Purpose Adequate patient allocation is pivotal for optimal resource management in strained healthcare systems, and requires detailed knowledge of clinical and virological disease trajectories. The purpose of this work was to identify risk factors associated with need for invasive mechanical ventilation (IMV), to analyse viral kinetics in patients with and without IMV and to provide a comprehensive description of clinical course. Methods A cohort of 168 hospitalised adult COVID-19 patients enrolled in a prospective observational study at a large European tertiary care centre was analysed. Results Forty-four per cent (71/161) of patients required invasive mechanical ventilation (IMV). Shorter duration of symptoms before admission (aOR 1.22 per day less, 95% CI 1.10–1.37, p < 0.01) and history of hypertension (aOR 5.55, 95% CI 2.00–16.82, p < 0.01) were associated with need for IMV. Patients on IMV had higher maximal concentrations, slower decline rates, and longer shedding of SARS-CoV-2 than non-IMV patients (33 days, IQR 26–46.75, vs 18 days, IQR 16–46.75, respectively, p < 0.01). Median duration of hospitalisation was 9 days (IQR 6–15.5) for non-IMV and 49.5 days (IQR 36.8–82.5) for IMV patients. Conclusions Our results indicate a short duration of symptoms before admission as a risk factor for severe disease that merits further investigation and different viral load kinetics in severely affected patients. Median duration of hospitalisation of IMV patients was longer than described for acute respiratory distress syndrome unrelated to COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-021-01594-w.
【저자키워드】 Respiratory distress syndrome, mechanical ventilation, Prospective Study, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Coronavirus disease 2019 (COVID-19), COVID-19 nucleic acid testing, Artificial respiration, Viral concentration, Symptom assessment, 【초록키워드】 COVID-19, SARS-CoV-2, prospective observational study, knowledge, Symptom, risk factor, hypertension, Cohort, Clinical course, Viral load, management, Patient, viral kinetics, resource, Admission, Care, patients, acute respiratory distress, Invasive mechanical ventilation, severe disease, Healthcare systems, Virological, supplementary material, 95% CI, syndrome, short duration, duration of hospitalisation, hospitalised, European, IMV, concentrations, disease trajectories, Result, enrolled, described, identify, affected, required, analysed, per day, less, Adequate, adult COVID-19 patient, duration of symptom, IQR, strained, 【제목키워드】 prospective observational study, Characteristics, clinical, First wave, Care, Virological, hospitalised COVID-19 patient, the SARS-CoV-2,