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    Approximately one fifth of hospitalized COVID-19patients died

    Berlin. Approximately one fifth of COVID-19patients admitted to German hospitals between the end of February and mid-April died. For patients receiving ventilation, the mortality rate was 53 percent. For those not receiving ventilation, the rate was significantly lower at 16percent. 17percent of all patients were ventilated during this period. These are the main resultsofan analysis by WIdO, the research institute of the AOK health insurance, DIVI, the German Interdisciplinary AssociationofCritical Care andEmergency Medicine, and Technische Universität Berlin published in the specialist medical journal, The Lancet Respiratory Medicine. Data were analyzed for 10,000patients withaconfirmed COVID-19infectionadmitted to 920German hospitals between 26February and 19April2020. The joint study providesnationwide and representative findingson the treatment of COVID-19patients in Germany based on AOK administrative claims data, which cover almost one third of the German population. Onefocus is on thesituation regarding ventilated patients. Approximately onefifth (22percent) of COVID-19patients treated in hospitals died (Figure 1). The mortality rate for men(25percent)was 6 percentage pointshigher than that for women (19 percent). Mortality among older patients was very high, irrespective of gender: 27percent of patients aged 70 to 79 died, with the number rising to 38percent forpatients over 80years.

    High mortality rate among ventilated patientsSlightly more than half of all patients requiring mechanical ventilationdied (53percent). The highest rates were among patients aged 70 to 79 (63percent) and patients aged over 80 (72percent). The mortality rate for ventilated patients treated with dialysis due to kidney failure during hospitalization (27percent of all ventilated patients) was also very high at 73percent. The mortality rates for men and women requiring ventilation were similar. The number of patients not receiving ventilation who died was significantly lower, but still reached 16percent. Here again, there was a correlation between age and mortality. “These high mortality rates clearly show that a relatively high number of patients with a very seriouscourse of diseasewere treated in hospitals. Such serious course of diseases mainly affect older people and people whose health is already compromised, but also occur inyounger patients,” says Jürgen Klauber, director of WIdO. “Even though infection rates in Germany are currently low, we should continue to take all necessary precautionary measures to ensure that the risk of infection remains as low as possible.” Almost twice as many men as women with COVID-19receive ventilationThe data for COVID-19patients with and without mechanicalventilation were analyzed separately. Of the 10,021 hospitalized COVID-19patients, 1,727 received mechanical ventilation. Just over threequarters of ventilated patients were treated with invasive ventilation. Theaverage age of patients was 68–in both the ventilated and the non-ventilated group. The proportion of patients receiving ventilation according to agegroup were as follows (Figure 2): Among those aged 60 to 69 and those aged 70 to 79, itwas 24percent and 25percent,respectively, it was 15percent of those aged 18 to 59 and 12percentfor patients aged 80 and over. “Although the proportion of older patients receiving ventilation is relatively low, we can assume that in Germany all patients requiring this treatment will have received it. This is due to the fact that during the entire pandemic, there have always been enough intensive care beds available across Germany and fortunately the capacityof the intensive care units was never fully utilized,” says Christian Karagiannidis, speaker of the lung andrespiratory failure section of DIVI and head of the ECMO center at the Cologne-Merheim lung clinic. “International comparisons are difficult due to the different samples used in studies. There is, however, evidence to suggest that less old people with COVID-19have received ventilation in other countries–presumably due to the capacities available.” An examination of data by gender also produces interesting results: Although the proportion of men receiving ventilation(22percent)was almost twice as high as that of women (12percent), mortality rates were similar. “The administrative claimsdata provides us with no explanation for this imbalance and further research is required,” says Karagiannidis.Ventilated patients are more likely to have comorbiditiesCOVID-19patients treated in hospitals often suffer from a range of comorbidities (Figure 3). The number of patients with comorbidities was considerably higher among those who received ventilation than among those who did not. For example, 24percent of patients not receiving ventilation had cardiac arrhythmiasas opposed to 43percent among those who did receive ventilation. Diabetes was present in 26percent of patients withoutventilation butin 39percent for ventilated patients.Half of ventilated patients received ventilation for more than 10 daysThe average length of hospital stayfor COVID-19patients was 14days.Itwas considerablyshorter at 12days for patients without ventilation than for patients with ventilation (25days).Duration of ventilationwas on average 14days with a median period of 10days (Figure 4). 23percent of patients required mechanical ventilationfor more than 21days. “Our analyses provide useful data for forecasts regarding hospital and ventilation capacities. We observe that on average 240days of ventilation are required for every 100hospitalized patients. These are importantnumbersto prepare for a second wave of the pandemic. However, we do not anticipate any problems with normal hospital beds, even with high infection rates,” says Reinhard Busse, professor of health care management at TU Berlin.First national study for Germany based on extensive and high-quality dataThe study analyzed 10,021patients with confirmed cases of COVID-19who were admitted to 920German hospitals between 26February and 19April2020 and have already beendischarged or died in hospital. It is the most extensive study of COVID-19patients treated in German hospitals to date. The underlying sample of AOK-insured persons corresponds to about onethird of the total population and is representative inage and gender. Many of the internationallypublishedstudies using large databases include patients who are still in hospital. This means that for these studies length of hospital stayandduration ofventilation as well as mortality rates cannot yet be precisely determined.

    Link to the publication:https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30316-7/fulltex


    Peter Kremeier, Sven Pulletz, Christian Woll, Wolfgang Oczenski, Stephan Böhm: 
    Ventilation and intensive care therapy for COVID-19 – Manual for all medical practitioners.
    Working with ventilated critical pathogen spectrum patients

    Pabst, 136 pages, eBook ISBN 978-3-95853-600-5
     

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