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CHARACTERISTICS AND OUTCOMES OF AN INTERNATIONAL COHORT OF 600 000 HOSPITALIZED PATIENTS WITH COVID-19
Author
Kartsonaki, Christiana
Baillie, J. Kenneth
Barrio, Noelia García
Baruch, Joaquín
Beane, Abigail
Blumberg, Lucille
Bozza, Fernando A.
Broadley, Tessa
Burrell, Aidan
Carson, Gail
Citarella, Barbara Wanjiru
Dagens, Andrew
Dankwa, Emmanuelle A.
Donnelly, Christl A.
Dunning, Jake
Elotmani, Loubna
Escher, Martina
Farshait, Nataly
Goffard, Jean-Christophe
Gonçalves, Bronner P.
Hall, Matthew
Hashmi, Madiha
Heng, Benedict Sim Lim
Ho, Antonia
Jassat, Waasila
Jiménez, Miguel Pedrera
Laouenan, Cedric
Lissauer, Samantha
Martin-Loeches, Ignacio
Mentré, France
Merson, Laura
Morton, Ben
Munblit, Daniel
Nekliudov, Nikita A.
Nichol, Alistair D.
Oinam, Budha Charan Singh
Ong, David
Panda, Prasan Kumar
Petrovic, Michele
Pritchard, Mark G.
Ramakrishnan, Nagarajan
Ramos, Grazielle Viana
Roger, Claire
Sandulescu, Oana
Semple, Malcolm G.
Sharma, Pratima
Sigfrid, Louise
Somers, Emily C.
Streinu-Cercel, Anca
Taccone, Fabio
Vecham, Pavan Kumar
Vijayaraghavan, Bharath Kumar Tirupakuzhi
Wei, Jia
Wils, Evert-Jan
Wong, Xin Ci
Horby, Peter
Rojek, Amanda
Olliaro, Piero L.
Baillie, J. Kenneth
Barrio, Noelia García
Baruch, Joaquín
Beane, Abigail
Blumberg, Lucille
Bozza, Fernando A.
Broadley, Tessa
Burrell, Aidan
Carson, Gail
Citarella, Barbara Wanjiru
Dagens, Andrew
Dankwa, Emmanuelle A.
Donnelly, Christl A.
Dunning, Jake
Elotmani, Loubna
Escher, Martina
Farshait, Nataly
Goffard, Jean-Christophe
Gonçalves, Bronner P.
Hall, Matthew
Hashmi, Madiha
Heng, Benedict Sim Lim
Ho, Antonia
Jassat, Waasila
Jiménez, Miguel Pedrera
Laouenan, Cedric
Lissauer, Samantha
Martin-Loeches, Ignacio
Mentré, France
Merson, Laura
Morton, Ben
Munblit, Daniel
Nekliudov, Nikita A.
Nichol, Alistair D.
Oinam, Budha Charan Singh
Ong, David
Panda, Prasan Kumar
Petrovic, Michele
Pritchard, Mark G.
Ramakrishnan, Nagarajan
Ramos, Grazielle Viana
Roger, Claire
Sandulescu, Oana
Semple, Malcolm G.
Sharma, Pratima
Sigfrid, Louise
Somers, Emily C.
Streinu-Cercel, Anca
Taccone, Fabio
Vecham, Pavan Kumar
Vijayaraghavan, Bharath Kumar Tirupakuzhi
Wei, Jia
Wils, Evert-Jan
Wong, Xin Ci
Horby, Peter
Rojek, Amanda
Olliaro, Piero L.
Affilliation
University of Oxford. Nuffield Department of Population Health. Clinical Trials Service Unit and Epidemiological Studies Unit. Medical Research Council Population Health Research Unit. Oxford, UK.
University of Edinburgh. Roslin Institute. Edinburgh, UK / Royal Infirmary of Edinburgh. Intensive Care Unit. Edinburgh, UK.
Hospital 12 de Octubre. Madrid, Spain.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and emerging Infection Consortium Global Support Centre. Oxford, UK.
Critical Care Asia. Bangkok, Thailand.
National Institute for Communicable Diseases. Johannesburg, South Africa.
Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectious Disease. Clinical Research Laboratory in Intensive Medicine. Rio de Janeiro, RJ, Brazil / D'Or Institute of Research and Education. Rio de Janeiro, RJ, Brazil.
Monash University. Clayton, Melbourne, Australia.
