostrander BT, DeConde AS. Self-reported olfactory loss associates with outpatient clinical course in COVID-19. Int Forum Allergy Rhinol. 2020;10(7):821-31.  https://doi.org/10.1002/alr.22592  PMID: 32329222 
  27. Zhang P, Zhu L, Cai J, Lei F, Qin J-J, Xie J, et al. Association of Inpatient Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Mortality Among Patients With Hypertension Hospitalized With COVID-19. Circ Res. 2020;126(12):1671-81.  https://doi.org/10.1161/CIRCRESAHA.120.317134  PMID: 32302265 
  28. Bertran Recasens B, Martinez-Llorens JM, Rodriguez-Sevilla JJ, Rubio MA. Lack of dyspnea in patients with Covid-19: another neurological conundrum? Eur J Neurol. 2020;ene.14265.  https://doi.org/10.1111/ene.14265  PMID: 32301553 
  29. Channappanavar R, Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology. Semin Immunopathol. 2017;39(5):529-39.  https://doi.org/10.1007/s00281-017-0629-x  PMID: 28466096 
  30. Pedersen SF, Ho Y-C. SARS-CoV-2: a storm is raging. J Clin Invest. 2020;130(5):2202-5.  https://doi.org/10.1172/JCI137647  PMID: 32217834 
  31. Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, et al. , RECOVERY Collaborative Group. Dexamethasone in Hospitalized Patients with Covid-19 - Preliminary Report. N Engl J Med. 2020:NEJMoa2021436. PMID: 32678530 
  32. Cummings MJ, Baldwin MR, Abrams D, Jacobson SD, Meyer BJ, Balough EM, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet. 2020;395(10239):1763-70.  https://doi.org/10.1016/S0140-6736(20)31189-2  PMID: 32442528 
Clinical characteristics and risk factors associated with severe COVID-19: prospective analysis of 1,045 hospitalised cases in North-Eastern France, March 2020
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Charlotte+Kaeuffer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kaeuffer Charlotte</a>, <a href="/search?value1=Coralie+Le+Hyaric&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Le Hyaric Coralie</a>, <a href="/search?value1=Thibaut+Fabacher&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Fabacher Thibaut</a>, <a href="/search?value1=Joy+Mootien&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mootien Joy</a>, <a href="/search?value1=Benjamin+Dervieux&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Dervieux Benjamin</a>, <a href="/search?value1=Yvon+Ruch&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ruch Yvon</a>, <a href="/search?value1=Antonin+Hugerot&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hugerot Antonin</a>, <a href="/search?value1=Yves-Jean+Zhu&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Zhu Yves-Jean</a>, <a href="/search?value1=Valentin+Pointurier&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pointurier Valentin</a>, <a href="/search?value1=Raphael+Clere-Jehl&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Clere-Jehl Raphael</a>, <a href="/search?value1=Valentin+Greigert&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Greigert Valentin</a>, <a href="/search?value1=Loic+Kassegne&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kassegne Loic</a>, <a href="/search?value1=Nicolas+Lefebvre&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lefebvre Nicolas</a>, <a href="/search?value1=Floriane+Gallais&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gallais Floriane</a>, <a href="/search?value1=Covid+Alsace+Study+Group&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Covid Alsace Study Group</a>, <a href="/search?value1=Nicolas+Meyer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Meyer Nicolas</a>, <a href="/search?value1=Yves+Hansmann&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hansmann Yves</a>, <a href="/search?value1=Olivier+Hinschberger&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hinschberger Olivier</a>, <a href="/search?value1=Fran%C3%A7ois+Danion&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Danion François</a></span>. Clinical characteristics and risk factors associated with severe COVID-19: prospective analysis of 1,045 hospitalised cases in North-Eastern France, March 2020. <a href="/content/ecdc">Euro Surveill.</a> 2020;25(48):pii=2000895. <a href="https://doi.org/10.2807/1560-7917.ES.2020.25.48.2000895" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2020.25.48.2000895</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 11 May 2020;&nbsp;&nbsp; <span class="generated">Accepted</span>: 14 Aug 2020 </span> </p>
/content/10.2807/1560-7917.ES.2020.25.48.2000895
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