Risk factors for severity on admission and the disease progression during hospitalisation in a large cohort of patients with COVID-19 in Japan
ObjectivesTo investigate the risk factors contributing to severity on admission. Additionally, risk factors of worst severity and fatality were studied. Moreover, factors were compared based on three points: early severity, worst severity and fatality.DesignAn observational cohort study using data e...
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| Published in | BMJ open Vol. 11; no. 6; p. e047007 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
London
British Medical Journal Publishing Group
15.06.2021
BMJ Publishing Group LTD BMJ Publishing Group |
| Series | Original research |
| Subjects | |
| Online Access | Get full text |
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| Abstract | ObjectivesTo investigate the risk factors contributing to severity on admission. Additionally, risk factors of worst severity and fatality were studied. Moreover, factors were compared based on three points: early severity, worst severity and fatality.DesignAn observational cohort study using data entered in a Japan nationwide COVID-19 inpatient registry, COVIREGI-JP.SettingAs of 28 September 2020, 10480 cases from 802 facilities have been registered. Participating facilities cover a wide range of hospitals where patients with COVID-19 are admitted in Japan.ParticipantsParticipants who had a positive test result on any applicable SARS-CoV-2 diagnostic tests were admitted to participating healthcare facilities. A total of 3829 cases were identified from 16 January to 31 May 2020, of which 3376 cases were included in this study.Primary and secondary outcome measuresPrimary outcome was severe or nonsevere on admission, determined by the requirement of mechanical ventilation or oxygen therapy, SpO2 or respiratory rate. Secondary outcome was the worst severity during hospitalisation, judged by the requirement of oxygen and/orinvasive mechanical ventilation/extracorporeal membrane oxygenation.ResultsRisk factors for severity on admission were older age, men, cardiovascular disease, chronic respiratory disease, diabetes, obesity and hypertension. Cerebrovascular disease, liver disease, renal disease or dialysis, solid tumour and hyperlipidaemia did not influence severity on admission; however, it influenced worst severity. Fatality rates for obesity, hypertension and hyperlipidaemia were relatively lower.ConclusionsThis study segregated the comorbidities influencing severity and death. It is possible that risk factors for severity on admission, worst severity and fatality are not consistent and may be propelled by different factors. Specifically, while hypertension, hyperlipidaemia and obesity had major effect on worst severity, their impact was mild on fatality in the Japanese population. Some studies contradict our results; therefore, detailed analyses, considering in-hospital treatments, are needed for validation.Trial registration numberUMIN000039873. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000045453 |
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| AbstractList | ObjectivesTo investigate the risk factors contributing to severity on admission. Additionally, risk factors of worst severity and fatality were studied. Moreover, factors were compared based on three points: early severity, worst severity and fatality.DesignAn observational cohort study using data entered in a Japan nationwide COVID-19 inpatient registry, COVIREGI-JP.SettingAs of 28 September 2020, 10480 cases from 802 facilities have been registered. Participating facilities cover a wide range of hospitals where patients with COVID-19 are admitted in Japan.ParticipantsParticipants who had a positive test result on any applicable SARS-CoV-2 diagnostic tests were admitted to participating healthcare facilities. A total of 3829 cases were identified from 16 January to 31 May 2020, of which 3376 cases were included in this study.Primary and secondary outcome measuresPrimary outcome was severe or nonsevere on admission, determined by the requirement of mechanical ventilation or oxygen therapy, SpO2 or respiratory rate. Secondary outcome was the worst severity during hospitalisation, judged by the requirement of oxygen and/orinvasive mechanical ventilation/extracorporeal membrane oxygenation.ResultsRisk factors for severity on admission were older age, men, cardiovascular disease, chronic respiratory disease, diabetes, obesity and hypertension. Cerebrovascular disease, liver disease, renal disease or dialysis, solid tumour and hyperlipidaemia did not influence severity on admission; however, it influenced worst severity. Fatality rates for obesity, hypertension and hyperlipidaemia were relatively lower.ConclusionsThis study segregated the comorbidities influencing severity and death. It is possible that risk factors for severity on admission, worst severity and fatality are not consistent and may be propelled by different factors. Specifically, while hypertension, hyperlipidaemia and obesity had major effect on worst severity, their impact was mild on fatality in the Japanese population. Some studies contradict our results; therefore, detailed analyses, considering in-hospital treatments, are needed for validation.Trial registration numberUMIN000039873. