Risk Factors Associated with Severe COVID-19 in Eastern France: Analysis of 1045 Cases

Background: In March 2020, the World Health Organization declared Europe as the new epicentre of the coronavirus disease 2019 (COVID-19) pandemic. Chatacteristics associated with poor outcome in this population remain unclear. Our objective was to identify risk factors predictive of severe disease in hospitalised patients. Methods: In this prospective observational cohort study, we included hospitalised adult patients with confirmed COVID-19, admitted in Strasbourg hospital, and Mulhouse hospital (France) in March 2020. Using multivariate analysis, we compared patients who developed non-severe or severe disease, which was defined by the admission to an intensive care unit or death in the first seven days of hospitalisation. Findings: 1045 patients were included in this study. Overall, 424 (401%) patients satisfied the composite criteria for severe disease, including 335 (32%) who were admitted to intensive care units, and 111 (11%) who died. The demographic risk factors associated with severe disease were advanced age (odds ratio (OR) 1∙1 per ten-year increase; 95% credible interval (CrI), 1∙0–1∙3), being male (OR 2∙1; 1∙5–2∙8), and having a body mass index of 25–29∙9 (OR 1∙8; 1∙2–2∙7) or ≥30 (OR 2∙2; 1∙5–3∙3). Dyspnoea (OR 2∙5; 1∙8–3∙4), a C-reactive protein level of 100–199 mg/L (OR 1∙7; 1∙2–2∙3) or ≥200 mg/L (OR 4∙2; 2∙6–6∙5), a neutrophil count ≥8000 per µL (OR 2∙1; 1∙4–3∙0), lymphocyte count <1000 per µL (OR 1∙4; 1∙1–1∙9), and treatment with a macrolide in the seven days before hospitalisation (OR 1∙8; 1∙1–2∙7) were also associated with the development of severe disease. Interpretation: Being overweight, of advanced age, and male, and presenting with dyspnoea and inflammation are risk factors for severe COVID-19 in hospitalised patients. Identifying these features might improve the management of this infection. Funding Statement: No funding. Declaration of Interests: No conflict to declare. Ethics Approval Statement: The study was approved by the Ethics Committee of the University Hospital of Strasbourg (N°CE-2020-51).