BMC Infectious Diseases (Jan 2021)

First wave of COVID-19 hospital admissions in Denmark: a Nationwide population-based cohort study

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

DOI
https://doi.org/10.1186/s12879-020-05717-w
Journal volume & issue
Vol. 21, no. 1
pp. 1 – 16

Abstract

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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.

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