Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19
Christiana Kartsonaki, J. Kenneth Baillie, Noelia García Barrio, Joaquín Baruch, Abi Beane, Lucille Blumberg, Fernando A. Bozza, Tessa Broadley, Aidan Burrell, Gail Carson, Barbara Wanjiru Citarella, Andrew Dagens, Emmanuelle A. Dankwa, Christl A. Donnelly, Jake Dunning, Loubna Elotmani, Martina Escher, Nataly Farshait, Jean‐Christophe Goffard, Bronner P. Gonçalves, Matthew Hall, Madiha Hashmi, Benedict Sim Lim Heng, Antonia Ho, Waasila Jassat, Miguel Pedrera‐Jiménez, Cédric Laouenan, Samantha Lissauer, Ignacio Martín‐Loeches, France Mentré, Laura Merson, Ben Morton, Daniel Munblit, Nikita Nekliudov, Alistair Nichol, Budha Charan Singh Oinam, David S. Y. Ong, Prasan Kumar Panda, Michele Petrovic, Mark G. Pritchard, Nagarajan Ramakrishnan, Grazielle Viana Ramos, Claire Roger, Oana Săndulescu, Malcolm G. Semple, Pratima Sharma, Louise Sigfrid, Emily C. Somers, Anca Streinu‐Cercel, Fabio Silvio Taccone, Pavan Kumar Vecham, Bharath Kumar Tirupakuzhi Vijayaraghavan, Jia Wei, Evert‐Jan Wils, Xin Ci Wong, Peter Horby, Amanda Rojek, Piero Olliaro, Ali Abbas, Sheryl Ann Abdukahil, Nurul Najmee Abdulkadir, Ryuzo Abe, Laurent Abel, Lara Absil, Subhash Prasad Acharya, Andrew Acker, Elisabeth Adam, Diana Adrião, Saleh Al Ageel, Shakeel Ahmed, Kate Ainscough, Eka Airlangga, Tharwat Aisa, Ali Ait Hssain, Younes Ait Tamlihat, Takako Akimoto, Ernita Akmal, Eman Al Qasim, Razi Alalqam, Angela Alberti, Tala Al-dabbous, Senthilkumar Alegesan, Cynthia Alegre, Marta Alessi, Beatrice Alex, Kévin Alexandre, Abdulrahman Al‐Fares, Huda Alfoudri, Imran Ali, Adam Ali, Naseem Ali Shah, Kazali Enagnon Alidjnou, Jeffrey Aliudin, Qabas Alkhafajee, Clotilde Allavena, Nathalie Allou, Aneela Altaf, João Alves, Rita Vieira Alves, João Alves
Abstract
BACKGROUND: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. METHODS: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). RESULTS: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. CONCLUSIONS: Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death.