Monash University. Clayton, Melbourne, Australia.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK.
University of Oxford. Department of Statistics. Oxford, UK.
University of Oxford. Department of Statistics. Oxford, UK / Imperial College London. Abdul Latif Jameel Institute for Disease and Emergency Analytics and Department of Infectious Disease Epidemiology. MRC Centre for Global Infectious Disease Analysis. London, UK.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK.
CHU Caremeau. Nîmes, France.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK.
Humber River Hospital. Toronto, Canada.
Cliniques Universitaires de Bruxelles Hopital Erasme. Anderlecht, Belgium.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK.
University of Oxford. Nuffield Department of Medicine. Big Data Institute. Oxford, UK.
Critical Care Asia and Ziauddin University. Karachi, Pakistan.
Ministry of Health. Hospital Sungai Buloh. Sungai Buloh, Malaysia.
Medical Research Council-University of Glasgow Centre for Virus Research. Glasgow, UK / Queen Elizabeth University Hospital. Department of Infectious Diseases. Glasgow, UK.
National Institute for Communicable Diseases. Johannesburg, South Africa.
Hospital 12 de Octubre. Madrid, Spain.
Université de Paris. France / INSERM. Infection, Antimicrobials, Modelling, Evolution. Paris, France.
Malawi-Liverpool Wellcome Trust. Blantyre, Malawi.
St James's Hospital. Dublin, Ireland.
Université de Paris. France / INSERM. Infection, Antimicrobials, Modelling, Evolution. Paris, France.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK / University of Oxford. Centre for Tropical Medicine and Global Health. Infectious Diseases Data Observatory. Oxford, UK.
Liverpool School of Tropical Medicine. Liverpool, UK.
Sechenov First Moscow State Medical University. Institute of Child's Health. Department of Paediatrics and Paediatric Infectious Diseases. Moscow, Russia / Imperial College London. Faculty of Medicine. National Heart and Lung Institute. Inflammation, Repair and Development Section. London, UK.
Sechenov University. Moscow, Russia.
Irish Critical Care Critical Clinical Trials Network. Dublin, Ireland.
All India Institute of Medical Sciences. Rishikesh, India.
Franciscus Gasthuis & Vlietland. Rotterdam, Netherlands.
All India Institute of Medical Sciences. Rishikesh, India.
Humber River Hospital. Toronto, Canada.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK.
Apollo Hospitals Chennai. Chennai, India.
Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectious Disease. Rio de Janeiro, RJ, Brazil / D'Or Institute of Research and Education. Rio de Janeiro, RJ, Brazil.
CHU Caremeau. Nîmes, France.
Carol Davila University of Medicine and Pharmacy. Bucharest, Romania / National Institute for Infectious Diseases 'Prof. Dr. Matei Bals'. Bucharest, Romania.
University of Liverpool. Faculty of Health and Life Sciences. Veterinary and Ecological Sciences. Institute of Infection. Liverpool, UK / UK Respiratory Medicine. Alder Hey Children's NHS Foundation Trust. Liverpool, UK.
University of Michigan Schools of Medicine & Public Health. Ann Arbor, Michigan, USA.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK.
University of Michigan Schools of Medicine & Public Health. Ann Arbor, Michigan, USA.
Carol Davila University of Medicine and Pharmacy. Bucharest, Romania.
Cliniques Universitaires de Bruxelles Hopital Erasme. Anderlecht, Belgium.
Apollo Hospitals Chennai. Chennai, India.
Apollo Hospitals. Department of Critical Care Medicine. Chennai, India / The George Institute for Global Health. New Delhi, India.
University of Oxford. Nuffield Department of Medicine. Big Data Institute. Oxford, UK.
Franciscus Gasthuis & Vlietland. Rotterdam, Netherlands.
Ministry of Health. National Institutes of Health. Shah Alam, Malaysia.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK / Royal Melbourne Hospital. Melbourne, Australia / University of Melbourne. Centre for Integrated Critical Care. Melbourne, Australia.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK.
University of Edinburgh. Roslin Institute. Edinburgh, UK / Royal Infirmary of Edinburgh. Intensive Care Unit. Edinburgh, UK.
Hospital 12 de Octubre. Madrid, Spain.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and emerging Infection Consortium Global Support Centre. Oxford, UK.
Critical Care Asia. Bangkok, Thailand.
National Institute for Communicable Diseases. Johannesburg, South Africa.
Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectious Disease. Clinical Research Laboratory in Intensive Medicine. Rio de Janeiro, RJ, Brazil / D'Or Institute of Research and Education. Rio de Janeiro, RJ, Brazil.
Monash University. Clayton, Melbourne, Australia.
Monash University. Clayton, Melbourne, Australia.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK.
University of Oxford. Department of Statistics. Oxford, UK.
University of Oxford. Department of Statistics. Oxford, UK / Imperial College London. Abdul Latif Jameel Institute for Disease and Emergency Analytics and Department of Infectious Disease Epidemiology. MRC Centre for Global Infectious Disease Analysis. London, UK.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK.
CHU Caremeau. Nîmes, France.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK.
Humber River Hospital. Toronto, Canada.
Cliniques Universitaires de Bruxelles Hopital Erasme. Anderlecht, Belgium.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK.
University of Oxford. Nuffield Department of Medicine. Big Data Institute. Oxford, UK.
Critical Care Asia and Ziauddin University. Karachi, Pakistan.
Ministry of Health. Hospital Sungai Buloh. Sungai Buloh, Malaysia.
Medical Research Council-University of Glasgow Centre for Virus Research. Glasgow, UK / Queen Elizabeth University Hospital. Department of Infectious Diseases. Glasgow, UK.
National Institute for Communicable Diseases. Johannesburg, South Africa.
Hospital 12 de Octubre. Madrid, Spain.
Université de Paris. France / INSERM. Infection, Antimicrobials, Modelling, Evolution. Paris, France.
Malawi-Liverpool Wellcome Trust. Blantyre, Malawi.
St James's Hospital. Dublin, Ireland.
Université de Paris. France / INSERM. Infection, Antimicrobials, Modelling, Evolution. Paris, France.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK / University of Oxford. Centre for Tropical Medicine and Global Health. Infectious Diseases Data Observatory. Oxford, UK.
Liverpool School of Tropical Medicine. Liverpool, UK.
Sechenov First Moscow State Medical University. Institute of Child's Health. Department of Paediatrics and Paediatric Infectious Diseases. Moscow, Russia / Imperial College London. Faculty of Medicine. National Heart and Lung Institute. Inflammation, Repair and Development Section. London, UK.
Sechenov University. Moscow, Russia.
Irish Critical Care Critical Clinical Trials Network. Dublin, Ireland.
All India Institute of Medical Sciences. Rishikesh, India.
Franciscus Gasthuis & Vlietland. Rotterdam, Netherlands.
All India Institute of Medical Sciences. Rishikesh, India.
Humber River Hospital. Toronto, Canada.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK.
Apollo Hospitals Chennai. Chennai, India.
Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectious Disease. Rio de Janeiro, RJ, Brazil / D'Or Institute of Research and Education. Rio de Janeiro, RJ, Brazil.
CHU Caremeau. Nîmes, France.
Carol Davila University of Medicine and Pharmacy. Bucharest, Romania / National Institute for Infectious Diseases 'Prof. Dr. Matei Bals'. Bucharest, Romania.
University of Liverpool. Faculty of Health and Life Sciences. Veterinary and Ecological Sciences. Institute of Infection. Liverpool, UK / UK Respiratory Medicine. Alder Hey Children's NHS Foundation Trust. Liverpool, UK.
University of Michigan Schools of Medicine & Public Health. Ann Arbor, Michigan, USA.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK.
University of Michigan Schools of Medicine & Public Health. Ann Arbor, Michigan, USA.
Carol Davila University of Medicine and Pharmacy. Bucharest, Romania.
Cliniques Universitaires de Bruxelles Hopital Erasme. Anderlecht, Belgium.
Apollo Hospitals Chennai. Chennai, India.
Apollo Hospitals. Department of Critical Care Medicine. Chennai, India / The George Institute for Global Health. New Delhi, India.
University of Oxford. Nuffield Department of Medicine. Big Data Institute. Oxford, UK.
Franciscus Gasthuis & Vlietland. Rotterdam, Netherlands.
Ministry of Health. National Institutes of Health. Shah Alam, Malaysia.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK / Royal Melbourne Hospital. Melbourne, Australia / University of Melbourne. Centre for Integrated Critical Care. Melbourne, Australia.
University of Oxford. Nuffield Department of Medicine. Pandemic Sciences Institute. International Severe Acute Respiratory and Emerging Infection Consortium Global Support Centre. Oxford, UK.
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.
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