Invasive ventilation, older age, dialysis tied to COVID-19 death in Germany

An observational study of 10,021 COVID-19 patients admitted to 920 German hospitals has found that patients requiring mechanical ventilation were at highest risk for death—especially those 80 years and older and those needing dialysis.

The study, published yesterday in The Lancet Respiratory Medicine, examined claims data from hospitalized coronavirus virus patients from Feb 26 to Apr 19. Of the 10,021 patients, 2,229 (22%) died.

The death rate was much higher in patients receiving any kind of ventilation (906 of 1,727 [53%]) than in those who did not (1,323/8,294 [16%]). For ventilated patients, the death rate ranged from 28% (117/422) in those 18 to 59 years old to 72% (280/388) in those 80 and older. Half of all deaths among patients receiving ventilation occurred within the first 12 days of hospitalization.

The highest death rate was in patients receiving both invasive mechanical ventilation and dialysis (342/469 [73%]), followed by those receiving mechanical ventilation only (696/1,318 [53%]), those in whom noninvasive ventilation failed (70/141 [50%]), and those requiring noninvasive ventilation only (65/145 [45%]). The death rate was 34% in patients 80 years and older who didn't need mechanical ventilation.

Of the 10,021 patients, 1,727 (17%) required mechanical ventilation, 24% of whom were 18 to 59 years, 22% were 60 to 69, 31% were 70 to 79, and 23% were 80 or older.

A total of 599 of 10,021 patients (6%) needed dialysis, as did 469 of 1,727 ventilated patients (27%). The nonventilated group of patients was made up equally of men and women, while twice as many men received ventilation.  The most common underlying conditions were high blood pressure (56%), diabetes (28%), abnormal heart rhythms (27%), kidney failure (23%), heart failure (20%), and chronic lung disease (14%).

The authors noted that the German health system has not been overwhelmed during the pandemic. "With unrestrained resources, a small but considerable number of older patients and patients with comorbidities can survive severe forms of COVID-19, but in the event of a strong second wave of the pandemic, longer treatment times could limit hospital capacities," they wrote.
Jul 28 Lancet Respir Med study

Predicting risk of COVID-19 infection through app inexact, study finds

Tracking COVID-19 symptoms through an app may not be a good predictor of the spread of the disease, according to a research letter published yesterday in Family Practice.

Researchers in Switzerland and France analyzed data from a Nature Medicine study published on May 11 that suggested that a prediction score combining loss of smell and taste, fatigue, cough, and loss of appetite collected in real time through an app could identify people at risk for COVID-19.

The authors compared the main features of the population involved in the Nature Medicine study and the performance of their score with data from a cross-sectional study conducted from Mar 24 to Apr 29. Applying the probability threshold in the Nature Medicine study to these data showed that 41% of positive tests were false-positives, and 17% of negative tests were false-negatives.

In the Family Practice study, family practitioners referred most patients because they had symptoms characteristic of COVID-19, likely because of the triage performed before testing. Nearly half the patients in the sample reported fever (45.4%), the most common reason for physicians to refer patients for testing at the time, whereas only one third of patients listed fever as a symptom in the app in the Nature Medicine study.

The authors said that real-time symptom collection through an app would seem like a good way to screen patients and that the Nature Medicine study supports the value of collecting information on symptoms such as loss of smell and taste, but that the score generated by the app doesn't seem accurate in primary care patients.

"These results confirm the crucial role of laboratory testing in COVID-19 and the need to support research on COVID-19 in primary care populations," coauthor Benoit Tudrej, MD, PhD, said in an Oxford University Press news release. "The score they propose should not be applied as such for primary care patients as it does not appear to perform well in this population."
Jul 28 Fam Pract research letter
Jul 28 Oxford University Press USA news release