Clinical and virological characteristics of hospitalised COVID-19 patients in a German tertiary care centre during the first wave of the SARS-CoV-2 pandemic: a prospective observational study
Authors: Thibeault Charlotte , Mühlemann Barbara , Helbig Elisa T. , Mittermaier Mirja , Lingscheid Tilman , Tober-Lau Pinkus , Meyer-Arndt Lil A. , Meiners Leonie , Stubbemann Paula , Haenel Sascha S. , Bosquillon de Jarcy Laure , Lippert Lena , Pfeiffer Moritz , Stegemann Miriam S. , Roehle Robert , Wiebach Janine , Hippenstiel Stefan , Zoller Thomas , Müller-Redetzky Holger , Uhrig Alexander , Balzer Felix , von Kalle Christof , Suttorp Norbert , Jones Terry C. , Drosten Christian , Witzenrath Martin , Sander Leif E. ,   Pa-COVID Study Group, Jürgens Linda , Kleinschmidt Malte , Denker Sophy , Ruwwe-Glösenkamp Christoph , Temmesfeld-Wollbrück Bettina , Heim Katrin M. , Schürmann Dirk , Hocke Andreas , Opitz Bastian , Pascual-Leone Belén Millet , Schuhmacher Rosa C. , Olk Nadine , Hillus David , Machleidt Felix , Albus Sebastian , Bremer Felix , Doehn Jan-Moritz , Garcia Carmen , Knape Philipp , Krause Philipp M. , Lechtenberg Liron , Li Yaosi , Pergantis Panagiotis , Ritter Teresa , Yedikat Berna , Zobel Christian , Hefele Friederike L. , Kellermann Ute , Schürmann Mariana , Wackernagel Lisa-Marie , Wetzel Anne , Grund Daniel , Haumesser Jens K. , Hodes Johannes , Rein Johannes , Radünzel Peter , Breitbart Astrid , Münzenberg Sergej , Soll Dominik , Zhamurashvili Tamar , Hübner Ralf-Harto , Alius Florian , Andermann Tim , Cronen Thomas , Fraumann Simon , Frost Nikolaj , Geus Dominik , Godzick-Njomgang Gisele J. , Herholz Anne , Hermanns Vera , Hilbrandt Moritz , Jacobi Till , Kim Ye-Ji , Madlung Elena , Martin Luise , Menner Nikolai , Mikolajewska Agata , Mrziglod Luisa , Muller Nadine , Niebank Michaela , Pappe Eva , Pfäfflin Frieder , Pfannkuch Lennart , Raspe Matthias , Reck Nicola , Ritter Anne , Saccomanno Jacopo , Schmalbrock Laura K. , Steinbeis Fridolin , Tabeling Christoph , Vogtmann Markus , Weber Susanne , Brack Markus , Felten Matthias , Schmidt Sein , Rönnefarth Maria , Schwanitz Georg , Krannich Alexander , Zvorc Saskia , Behrens Uwe D. , Kretzler Lucie , Li Linna , Wirsching Isabelle , Dang-Heine Chantip , Hummel Michael , Briesemeister Dana , Treue Denise , Möckel Martin , Knauß Samuel , Endres Matthias , Spies Claudia , Weber-Carstens Steffen , Kruse Jan M. , Zickler Daniel , Edel Andreas , Stier Britta , Enghard Philipp , Körner Roland , Eckardt Kai-Uwe , Elbert Lucas , Neumann Christopher , Eckart Marius A. , Pham Thuy N. , Schönberger Solveig , Wree Alexander , Tacke Frank , Mang Josef , de Vries Nadia A. , Wittenberg Marcel , Riecke Jana , Heeschen Julia , Treskatsch Sascha , Angermair Stefan , van Dijck Phillip , Corman Victor M. , Kurth Florian 
Published: April 2021

Abstract
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.