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000045453 Objectives To investigate the risk factors contributing to severity on admission. Additionally, risk factors of worst severity and fatality were studied. Moreover, factors were compared based on three points: early severity, worst severity and fatality.Design An observational cohort study using data entered in a Japan nationwide COVID-19 inpatient registry, COVIREGI-JP.Setting As of 28 September 2020, 10480 cases from 802 facilities have been registered. Participating facilities cover a wide range of hospitals where patients with COVID-19 are admitted in Japan.Participants Participants who had a positive test result on any applicable SARS-CoV-2 diagnostic tests were admitted to participating healthcare facilities. A total of 3829 cases were identified from 16 January to 31 May 2020, of which 3376 cases were included in this study.Primary and secondary outcome measures Primary outcome was severe or nonsevere on admission, determined by the requirement of mechanical ventilation or oxygen therapy, SpO2 or respiratory rate. Secondary outcome was the worst severity during hospitalisation, judged by the requirement of oxygen and/orinvasive mechanical ventilation/extracorporeal membrane oxygenation.Results Risk factors for severity on admission were older age, men, cardiovascular disease, chronic respiratory disease, diabetes, obesity and hypertension. Cerebrovascular disease, liver disease, renal disease or dialysis, solid tumour and hyperlipidaemia did not influence severity on admission; however, it influenced worst severity. Fatality rates for obesity, hypertension and hyperlipidaemia were relatively lower.Conclusions This study segregated the comorbidities influencing severity and death. It is possible that risk factors for severity on admission, worst severity and fatality are not consistent and may be propelled by different factors. Specifically, while hypertension, hyperlipidaemia and obesity had major effect on worst severity, their impact was mild on fatality in the Japanese population. Some studies contradict our results; therefore, detailed analyses, considering in-hospital treatments, are needed for validation.Trial registration number UMIN000039873. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000045453 To investigate the risk factors contributing to severity on admission. Additionally, risk factors of worst severity and fatality were studied. Moreover, factors were compared based on three points: early severity, worst severity and fatality.OBJECTIVESTo investigate the risk factors contributing to severity on admission. Additionally, risk factors of worst severity and fatality were studied. Moreover, factors were compared based on three points: early severity, worst severity and fatality.An observational cohort study using data entered in a Japan nationwide COVID-19 inpatient registry, COVIREGI-JP.DESIGNAn observational cohort study using data entered in a Japan nationwide COVID-19 inpatient registry, COVIREGI-JP.As of 28 September 2020, 10480 cases from 802 facilities have been registered. Participating facilities cover a wide range of hospitals where patients with COVID-19 are admitted in Japan.SETTINGAs of 28 September 2020, 10480 cases from 802 facilities have been registered. Participating facilities cover a wide range of hospitals where patients with COVID-19 are admitted in Japan.Participants who had a positive test result on any applicable SARS-CoV-2 diagnostic tests were admitted to participating healthcare facilities. A total of 3829 cases were identified from 16 January to 31 May 2020, of which 3376 cases were included in this study.PARTICIPANTSParticipants who had a positive test result on any applicable SARS-CoV-2 diagnostic tests were admitted to participating healthcare facilities. A total of 3829 cases were identified from 16 January to 31 May 2020, of which 3376 cases were included in this study.Primary outcome was severe or nonsevere on admission, determined by the requirement of mechanical ventilation or oxygen therapy, SpO2 or respiratory rate. Secondary outcome was the worst severity during hospitalisation, judged by the requirement of oxygen and/orinvasive mechanical ventilation/extracorporeal membrane oxygenation.PRIMARY AND SECONDARY OUTCOME MEASURESPrimary outcome was severe or nonsevere on admission, determined by the requirement of mechanical ventilation or oxygen therapy, SpO2 or respiratory rate. Secondary outcome was the worst severity during hospitalisation, judged by the requirement of oxygen and/orinvasive mechanical ventilation/extracorporeal membrane oxygenation.Risk factors for severity on admission were older age, men, cardiovascular disease, chronic respiratory disease, diabetes, obesity and hypertension. Cerebrovascular disease, liver disease, renal disease or dialysis, solid tumour and hyperlipidaemia did not influence severity on admission; however, it influenced worst severity. Fatality rates for obesity, hypertension and hyperlipidaemia were relatively lower.RESULTSRisk factors for severity on admission were older age, men, cardiovascular disease, chronic respiratory disease, diabetes, obesity and hypertension. Cerebrovascular disease, liver disease, renal disease