Clinical and virological characteristics of hospitalised COVID-19 patients in a German tertiary care centre during the first wave of the SARS-CoV-2 pandemic: a prospective observational study
Charlotte Thibeault, Barbara Mühlemann, Elisa T. Helbig, Mirja Mittermaier, Tilman Lingscheid, Pinkus Tober‐Lau, Lil Meyer‐Arndt, Leonie Meiners, Paula Stubbemann, Sascha S. Haenel, Laure Bosquillon de Jarcy, Lena J. Lippert, Moritz Pfeiffer, Miriam Stegemann, Robert Roehle, Janine Wiebach, Stefan Hippenstiel, Thomas Zöller, Holger Müller-Redetzky, Alexander Uhrig, Felix Balzer, Christof von Kalle, Norbert Suttorp, Terry C. Jones, Christian Drosten, Martin Witzenrath, Leif Erik Sander, Pa-COVID Study Group, Linda Jürgens, Malte Kleinschmidt, Sophy Denker, Christoph Ruwwe‐Glösenkamp, Bettina Temmesfeld‐Wollbrück, Kathrin Heim, Dirk Schürmann, Andreas C. Hocke, Bastian Opitz, Belén Millet Pascual-Leone, Rosa C. Schuhmacher, Nadine Olk, David Hillus, Felix Machleidt, Sebastian Albus, Felix Bremer, Jan-Moritz Doehn, Carmen García, Philipp Knape, Philipp M. Krause, Liron Lechtenberg, Yaosi Li, Panagiotis Pergantis, Teresa Ritter, Berna Yedikat, Christian Zobel, Friederike L. Hefele, Ute Kellermann, Mariana Schürmann, Lisa-Marie Wackernagel, Anne Wetzel, Daniel Grund, Jens K. Haumesser, Johannes Hodes, Johannes Rein, Peter Radünzel, Astrid Breitbart, Sergej Münzenberg, Dominik Soll, Tamar Zhamurashvili, Ralf‐Harto Hübner, Florian Alius, Tim Andermann, Thomas Cronen, Simon Fraumann, Nikolaj Frost, Dominik Geus, Gisele J. Godzick-Njomgang, Anne Herholz, Vera Hermanns, Moritz Hilbrandt, Till Jacobi, Yeji Kim, Elena Madlung, Luise Martin, Nikolai Menner, Agata Mikołajewska, Luisa Mrziglod, Nadine Müller, Michaela Niebank, Eva Pappe, Frieder Pfäfflin, Lennart Pfannkuch, Matthias Raspe, N. Reck, Anne C. Ritter, Jacopo Saccomanno, Laura K. Schmalbrock, Fridolin Steinbeis, Christoph Tabeling, Markus Vogtmann, Susanne Weber
Abstract
PURPOSE: Adequate patient allocation is pivotal for optimal resource management in strained healthcare systems, and requires detailed knowledge of clinical and virological disease trajectories. The purpose of this work was to identify risk factors associated with need for invasive mechanical ventilation (IMV), to analyse viral kinetics in patients with and without IMV and to provide a comprehensive description of clinical course. METHODS: A cohort of 168 hospitalised adult COVID-19 patients enrolled in a prospective observational study at a large European tertiary care centre was analysed. RESULTS: Forty-four per cent (71/161) of patients required invasive mechanical ventilation (IMV). Shorter duration of symptoms before admission (aOR 1.22 per day less, 95% CI 1.10-1.37, p < 0.01) and history of hypertension (aOR 5.55, 95% CI 2.00-16.82, p < 0.01) were associated with need for IMV. Patients on IMV had higher maximal concentrations, slower decline rates, and longer shedding of SARS-CoV-2 than non-IMV patients (33 days, IQR 26-46.75, vs 18 days, IQR 16-46.75, respectively, p < 0.01). Median duration of hospitalisation was 9 days (IQR 6-15.5) for non-IMV and 49.5 days (IQR 36.8-82.5) for IMV patients. CONCLUSIONS: Our results indicate a short duration of symptoms before admission as a risk factor for severe disease that merits further investigation and different viral load kinetics in severely affected patients. Median duration of hospitalisation of IMV patients was longer than described for acute respiratory distress syndrome unrelated to COVID-19.