Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 151 No. 2930 (2021)

Temporal trends of COVID-19 related in-hospital mortality and demographics in Switzerland – a retrospective single centre cohort study

DOI
https://doi.org/10.4414/smw.2021.20572
Cite this as:
Swiss Med Wkly. 2021;151:w20572
Published
29.07.2021

Summary

AIMS

The aim of this study was to analyse the demographics, risk factors and in-hospital mortality rates of patients admitted with coronavirus disease 2019 (COVID-19) to a tertiary care hospital in Switzerland.

METHODS

In this single-centre retrospective cohort study at the University Hospital Basel, we included all patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection hospitalised from 27 February 2020 to 10 May 2021. Patients’ characteristics were extracted from the electronic medical record system. The primary outcome of this study was temporal trends of COVID-19-related in-hospital mortality. Secondary outcomes were COVID-19-related mortality in patients hospitalised on the intensive care unit (ICU), admission to ICU, renal replacement therapy and length of hospital stay, as well as a descriptive analysis of risk factors for in-hospital mortality.

RESULTS

During the study period we included 943 hospitalisations of 930 patients. The median age was 65 years (interquartile range [IQR] 53–76) and 63% were men.

The numbers of elderly patients, patients with multiple comorbidities and need for renal replacement therapy decreased from the first and second to the third wave. The median length of stay and need for ICU admission were similar in all waves. Throughout the study period 88 patients (9.3%) died during the hospital stay. Crude in-hospital mortality was similar over the course of the first two waves (9.5% and 10.2%, respectively), whereas it decreased in the third wave (5.4%). Overall mortality in patients without comorbidities was low at 1.6%, but it increased in patients with any comorbidity to 12.6%. Predictors of all-cause mortality over the whole period were age (adjusted odds ratio [aOR] per 10-year increase 1.81, 95% confidence interval [CI] 1.45–2.26; p <0.001), male sex (aOR 1.68, 95% CI 1.00–2.82; p = 0.048), immunocompromising condition (aOR 2.09, 95% CI 1.01–4.33; p = 0.048) and chronic kidney disease (aOR 2.25, 95% CI 1.35–3.76; p = 0.002).

CONCLUSION

In our study in-hospital mortality was 9.5%, 10.2% and 5.4% in the first, second and third waves, respectively. Age, immunocompromising condition, male sex and chronic kidney disease were factors associated with in-hospital mortality. Importantly, patients without any comorbidity had a very low in-hospital mortality regardless of age.

