First Wave of COVID-19 Hospital Admissions in Denmark: A Nationwide Population-Based Cohort Study

Jon Gitz Holler*, Robert Eriksson, Thomas Østergaard Jensen, Maarten van Wijhe, Thea Kølsen Fischer, Ole Schmeltz Søgaard, Simone Bastrup Istaelsen, Rajesh Mohey, Thilde Fabricius, Frederik Jøhnk, Lothar Wiese, Stine Johnsen, Christian Søborg, Henrik Nielsen, Ole Kirk, Brigitte Lindegaard Madsen, Zitta Barrella Harboe

*Corresponding author

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated disease coronavirus disease 2019 (COVID-19), is a worldwide emergency. Demographic, comorbidity and laboratory determinants of death and of ICU admission were explored in all Danish hospitalised patients. Methods: National health registries were used to identify all hospitalized patients with a COVID-19 diagnosis. We obtained demographics, Charlson Comorbidity Index (CCI), and laboratory results on admission and explored prognostic factors for death using multivariate Cox proportional hazard regression and competing risk survival analysis. Results: Among 2431 hospitalised patients with COVID-19 between February 27 and July 8 (median age 69 years [IQR 53–80], 54.1% males), 359 (14.8%) needed admission to an intensive care unit (ICU) and 455 (18.7%) died within 30 days of follow-up. The seven-day cumulative incidence of ICU admission was lower for females (7.9%) than for males (16.7%), (p < 0.001). Age, high CCI, elevated C-reactive protein (CRP), ferritin, D-dimer, lactate dehydrogenase (LDH), urea, creatinine, lymphopenia, neutrophilia and thrombocytopenia within ±24-h of admission were independently associated with death within the first week in the multivariate analysis. Conditional upon surviving the first week, male sex, age, high CCI, elevated CRP, LDH, creatinine, urea and neutrophil count were independently associated with death within 30 days. Males presented with more pronounced laboratory abnormalities on admission. Conclusions: Advanced age, male sex, comorbidity, higher levels of systemic inflammation and cell-turnover were independent factors for mortality. Age was the strongest predictor for death, moderate to high level of comorbidity were associated with a nearly two-fold increase in mortality. Mortality was significantly higher in males after surviving the first week.

OriginalsprogEngelsk
Artikelnummer39
TidsskriftBMC Infectious Diseases
Vol/bind21
Udgave nummer1
ISSN2374-4235
DOI
StatusUdgivet - 9 jan. 2021

Bibliografisk note

Funding Information:
RE was partly supported by the European Open Science Cloud, COVID-19 related co-creation activities (grant 19). MvW was partly supported by the Independent Research Fund Denmark (grant # 8020-00284), Carlsberg Foundation, Semper Ardens Research Project (grant # CF20-0046).The funding body had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.The involved research professionals have no financial or company related conflicts of interest. The study was hosted by Department of Pulmonary and Infectious Diseases at North Zealand University Hospital, Copenhagen, Denmark. No external benefactor was involved in this work. Participants will not receive financial compensation.

Funding Information:
The authors would like to thank Head of Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, North Zealand Hospital, Denmark, Associate Professor Thyge Lyngh?j Nielsen, MD, PhD for collaboration and support, and Professor Niels Obel, Department of Infectious Diseases, Rigshospitalet, Denmark for the critical reading of the manuscript. We will like to acknowledge with gratitude the work of all clinical staff assisting COVID-19 patients in the frontline.

Publisher Copyright:
© 2021, The Author(s).

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