Predictors of mortality, ICU hospitalization, and extrapulmonary complications in COVID-19 patients - 21/07/21

Doi : 10.1016/j.idnow.2021.07.002

M. Martinot ^a,⁎ , M. Eyriey ^b, S. Gravier ^a, T. Bonijoly ^a, D. Kayser ^a, C. Ion ^a, M. Mohseni-Zadeh ^a, S. Camara ^b, J. Dubois ^b, E. Haerrel ^b, J. Drouaine ^b, J. Kaiser ^b,^c, J.C. Ongagna ^b, A. Schieber-Pachart ^b, C. Kempf ^b
the Centre Alsace COVID-19 Study Group^¹
Center Alsace COVID-19 Study Group (Hôpitaux Civils de Colmar): Maxime Bach-Bunner, Camille Martinez, Anne Leluan, Jean Marie Woehl, Jean-Philippe Oster, Lionel Moreau, Angela Pinazo, Anne Catherine Neidhardt, Claire Denis, Laurent Messer, Antoine Mahe, Elisabeth Gaertner, Guillaume Trumpff, Olivia Trau, André Jocelyn, Otto Hartmann, Jean François Cerfon, Dominique Debriel, Guillaume Gregorowizc, Olivier Augereau, Alexandre Klein, Marion Bolliet, Laurianne Plastaras, Hanae Touati, Daniel Benitah, Jean-Marc Limacher, Celine Iltis, Jacque Chapiro, Laszlo Levai, Stephane Greciano, Wael Younes, Agnès Smagala, François Sellal, Geoffroy Hautecloque, Yannick Gottwalles, Eric Thibaud, Nicolas Kempf, Thomas Schohn, Emeric Robert, Jihad Mortada, Caroline Baunstein, Céline Hassenforder, Pauline Badina, Soad Bentichikou, Marie Szulc, Jean-Marc Michel, Pierre Anthony, Stéphanie Libercier, Benjamin Egloff, Yoann Gag, Thibaut Wolf, Anais Henric, Cléa Rouillon, Léo Caudrelier.
^a Infectious Diseases Department, Hôpitaux Civils, 39, avenue de la liberté, 68024 Colmar, France
^b Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
^c Pharmacy Department, Hôpitaux Civils de Colmar, Colmar, France

^⁎Corresponding author.

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Highlights

•	In March 2020, 25% of patients with COVID-19 were admitted to the intensive care unit (ICU) and 19% died.
•	The main clinical factors associated with death were age and neurological or renal disease.
•	The main biological factors associated with death were high CRP and creatinine levels, and low hemoglobin levels.
•	The main complications were kidney and liver failure, cardiac and thromboembolism events.
•	Most extrapulmonary complications occurred in ICU patients.

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Abstract

Objective

A major coronavirus disease 2019 (COVID-19) outbreak occurred in Northeastern France in spring 2020. This single-center retrospective observational cohort study aimed to compare patients with severe COVID-19 and those with non-severe COVID-19 (survivors vs. non-survivors, ICU patients vs. non-ICU patients) and to describe extrapulmonary complications.

Patients and methods

We included all patients with a confirmed diagnosis of COVID-19 admitted to Colmar Hospital in March 2020.

Results

We examined 600 patients (median age 71.09 years; median body mass index: 26.9 kg/m²); 57.7% were males, 86.3% had at least one comorbidity, 153 (25.5%) required ICU hospitalization, and 115 (19.1%) died. Baseline independent factors associated with death were older age (>75 vs. ≤75 years), male sex, oxygen supply, chronic neurological, renal, and pulmonary diseases, diabetes, cancer, low platelet and hemoglobin counts, and high levels of C-reactive protein (CRP) and serum creatinine. Factors associated with ICU hospitalization were age <75 years, oxygen supply, chronic pulmonary disease, absence of dementia, and high levels of CRP, hemoglobin, and serum creatinine. Among the 600 patients, 80 (13.3%) had an acute renal injury, 33 (5.5%) had a cardiovascular event, 27 (4.5%) had an acute liver injury, 24 (4%) had venous thromboembolism, eight (1.3%) had a neurological event, five (0.8%) had rhabdomyolysis, and one had acute pancreatitis. Most extrapulmonary complications occurred in ICU patients.

Conclusion

This study highlighted the main risk factors for ICU hospitalization and death caused by severe COVID-19 and the frequency of numerous extrapulmonary complications in France.

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Keywords : COVID-19, SARS-CoV-2, Outcome, Extrapulmonary COVID-19, Mortality