References

  1. Federal Office of Public Health FOPH. Covid-⁠19 Schweiz Informationen zur aktuellen Lage, Stand 21. Juni 2021 [Internet]. [cited 2021 Jun 21]. Available from: https://www.covid19.admin.ch/de/epidemiologic/vacc-persons?demoSum=total
  2. Cao Y, Hiyoshi A, Montgomery S. COVID-19 case-fatality rate and demographic and socioeconomic influencers: worldwide spatial regression analysis based on country-level data. BMJ Open. 2020;10(11):e043560. doi:.https://doi.org/10.1136/bmjopen-2020-043560
  3. Petrilli CM, Jones SA, Yang J, Rajagopalan H, O’Donnell L, Chernyak Y, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020;369:m1966. doi:.https://doi.org/10.1136/bmj.m1966
  4. Dennis JM, McGovern AP, Vollmer SJ, Mateen BA. Improving Survival of Critical Care Patients With Coronavirus Disease 2019 in England: A National Cohort Study, March to June 2020. Crit Care Med. 2021;49(2):209–14. doi:.https://doi.org/10.1097/CCM.0000000000004747
  5. Anesi GL, Jablonski J, Harhay MO, Atkins JH, Bajaj J, Baston C, et al. Characteristics, Outcomes, and Trends of Patients With COVID-19-Related Critical Illness at a Learning Health System in the United States. Ann Intern Med. 2021;174(5):613–21. doi:.https://doi.org/10.7326/M20-5327
  6. Challen R, Brooks-Pollock E, Read JM, Dyson L, Tsaneva-Atanasova K, Danon L. Risk of mortality in patients infected with SARS-CoV-2 variant of concern 202012/1: matched cohort study. BMJ. 2021;372:n579. doi:.https://doi.org/10.1136/bmj.n579
  7. Frampton D, Rampling T, Cross A, Bailey H, Heaney J, Byott M, et al. Genomic characteristics and clinical effect of the emergent SARS-CoV-2 B.1.1.7 lineage in London, UK: a whole-genome sequencing and hospital-based cohort study. Lancet Infect Dis. 2021:S1473-3099(21)00170-5. Online ahead of print. doi:.https://doi.org/10.1016/s1473-3099(21)00170-5
  8. Federal Office of Public Health (FOPH). Deaths related to COVID-19 in Switzerland and compared with other countries. Bern: FOPH; 2021
  9. Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020;584(7821):430–6. doi:.https://doi.org/10.1038/s41586-020-2521-4
  10. Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G, et al.; COVID-19 Lombardy ICU Network. Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy. JAMA Intern Med. 2020;180(10):1345–55. doi:.https://doi.org/10.1001/jamainternmed.2020.3539
  11. Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al.; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg. 2014;12(12):1500–24. doi:.https://doi.org/10.1016/j.ijsu.2014.07.014
  12. Azen R, Traxel N. Using Dominance Analysis to Determine Predictor Importance in Logistic Regression. Vol. 34. J Educ Behav Stat. 2009;34(3):319–47. doi:.https://doi.org/10.3102/1076998609332754
  13. Federal Office of Public Health FOPH. Covid-19 Switzerland, Information on the current situation, as of 4 June 2021 [Internet]. [cited 2021 Apr 6]. Available from: https://www.covid19.admin.ch/en/epidemiologic/case?demoView=graph
  14. Karagiannidis C, Mostert C, Hentschker C, Voshaar T, Malzahn J, Schillinger G, et al. Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 920 German hospitals: an observational study. Lancet Respir Med. 2020;8(9):853–62. doi:.https://doi.org/10.1016/S2213-2600(20)30316-7
  15. Docherty AB, Mulholland RH, Lone NI, Cheyne CP, De Angelis D, Diaz-Ordaz K, et al.; ISARIC4C Investigators. Changes in in-hospital mortality in the first wave of COVID-19: a multicentre prospective observational cohort study using the WHO Clinical Characterisation Protocol UK. Lancet Respir Med. 2021;9(7):773–85. doi:.https://doi.org/10.1016/S2213-2600(21)00175-2
  16. Holler JG, Eriksson R, Jensen TØ, van Wijhe M, Fischer TK, Søgaard OS, et al. First wave of COVID-19 hospital admissions in Denmark: a Nationwide population-based cohort study. BMC Infect Dis. 2021;21(1):39. doi:.https://doi.org/10.1186/s12879-020-05717-w
  17. Vernaz N, Agoritsas T, Calmy A, Gayet-Ageron A, Gold G, Perrier A, et al. Early experimental COVID-19 therapies: associations with length of hospital stay, mortality and related costs. Swiss Med Wkly. 2020;150:w20446.
  18. Schweiz - Lebenserwartung nach Geschlecht 2019 [Internet]. [cited 2021 Jul 6]. Available from: https://de.statista.com/statistik/daten/studie/18667/umfrage/lebenserwartung-in-der-schweiz
  19. Stadler RN, Maurer L, Aguilar-Bultet L, Franzeck F, Ruchti C, Kühl R, et al. Systematic screening on admission for SARS-CoV-2 to detect asymptomatic infections. Antimicrob Resist Infect Control. 2021;10(1):44. doi:.https://doi.org/10.1186/s13756-021-00912-z
  20. Bhimraj A, Morgan RL, Shumaker AH, Lavergne V, Baden L, Cheng VC, et al. Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19. Infectious Diseases Society of America 2021; Version 4.3.0 [Internet]. [cited 2021 May 6]. Available from: https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/
