Clinical and Virological Characteristics of Hospitalized COVID-19 Patients in a German Tertiary Care Center during the First Wave of the SARS-CoV-2 Pandemic

  1. Charlotte Thibeault
  2. Barbara Mühlemann
  3. Elisa T. Helbig
  4. Mirja Mittermaier
  5. Tilman Lingscheid
  6. Pinkus Tober-Lau
  7. Lil A. Meyer-Arndt
  8. Leonie Meiners
  9. Paula Stubbemann
  10. Sascha S. Haenel
  11. Laure Bosquillon de Jarcy
  12. Lena Lippert
  13. Moritz Pfeiffer
  14. Miriam S. Stegemann
  15. Robert Roehle
  16. Janine Wiebach
  17. Stefan Hippenstiel
  18. Thomas Zoller
  19. Holger Müller-Redetzky
  20. Alexander Uhrig
  21. Felix Balzer
  22. Christof von Kalle
  23. Norbert Suttorp
  24. Terry C. Jones
  25. Christian Drosten
  26. Martin Witzenrath
  27. Leif E. Sander
  28. Pa-COVID Study Group
  29. Victor M. Corman
  30. Florian Kurth

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Abstract

Background

Adequate patient allocation is pivotal for optimal resource management in strained healthcare systems, and requires detailed knowledge of clinical and virological disease trajectories.

Methods

A cohort of 168 hospitalized adult COVID-19 patients enrolled in a prospective observational study at a large European tertiary care center was analyzed.

Results

Forty-four percent (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), age 60-69 as compared to 18-59 years (aOR 4.33, 95%CI 1.07-20.10, p=0.04), 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 hospitalization was 9 days (IQR 6-15.5) for non-IMV and 49.5 days (IQR 36.8-82.5) for IMV-patients.

Conclusion

Our results indicate a short duration of symptoms before admission as a risk factor for severe disease and different viral load kinetics in severely affected patients.

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  1. ScreenIT

    SciScore for 10.1101/2020.12.12.20247726: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Adult patients admitted between March 1st and June 30th, 2020, with PCR-confirmed SARS-CoV-2 infection were included if patients or their legal representatives gave informed consent.
    IRB: The study was approved by the ethics committee of Charité – Universitätsmedizin Berlin (EA2/066/20), conducted according to the Declaration of Helsinki and Good Clinical Practice principles (ICH 1996) and is registered in the German and WHO international clinical trials registry (DRKS00021688) [14].
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Analyses were conducted with R (version 3.6.1) [29], JMP (version 14.2.0) [30], and statsmodels (version 0.12.0) in Python 3.7.9 [31].
    Python
    suggested: (IPython, RRID:SCR_001658)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Although a remarkable proportion (29.8%) of patients were transferred to our center due to severe ARDS, and overall 44.1% needed IMV, we report a comparatively low in-hospital mortality of 13.6% in patients without limitations of therapy. In comparison, Karagiannadis et al. reported in-hospital mortality of 22.2% [1] and Rieg et al. of 23.9% [45] in cohorts with 17.2% [1] and 32.9% [45] ventilated patients, respectively. Of note, our data show a high median length of hospital stay of 49.5 days for patients requiring IMV. By comparison, the median length of hospital stay for non-COVID ARDS patients was 17 days in a recent global multi-center prospective study [46]. There is growing evidence that the length of IMV-, ICU-, and inpatient treatment of patients with COVID-19 ARDS exceeds that of patients with ARDS unrelated to COVID-19 [42, 45]. Despite the long median duration of hospital stay, a considerable percentage of patients could not successfully be weaned off the ventilator (18%), and 6% required ongoing oxygen therapy following discharge. The mere number of deceased patients therefore depicts the burden of disease of COVID-19 only very incompletely, particularly with respect to long-term morbidity. The prospective approach of our study will allow us to evaluate long-term complications in the aftermath of COVID-19. Prospective observational studies are often hampered by selection of patients with relatively mild disease courses due to need for informed consent. In our stu...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. ScreenIT

    SciScore for 10.1101/2020.12.12.20247726: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementThe study was approved by the ethics committee of Charité – Universitätsmedizin Berlin (EA2/066/20), conducted according to the Declaration of Helsinki and Good Clinical Practice principles (ICH 1996) and is registered in the German and WHO international clinical trials registry (DRKS00021688) [14].Randomizationnot detected.Blindingnot detected.Power Analysisnot detected.Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Analyses were conducted with R (version 3.6.1) [29], JMP (version 14.2.0) [30], and statsmodels (version 0.12.0) in Python 3.7.9 [31].
    Python
    suggested: (IPython, RRID:SCR_001658)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

    Although a remarkable proportion (29.8%) of patients were transferred to our center due to severe ARDS, and overall 44.1% needed IMV, we report a comparatively low in-hospital mortality of 13.6% in patients without limitations of therapy. In comparison, Karagiannadis et al. reported in-hospital mortality of 22.2% [1] and Rieg et al. of 23.9% [45] in cohorts with 17.2% [1] and 32.9% [45] ventilated patients, respectively. Of note, our data show a high median length of hospital stay of 49.5 days for patients requiring IMV. By comparison, the median length of hospital stay for non-COVID ARDS patients was 17 days in a recent global multi-center prospective study [46]. There is growing evidence that the length of IMV-, ICU-, and inpatient treatment of patients with COVID- ARDS exceeds that of patients with ARDS unrelated to COVID-19 [42, 45]. Despite the long median duration of hospital stay, a considerable percentage of patients could not successfully be weaned off the ventilator (18%), and 6% required ongoing oxygen therapy following discharge. The mere number of deceased patients therefore depicts the burden of disease of COVID-19 only very incompletely, particularly with respect to long-term morbidity. The prospective approach of our study will allow us to evaluate long-term complications in the aftermath of COVID-19. Prospective observational studies are often hampered by selection of patients with relatively mild disease courses due to need for informed consent. In our study...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.12.12.20247726v1 on medRxiv