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Trajectories of Hospitalization in COVID-19 Patients: An Observational Study in France
Pierre-Yves Boëlle1, Tristan Delory1,2, Xavier Maynadier1
1Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Assistance Publique - Hôpitaux de Paris, 75012 Paris, France.
Insights
Hospitalized COVID-19 patient trajectories reveal age-related differences in care needs and outcomes. Understanding these patterns is crucial for effective hospital capacity management during epidemics.
Area of Science:
- Infectious Diseases
- Epidemiology
- Critical Care Medicine
Background:
- Effective management of hospital capacity is vital for responding to public health crises like the COVID-19 pandemic.
- Analyzing patient trajectories provides insights into resource utilization and patient outcomes.
Purpose of the Study:
- To characterize the hospital trajectories of COVID-19 patients.
- To identify factors influencing hospitalization duration, intensive care unit (ICU) admission, and mortality.
- To inform future hospital capacity planning and care strategies.
Main Methods:
- Retrospective analysis of 1321 hospitalized COVID-19 patients in northern and eastern France.
- Examination of patient demographics, time from symptom onset to hospitalization, length of stay, ICU admission rates, and mortality.
- Statistical analysis to determine associations between patient characteristics and outcomes, including age, sex, and time to admission.
Main Results:
- The time from symptom onset to hospitalization decreased with age.
- The overall hospital length of stay was 15.9 days, with a 20% mortality rate.
- Older patients had lower ICU admission rates but higher mortality; male sex and early admission were associated with increased mortality.
- Mortality rates decreased over the epidemic's course, suggesting improved care.
Conclusions:
- COVID-19 patient trajectories vary significantly by age, impacting ICU needs and mortality.
- Rapid ICU admission and prolonged ICU stays present challenges for hospital resource management.
- Improvements in care over time have led to reduced mortality, highlighting the importance of adaptive strategies.
Abstract:
Describing the characteristics of COVID-19 patients in the hospital is of importance to assist in the management of hospital capacity in the future. Here, we analyze the trajectories of 1321 patients admitted to hospitals in northern and eastern France. We found that the time from onset to hospitalization decreased with age, from 7.3 days in the 20-65 year-olds to 4.5 in the >80 year-olds (p < 0.0001). Overall, the length of stay in the hospital was 15.9 days, and the death rate was 20%. One patient out of four was admitted to the intensive care unit (ICU) for approximately one month. The characteristics of trajectories changed with age: fewer older patients were admitted to the ICU and the death rate was larger in the elderly. Admission shortly after onset was associated with increased mortality (odds-ratio (OR) = 1.8, Confidence Interval (CI) 95% [1.3, 2.6]) as well as male sex (OR = 2.1, CI 95% [1.5, 2.9]). Time from admission within the hospital to the transfer to ICU was short. The age- and sex-adjusted mortality rate decreased over the course of the epidemic, suggesting improvement in care over time. In the SARS-CoV-2 epidemic, the urgent need for ICU at admission and the prolonged length of stay in ICU are a challenge for bed management and organization of care.
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