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Adverse Clinical Outcomes in COVID-19 Versus SARS: A Territory-Wide Cohort Study in Hong Kong
34 Pages Posted: 21 Apr 2020
More...Abstract
Background: Coronavirus disease 2019 (COVID-19) and severe acute respiratory syndrome (SARS) are two infectious diseases caused by coronaviruses - SARS-CoV-2 and SARS-CoV respectively. The case fatality ratios (CFR) of these two infections appeared to differ substantially. We aimed to compare the CFR and its predictors of COVID-19 and SARS patients using a territory-wide cohort in Hong Kong.
Methods: This was a territory-wide retrospective cohort study using data from the Clinical Data Analysis and Reporting System (CDARS) under the management of Hospital Authority, Hong Kong. Laboratory-confirmed COVID-19 and SARS patients were identified with ICD-9-CM diagnosis codes and/or virological results. The primary endpoint was a composite endpoint of Intensive Care Unit (ICU) admission, use of invasive mechanical ventilation, and/or death.
Findings: We identified 114 COVID-19 patients (mean age 57.3 years, 50·0% male) diagnosed from 22 January to 8 March 2020 and 1,670 SARS patients (mean age 44·4 years, 44·0% male) in March to June 2003. Thirteen (11.4%) COVID-19 patients had ICU admission (n=8), use of invasive mechanical ventilation (n=7), or died (n=4) in 30 days. By day 53 of the outbreak on 15 March 2020, four patients had died (CFR, 3·5%). 432 (25·9%) SARS patients had ICU admission (n=333), use of invasive mechanical ventilation (n=61), or died (n=286) in 30 days. By 30 June 2003, 286 patients had died (CFR, 17·1%). After adjusting for clinical parameters, COVID-19 was associated with 55% lower risk of primary endpoint compared to SARS (adjusted hazard ratio [aHR] 0·45, 95% CI 0·26-0·79; p =0·005). Diabetes mellitus (aHR 5·87, 95% CI 1·55-22·22; p =0·009) and use of corticosteroid during follow-up (aHR 4·17, 95% CI 1·23-14·11; p =0·022) were two independent predictors of primary endpoint in COVID-19 patients.
Interpretation: COVID-19 was associated with an approximately 52% lower risk of adverse clinical outcomes, compared to SARS after adjusting for clinical parameters. Nonetheless, as there is still an ongoing, fast growing number of COVID-19 patients worldwide, the absolute number of deaths is going to be enormous. Health authorities should allocate adequate resources, in particular intensive care facilities, based on the trajectories of the numbers of confirmed cases and well ahead to avoid collapse of the healthcare systems.
Funding Statement: None.
Declaration of Interests: Grace Lui has served as an advisory committee member for Gilead, Merck and GSK, speaker for Merck and Gilead, and received research grant from Gilead, Merck and GSK. Terry Yip has served as an advisory committee member and a speaker for Gilead Sciences. Vincent Wong has served as an advisory committee member for 3V-BIO, AbbVie, Allergan, Boehringer Ingelheim, Echosens, Gilead Sciences, Intercept, Janssen, Novartis, Novo Nordisk, Perspectum Diagnostics, Pfizer, TARGET-NASH and Terns; and a speaker for Bristol-Myers Squibb, Echosens, Gilead Sciences and Merck. He has also received a research grant from Gilead Sciences. Henry Chan is an advisor for AbbVie, Aptorum, Arbutus, Hepion, Intellia, Janssen, Gilead, GSK, GRAIL, Medimmune, Merck, Roche, Vaccitech, VenatoRx, Vir Biotechnology; and a speaker for Mylan, Gilead and Roche. David Hui has served as an advisory committee member for Roche. Grace Wong has served as an advisory committee member for Gilead Sciences, as a speaker for Abbott, Abbvie, Bristol-Myers Squibb, Echosens, Furui, Gilead Sciences, Janssen and Roche, and received research grant from Gilead Sciences. The other authors declare that they have no competing interests
Ethics Approval Statement: The study protocol was approved by the Joint Chinese University of Hong Kong - New Territories East Cluster Clinical Research Ethics Committee.
Keywords: SARS-CoV-2, COVID-19, nCoV, death, pneumonia
Suggested Citation: Suggested Citation