or dialysis, solid tumour and hyperlipidaemia did not influence severity on admission; however, it influenced worst severity. Fatality rates for obesity, hypertension and hyperlipidaemia were relatively lower.This study segregated the comorbidities influencing severity and death. It is possible that risk factors for severity on admission, worst severity and fatality are not consistent and may be propelled by different factors. Specifically, while hypertension, hyperlipidaemia and obesity had major effect on worst severity, their impact was mild on fatality in the Japanese population. Some studies contradict our results; therefore, detailed analyses, considering in-hospital treatments, are needed for validation.CONCLUSIONSThis study segregated the comorbidities influencing severity and death. It is possible that risk factors for severity on admission, worst severity and fatality are not consistent and may be propelled by different factors. Specifically, while hypertension, hyperlipidaemia and obesity had major effect on worst severity, their impact was mild on fatality in the Japanese population. Some studies contradict our results; therefore, detailed analyses, considering in-hospital treatments, are needed for validation.UMIN000039873. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000045453.TRIAL REGISTRATION NUMBERUMIN000039873. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000045453. |
| Author | Saito, Sho Matsunaga, Nobuaki Sugiura, Wataru Hayakawa, Kayoko Ohmagari, Norio Tsuzuki, Shinya Terada, Mari Kutsuna, Satoshi Asai, Yusuke Ohtsu, Hiroshi |
| AuthorAffiliation | 3 AMR Clinical Reference Center , National Center for Global Health and Medicine , Tokyo , Japan 4 Faculty of Medicine and Health Sciences , University of Antwerp , Antwerp , Belgium 1 Department of Infectious Diseases, Disease Control and Prevention Center , National Center for Global Health and Medicine , Tokyo , Japan 2 Center for Clinical Sciences , National Center for Global Health and Medicine , Tokyo , Japan |
| AuthorAffiliation_xml | – name: 1 Department of Infectious Diseases, Disease Control and Prevention Center , National Center for Global Health and Medicine , Tokyo , Japan – name: 2 Center for Clinical Sciences , National Center for Global Health and Medicine , Tokyo , Japan – name: 4 Faculty of Medicine and Health Sciences , University of Antwerp , Antwerp , Belgium – name: 3 AMR Clinical Reference Center , National Center for Global Health and Medicine , Tokyo , Japan |
| Author_xml | – sequence: 1 givenname: Mari surname: Terada fullname: Terada, Mari organization: Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan – sequence: 2 givenname: Hiroshi orcidid: 0000-0003-3261-8828 surname: Ohtsu fullname: Ohtsu, Hiroshi organization: Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan – sequence: 3 givenname: Sho orcidid: 0000-0002-9981-7584 surname: Saito fullname: Saito, Sho email: ssaito@hosp.ncgm.go.jp organization: Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan – sequence: 4 givenname: Kayoko surname: Hayakawa fullname: Hayakawa, Kayoko organization: AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan – sequence: 5 givenname: Shinya orcidid: 0000-0002-8504-1244 surname: Tsuzuki fullname: Tsuzuki, Shinya organization: Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium – sequence: 6 givenname: Yusuke surname: Asai fullname: Asai, Yusuke organization: AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan – sequence: 7 givenname: Nobuaki surname: Matsunaga fullname: Matsunaga, Nobuaki organization: AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan – sequence: 8 givenname: Satoshi surname: Kutsuna fullname: Kutsuna, Satoshi organization: Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan – sequence: 9 givenname: Wataru surname: Sugiura fullname: Sugiura, Wataru organization: Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan – sequence: 10 givenname: Norio surname: Ohmagari fullname: Ohmagari, Norio organization: AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan |
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| Snippet | ObjectivesTo investigate the risk factors contributing to severity on admission. Additionally, risk factors of worst severity and fatality were studied.... To investigate the risk factors contributing to severity on admission. Additionally, risk factors of worst severity and fatality were studied. Moreover,... Objectives To investigate the risk factors contributing to severity on admission. Additionally, risk factors of worst severity and fatality were studied.... |
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| SubjectTerms | Chemotherapy Chronic obstructive pulmonary disease Comorbidity Coronaviruses COVID-19 Data collection Datasets Diabetes Epidemiology Extracorporeal membrane oxygenation Fatalities Infectious Diseases Kidney diseases Leukemia Pandemics Patients Peritoneal dialysis Public health Regression analysis Risk factors Severe acute respiratory syndrome coronavirus 2 virology |
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| Title | Risk factors for severity on admission and the disease progression during hospitalisation in a large cohort of patients with COVID-19 in Japan |
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