A nationwide analysis now shows how those patients who had to be treated in hospital after infection with Sars-CoV-2 were doing. The questions that are at the center of every clinical study on the novel coronavirus are: How old are the patients, how many survive and what role do complications and additional diseases play? The AOK scientific institute (Wido), the interdisciplinary association for intensive care and emergency medicine (DIVI) and the Technical University of Berlin have analyzed data from more than 10,000 Covid-19 patients from February 26 to April 19, 2020 in 920 German hospitals. The data were in the trade magazine Lancet Respiratory Medicine released.
The scientists had evaluated AOK billing data that recorded almost a third of the population in Germany. The average age of in-patient Covid 19 patients was 68 years. 22 percent of them died – with differences between the sexes: while 25 percent of the men died, it was 19 percent of the women. The decisive factor for the prognosis was whether the sick had to be ventilated, which was necessary in 17 percent of the patients. Of the ventilated patients, 53 percent died; without ventilation, the mortality rate was significantly lower at 16 percent. It was striking that the proportion of men who needed ventilation was almost twice as high as that of women at 22 percent.
If patients had to be ventilated, the kidneys often failed
The study confirmed that the proportion of deaths increases with age. In the 70- to 79-year-old age group, 27 percent of the patients treated in the hospital died; in the group aged 80 and over, it was 38 percent. If they had to be ventilated, two thirds to three quarters of the patients died in both age groups. In more than a quarter of all patients who had to be ventilated, the kidneys also failed, so that artificial blood washing was necessary. If the seriously ill depended on the support of a respirator and dialysis, 73 percent of them died.
“The high mortality rates show that a relatively large number of patients with a very severe course of the disease were treated,” says Jürgen Klauber from Wido. “The difficult courses tend to affect older people and people with health problems, but they also occur in younger people.” Even if the number of infections in Germany is currently low, all precautionary measures should be taken to keep the risk of infection low.
Up to a quarter of the patients had to be ventilated
Depending on their age, between twelve and 25 percent of inpatients with Covid 19 were ventilated. “The proportion of elderly patients with ventilation is relatively low, but we still assume that in Germany all patients who needed it could be ventilated,” says DIVI spokesman Christian Karagiannidis. “There were enough free intensive care beds available nationwide at all times during the pandemic and luckily the capacity of the intensive care units was never fully utilized.” Although it is difficult to assess the situation in an international comparison, Karagiannidis suspects that in other countries – probably also for reasons of capacity – fewer elderly people were ventilated with Covid-19.
Data from German hospitals also show that severe courses are more common in patients with comorbidities. Here, the proportion of patients with high blood pressure, diabetes, kidney and heart failure and chronic lung diseases was significantly increased – and particularly high among those who needed ventilation. For example, 43 percent of the patients with ventilation had additional cardiac arrhythmias, of the patients without ventilation only half as many.
Many studies to date have included patients who are still in the hospital, so that the total length of stay and the length of ventilation can be determined as little as mortality. In contrast, the German hospital study is completed and concludes that Covid 19 patients had to stay in the clinic for an average of 14 days. If they were ventilated, the patients stayed on average for 25 days. The duration of artificial ventilation was 14 days on average. From the data it can be deduced that the risk of severe courses increases significantly from the age of 60 – however, this is also the age at which comorbidities become more common. Hospital mortality at Covid-19 was 22 percent, similar to that in France; however, more patients were treated in the neighboring country.
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“Our evaluation provides helpful figures on the use of hospital and ventilation capacities for future projections,” says Reinhard Busse, an expert in management in the health sector at the TU Berlin. “This means an average of 240 ventilation days per 100 inpatients. These numbers are important for preparing for a second pandemic wave. However, with normal hospital beds, no problem can be expected even with high infection numbers.”