  21. Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al.; ACTT-1 Study Group Members. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med. 2020;383(19):1813–26. doi:.https://doi.org/10.1056/NEJMoa2007764
  22. Pan H, Peto R, Henao-Restrepo AM, Preziosi MP, Sathiyamoorthy V, Abdool Karim Q, et al., WHO Solidarity Trial Consortium. Repurposed Antiviral Drugs for Covid-19 - Interim WHO Solidarity Trial Results. N Engl J Med. 2021;384(6):497–511. doi:.https://doi.org/10.1056/NEJMoa2023184
  23. Spinner CD, Gottlieb RL, Criner GJ, Arribas López JR, Cattelan AM, Soriano Viladomiu A, et al.; GS-US-540-5774 Investigators. Effect of Remdesivir vs Standard Care on Clinical Status at 11 Days in Patients With Moderate COVID-19: A Randomized Clinical Trial. JAMA. 2020;324(11):1048–57. doi:.https://doi.org/10.1001/jama.2020.16349
  24. Soin AS, Kumar K, Choudhary NS, Sharma P, Mehta Y, Kataria S, et al. Tocilizumab plus standard care versus standard care in patients in India with moderate to severe COVID-19-associated cytokine release syndrome (COVINTOC): an open-label, multicentre, randomised, controlled, phase 3 trial. Lancet Respir Med. 2021;9(5):511–21. doi:.https://doi.org/10.1016/S2213-2600(21)00081-3
  25. Rosas IO, Bräu N, Waters M, Go RC, Hunter BD, Bhagani S, et al. Tocilizumab in Hospitalized Patients with Severe Covid-19 Pneumonia. N Engl J Med. 2021;384(16):1503–16. doi:.https://doi.org/10.1056/NEJMoa2028700
  26. Salama C, Han J, Yau L, Reiss WG, Kramer B, Neidhart JD, et al. Tocilizumab in Patients Hospitalized with Covid-19 Pneumonia. N Engl J Med. 2021;384(1):20–30. doi:.https://doi.org/10.1056/NEJMoa2030340
  27. Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, et al., RECOVERY Collaborative Group. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021;384(8):693–704. doi:.https://doi.org/10.1056/NEJMoa2021436
  28. Tomazini BM, Maia IS, Cavalcanti AB, Berwanger O, Rosa RG, Veiga VC, et al.; COALITION COVID-19 Brazil III Investigators. Effect of Dexamethasone on Days Alive and Ventilator-Free in Patients With Moderate or Severe Acute Respiratory Distress Syndrome and COVID-19: The CoDEX Randomized Clinical Trial. JAMA. 2020;324(13):1307–16. doi:.https://doi.org/10.1001/jama.2020.17021
  29. Elharrar X, Trigui Y, Dols A-M, Touchon F, Martinez S, Prud’homme E, et al. Use of Prone Positioning in Nonintubated Patients With COVID-19 and Hypoxemic Acute Respiratory Failure. JAMA. 2020;323(22):2336–8. doi:.https://doi.org/10.1001/jama.2020.8255
  30. Ferrando C, Mellado-Artigas R, Gea A, Arruti E, Aldecoa C, Adalia R, et al.; COVID-19 Spanish ICU Network. Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study. Crit Care. 2020;24(1):597. doi:.https://doi.org/10.1186/s13054-020-03314-6
  31. Diebold M, Zimmermann T, Dickenmann M, Schaub S, Bassetti S, Tschudin-Sutter S, et al. Comparison of Acute Kidney Injury in Patients with COVID-19 and Other Respiratory Infections: A Prospective Cohort Study. J Clin Med. 2021;10(11):2288. doi:.https://doi.org/10.3390/jcm10112288
  32. Diebold M, Schaub S, Landmann E, Steiger J, Dickenmann M. Acute kidney injury in patients with COVID-19: a retrospective cohort study from Switzerland. Swiss Med Wkly. 2021;151:w20482. doi:.https://doi.org/10.4414/smw.2021.20482
  33. Hirsch JS, Ng JH, Ross DW, Sharma P, Shah HH, Barnett RL, et al.; Northwell COVID-19 Research Consortium; Northwell Nephrology COVID-19 Research Consortium. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. 2020;98(1):209–18. doi:.https://doi.org/10.1016/j.kint.2020.05.006
  34. Charytan DM, Parnia S, Khatri M, Petrilli CM, Jones S, Benstein J, et al. Decreasing Incidence of Acute Kidney Injury in Patients with COVID-19 Critical Illness in New York City. Kidney Int Rep. 2021;6(4):916–27. doi:.https://doi.org/10.1016/j.ekir.2021.01.036
  35. Legrand M, Bell S, Forni L, Joannidis M, Koyner JL, Liu K, et al. Pathophysiology of COVID-19-associated acute kidney injury. Nat Rev Nephrol. 2021. Online ahead of print. doi:.https://doi.org/10.1038/s41581-021-00452-0
  36. Navaratnam AV, Gray WK, Day J, Wendon J, Briggs TWR. Patient factors and temporal trends associated with COVID-19 in-hospital mortality in England: an observational study using administrative data. Lancet Respir Med. 2021;9(4):397–406. doi:.https://doi.org/10.1016/S2213-2600(20)30579-8
  37. Kim L, Garg S, O’Halloran A, Whitaker M, Pham H, Anderson EJ, et al. Risk Factors for Intensive Care Unit Admission and In-hospital Mortality Among Hospitalized Adults Identified through the US Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET). Clin Infect Dis. 2021;72(9):e206–14. doi:.https://doi.org/10.1093/cid/ciaa1012

Most read articles by the same author(s)

1 2 3 4 5 6 7 > >>