CMAJ Open 2021 Jan-Mar;9(1):E181-E188. Epub 2021 Mar 8.
Division of Infectious Diseases, Department of Medicine (Lee), McGill University, Montréal, Que.; Ajmera Transplant Centre (Kumar), University Health Network, Toronto, Ont.; Department of Critical Care Medicine (Dechert), Brantford General Hospital, Brantford, Ont.; Department of Medicine (Sandhu), St. Michael's Hospital, Toronto, Ont.; School of Rehabilitation Science (Kho, O'Grady), McMaster University, Hamilton, Ont.; St. Joseph's Healthcare (Kelly), Hamilton, Ont.; Island Health Authority (Ovakim), Victoria, BC; Department of Anesthesiology and Department of Medicine - Critical Care Division (Carrier), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Department of Medicine (Daneman), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Faculté de médecine de l'Université de Montréal (Tessier-Grenier), Université de Montréal, Montréal, Que.; Vancouver Island Health Authority (Wood), Victoria, BC; Department of Medicine (Gu), McGill University, Montréal, Que.; Children's Hospital of Eastern Ontario Research Institute (O'Hearn), Ottawa, Ont.; Department of Community Health Sciences (Stelfox), University of Calgary, Calgary, Alta.; UBC Faculty of Medicine (Douglas), University of British Columbia, and Island Health, Vancouver, BC; Department of Medicine (Fowler), University of Toronto, Toronto, Ont.; Faculty of Medicine (Solomon), McGill University, Montréal, Que.; Department of Pediatrics (Goco) and of Critical Care Medicine (Guerguerian), The Hospital for Sick Children, Toronto, Ont.; Department of Medicine (Hsu), McGill University, Montréal, Que.; Divisions of Infectious Diseases and Medical Microbiology (Cheng), McGill University Health Centre, Montréal, Que.; Department of Medicine (Swanson), University of Victoria, Victoria, BC; Department of Medicine (Hall), Dalhousie University, Halifax, NS; Department of Medicine (Pitre), McMaster University, Hamilton, Ont.; Department of Pediatrics (Jouvet), Sainte-Justine Hospital, Université de Montréal, Montréal, Que.; Ottawa Hospital Research Institute (Pharand), Ottawa, Ont.; Department of Critical Care Medicine (Fiest), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine, University of British Columbia, and Island Health (Reel), Victoria, BC; Department of Medicine (Tsang), McMaster University, Hamilton, Ont., and Niagara Health (Tsang), St. Catharines, Ont.; Grand River Hospital (Kruisselbrink), Kitchener, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Université Laval, Laval, Que.; Department of Medicine (Rishu), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Medicine (Codan), University of Calgary, Calgary, Alta.; Departments of Medicine (Rewa, Sligl), of Critical Care Medicine (Kutsogiannis) and of Pediatrics (Joffe), University of Alberta, Edmonton, Alta.; Department of Medicine (Shadowitz), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Medicine (Sarfo-Mensah), The Ottawa Hospital/Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Lamontagne), Université de Sherbrooke, Sherbrooke, Que.; Department of Pediatrics (Menon), University of Ottawa, Ottawa, Ont.; McGill University Health Centre (Atique), Montréal, Que.; William Osler Health System (Richardson), Toronto, Ont.; Joseph Brant Hospital (Reeve), Burlington, Ont.; Department of Pediatrics (Murthy), University of British Columbia, Vancouver, BC.
Background: Clinical data on patients admitted to hospital with coronavirus disease 2019 (COVID-19) provide clinicians and public health officials with information to guide practice and policy. The aims of this study were to describe patients with COVID-19 admitted to hospital and intensive care, and to investigate predictors of outcome to characterize severe acute respiratory infection.
Methods: This observational cohort study used Canadian data from 32 selected hospitals included in a global multisite cohort between Jan. 24 and July 7, 2020. Adult and pediatric patients with a confirmed diagnosis of COVID-19 who received care in an intensive care unit (ICU) and a sampling of up to the first 60 patients receiving care on hospital wards were included. We performed descriptive analyses of characteristics, interventions and outcomes. The primary analyses examined in-hospital mortality, with secondary analyses of the length of hospital and ICU stay.
Results: Between January and July 2020, among 811 patients admitted to hospital with a diagnosis of COVID-19, the median age was 64 (interquartile range [IQR] 53-75) years, 495 (61.0%) were men, 46 (5.7%) were health care workers, 9 (1.1%) were pregnant, 26 (3.2%) were younger than 18 years and 9 (1.1%) were younger than 5 years. The median time from symptom onset to hospital admission was 7 (IQR 3-10) days. The most common symptoms on admission were fever, shortness of breath, cough and malaise. Diabetes, hypertension and cardiac, kidney and respiratory disease were the most common comorbidities. Among all patients, 328 received care in an ICU, admitted a median of 0 (IQR 0-1) days after hospital admission. Critically ill patients received treatment with invasive mechanical ventilation (88.8%), renal replacement therapy (14.9%) and extracorporeal membrane oxygenation (4.0%); 26.2% died. Among those receiving mechanical ventilation, 31.2% died. Age was an influential predictor of mortality (odds ratio per additional year of life 1.06, 95% confidence interval 1.03-1.09).
Interpretation: Patients admitted to hospital with COVID-19 commonly had fever, respiratory symptoms and comorbid conditions. Increasing age was associated with the development of critical illness and death; however, most critically ill patients in Canada, including those requiring mechanical ventilation, survived and were discharged from hospital.