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Direct Comparison of Clinical Characteristics, Outcomes, and Risk Prediction in Patients with COVID-19 and Controls—A Prospective Cohort Study
Most studies investigating early risk predictors in coronavirus disease 19 (COVID-19) lacked comparison with controls. We aimed to assess and directly compare outcomes and risk predictors at time of emergency department (ED) presentation in COVID-19 and controls. Consecutive patients presenting to t...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8234319/ https://www.ncbi.nlm.nih.gov/pubmed/34204453 http://dx.doi.org/10.3390/jcm10122672 |
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author | Lampart, Maurin Rüegg, Marco Jauslin, Andrea S. Simon, Noemi R. Zellweger, Núria Eken, Ceylan Tschudin-Sutter, Sarah Bassetti, Stefano Rentsch, Katharina M. Siegemund, Martin Bingisser, Roland Nickel, Christian H. Osswald, Stefan Kuster, Gabriela M. Twerenbold, Raphael |
author_facet | Lampart, Maurin Rüegg, Marco Jauslin, Andrea S. Simon, Noemi R. Zellweger, Núria Eken, Ceylan Tschudin-Sutter, Sarah Bassetti, Stefano Rentsch, Katharina M. Siegemund, Martin Bingisser, Roland Nickel, Christian H. Osswald, Stefan Kuster, Gabriela M. Twerenbold, Raphael |
author_sort | Lampart, Maurin |
collection | PubMed |
description | Most studies investigating early risk predictors in coronavirus disease 19 (COVID-19) lacked comparison with controls. We aimed to assess and directly compare outcomes and risk predictors at time of emergency department (ED) presentation in COVID-19 and controls. Consecutive patients presenting to the ED with suspected COVID-19 were prospectively enrolled. COVID-19-patients were compared with (i) patients tested negative (overall controls) and (ii) patients tested negative, who had a respiratory infection (respiratory controls). Primary outcome was the composite of intensive care unit (ICU) admission and death at 30 days. Among 1081 consecutive cases, 191 (18%) were tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and 890 (82%) were tested negative (overall controls), of which 323 (30%) had a respiratory infection (respiratory controls). Incidence of the composite outcome was significantly higher in COVID-19 (23%) as compared with the overall control group (10%, adjusted-HR 2.45 (95%CI, 1.61–3.74), p < 0.001) or the respiratory control group (10%, adjusted-HR 2.93 (95%CI, 1.66–5.17), p < 0.001). Blood oxygen saturation, age, high-sensitivity troponin, c-reactive protein, and lactate dehydrogenase were identified as the strongest predictors of poor outcome available at time of ED presentation in COVID-19 with highly comparable prognostic utility in overall and respiratory controls. In conclusion, patients presenting to the ED with COVID-19 have a worse outcome than controls, even after adjustment for differences in baseline characteristics. Most predictors of poor outcome in COVID-19 were not restricted to COVID-19, but of comparable prognostic utility in controls and therefore generalizable to unselected patients with suspected COVID-19. |
format | Online Article Text |
id | pubmed-8234319 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-82343192021-06-27 Direct Comparison of Clinical Characteristics, Outcomes, and Risk Prediction in Patients with COVID-19 and Controls—A Prospective Cohort Study Lampart, Maurin Rüegg, Marco Jauslin, Andrea S. Simon, Noemi R. Zellweger, Núria Eken, Ceylan Tschudin-Sutter, Sarah Bassetti, Stefano Rentsch, Katharina M. Siegemund, Martin Bingisser, Roland Nickel, Christian H. Osswald, Stefan Kuster, Gabriela M. Twerenbold, Raphael J Clin Med Article Most studies investigating early risk predictors in coronavirus disease 19 (COVID-19) lacked comparison with controls. We aimed to assess and directly compare outcomes and risk predictors at time of emergency department (ED) presentation in COVID-19 and controls. Consecutive patients presenting to the ED with suspected COVID-19 were prospectively enrolled. COVID-19-patients were compared with (i) patients tested negative (overall controls) and (ii) patients tested negative, who had a respiratory infection (respiratory controls). Primary outcome was the composite of intensive care unit (ICU) admission and death at 30 days. Among 1081 consecutive cases, 191 (18%) were tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and 890 (82%) were tested negative (overall controls), of which 323 (30%) had a respiratory infection (respiratory controls). Incidence of the composite outcome was significantly higher in COVID-19 (23%) as compared with the overall control group (10%, adjusted-HR 2.45 (95%CI, 1.61–3.74), p < 0.001) or the respiratory control group (10%, adjusted-HR 2.93 (95%CI, 1.66–5.17), p < 0.001). Blood oxygen saturation, age, high-sensitivity troponin, c-reactive protein, and lactate dehydrogenase were identified as the strongest predictors of poor outcome available at time of ED presentation in COVID-19 with highly comparable prognostic utility in overall and respiratory controls. In conclusion, patients presenting to the ED with COVID-19 have a worse outcome than controls, even after adjustment for differences in baseline characteristics. Most predictors of poor outcome in COVID-19 were not restricted to COVID-19, but of comparable prognostic utility in controls and therefore generalizable to unselected patients with suspected COVID-19. MDPI 2021-06-17 /pmc/articles/PMC8234319/ /pubmed/34204453 http://dx.doi.org/10.3390/jcm10122672 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Lampart, Maurin Rüegg, Marco Jauslin, Andrea S. Simon, Noemi R. Zellweger, Núria Eken, Ceylan Tschudin-Sutter, Sarah Bassetti, Stefano Rentsch, Katharina M. Siegemund, Martin Bingisser, Roland Nickel, Christian H. Osswald, Stefan Kuster, Gabriela M. Twerenbold, Raphael Direct Comparison of Clinical Characteristics, Outcomes, and Risk Prediction in Patients with COVID-19 and Controls—A Prospective Cohort Study |
title | Direct Comparison of Clinical Characteristics, Outcomes, and Risk Prediction in Patients with COVID-19 and Controls—A Prospective Cohort Study |
title_full | Direct Comparison of Clinical Characteristics, Outcomes, and Risk Prediction in Patients with COVID-19 and Controls—A Prospective Cohort Study |
title_fullStr | Direct Comparison of Clinical Characteristics, Outcomes, and Risk Prediction in Patients with COVID-19 and Controls—A Prospective Cohort Study |
title_full_unstemmed | Direct Comparison of Clinical Characteristics, Outcomes, and Risk Prediction in Patients with COVID-19 and Controls—A Prospective Cohort Study |
title_short | Direct Comparison of Clinical Characteristics, Outcomes, and Risk Prediction in Patients with COVID-19 and Controls—A Prospective Cohort Study |
title_sort | direct comparison of clinical characteristics, outcomes, and risk prediction in patients with covid-19 and controls—a prospective cohort study |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8234319/ https://www.ncbi.nlm.nih.gov/pubmed/34204453 http://dx.doi.org/10.3390/jcm10122672 |
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