Epidemiology, risk factors and clinical course of SARS-CoV-2 infected patients in a Swiss university hospital: An observational retrospective study

  1. Jean Regina
  2. Matthaios Papadimitriou-Olivgeris
  3. Raphaël Burger
  4. Marie-Annick Le Pogam
  5. Tapio Niemi
  6. Paraskevas Filippidis
  7. Jonathan Tschopp
  8. Florian Desgranges
  9. Benjamin Viala
  10. Eleftheria Kampouri
  11. Laurence Rochat
  12. David Haefliger
  13. Mehdi Belkoniene
  14. Carlos Fidalgo
  15. Antonios Kritikos
  16. Katia Jaton
  17. Laurence Senn
  18. Pierre-Alexandre Bart
  19. Jean-Luc Pagani
  20. Oriol Manuel
  21. Loïc Lhopitallier

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Abstract

This study aims to describe the epidemiology of COVID-19 patients in a Swiss university hospital.

Methods

This retrospective observational study included all adult patients hospitalized with a laboratory confirmed SARS-CoV-2 infection from March 1 to March 25, 2020. We extracted data from electronic health records. The primary outcome was the need to mechanical ventilation at day 14. We used multivariate logistic regression to identify risk factors for mechanical ventilation. Follow-up was of at least 14 days.

Results

145 patients were included in the multivariate model, of whom 36 (24.8%) needed mechanical ventilation at 14 days. The median time from symptoms onset to mechanical ventilation was 9·5 days (IQR 7.00, 12.75). Multivariable regression showed increased odds of mechanical ventilation with age (OR 1.09 per year, 95% CI 1.03–1.16, p = 0.002), in males (OR 6.99, 95% CI 1.68–29.03, p = 0.007), in patients who presented with a qSOFA score ≥2 (OR 7.24, 95% CI 1.64–32.03, p = 0.009), with bilateral infiltrate (OR 18.92, 3.94–98.23, p<0.001) or with a CRP of 40 mg/l or greater (OR 5.44, 1.18–25.25; p = 0.030) on admission. Patients with more than seven days of symptoms on admission had decreased odds of mechanical ventilation (0.087, 95% CI 0.02–0.38, p = 0.001).

Conclusions

This study gives some insight in the epidemiology and clinical course of patients admitted in a European tertiary hospital with SARS-CoV-2 infection. Age, male sex, high qSOFA score, CRP of 40 mg/l or greater and a bilateral radiological infiltrate could help clinicians identify patients at high risk for mechanical ventilation.

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  1. Version published to 10.1371/journal.pone.0240781
  2. ScreenIT

    SciScore for 10.1101/2020.05.11.20097741: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: The project received approval from the Ethics Committee of canton Vaud, Switzerland (2020-00657) that waived the need for informed consent.
    Consent: The project received approval from the Ethics Committee of canton Vaud, Switzerland (2020-00657) that waived the need for informed consent.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    A quarter of patients for which there were no limitation of care eventually required MV. MV occurred early during the course of hospitalization and the median duration of MV was shorter than previously reported [18]. This effect could result from selection bias of patients with no limitations of care and the limited duration of follow-up. As infection with SARS-CoV-2 may cause an excessive host immune response, leading to ARDS and death [19]. We would expect biomarkers of inflammation to be associated with unfavourable outcomes. In this study, CRP >40 mg/L on admission was associated with higher odds of MV, suggesting that an unfavourable course is more frequent in patients with a severe inflammatory response related to the infection. Several studies have identified an increased risk of mortality in COVID-19 patients with elevated CRP [17,20]. Other biomarkers (for example, d-dimers) have also been identified as being associated with an increased risk of unfavourable outcome, but we did not identify this link in our study [6]. We believe that CRP is an ubiquitous biomarker whose result could potentially help clinicians assessing the risk of MV in patients with COVID-19. Its use could be easily scaled up due to the availability of numerous point-of-care test. In our study, we noted an increase in the risk of mechanical ventilation for increasing score values for NEWS, CRB-65 and qSOFA. qSOFA has been proven a useful predictor of mortality among patients with suspected infectio...

    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 rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  3. Version published to 10.1101/2020.05.11.20097741 on medRxiv