scholarly journals GOLD severity stratification and risk of hospitalisation for COPD exacerbations

2016 ◽  
Vol 70 (4) ◽  
Author(s):  
M. Lusuardi ◽  
C. Lucioni ◽  
F. De Benedetto ◽  
S. Mazzi ◽  
C.M. Sanguinetti ◽  
...  
Keyword(s):  
Clinical Factors ◽  
Copd Exacerbations ◽  
Telephone Interviews ◽  
Function Classes ◽  
Prospective Multicentre Study ◽  
Relative Risks ◽  
Gold Stage ◽  
Copd Patients ◽  
Oral Corticosteroids

Background and Aim. The Italian Costs for Exacerbations in COPD (“ICE”) study, following a pharmacoeconomic assessment of costs due to COPD exacerbations (primary endpoint), aimed also at evaluating (secondary endpoint) which clinical factors, among those considered for cost-analysis, may, at follow up, present a risk of new exacerbations and re-admission to hospital. Materials and methods. A prospective, multicentre study was carried out on COPD patients admitted to 25 Hospital Centres as a result of an exacerbation from October- December 2002. Following discharge, a 6-month follow- up was performed in each patient via three bi-monthly telephone interviews with a questionnaire administered by an investigator clinician. Results. 570 patients were eligible for data processing, mean age 70.6 years (± 9.5 standard deviation, SD), males 69.2%. According to GOLD, severity stratification was as follows: moderate 36.4%; severe 31.3%; very severe 32.3%. 282 patients experienced at least one exacerbation at follow up, 42% of exacerbations requiring hospitalisation. No significant association was seen between exacerbations and GOLD stage or co-morbidities or treatments except LTOT. Conversely, COPD functional severity influenced hospitalisations very significantly, with relative risks 2.6 (95% Confidence Interval, CI 1.8-3.8) and 2.0 (CI 1.3-2.8) (GOLD very severe versus moderate and severe, respectively), and 1.3 (CI 0.85-2.1) (GOLD severe versus moderate). Hospitalisations were also significantly associated with treatments denoting more severe conditions (oral corticosteroids, oral theophylline, and LTOT). Conclusions. Severity stratification of COPD patients according to respiratory function classes as outlined in GOLD guidelines and need for LTOT are confirmed as important predictors of hospitalisation for an exacerbation.

scholarly journals β-Blockers are associated with a reduction in COPD exacerbations

Thorax ◽  
2015 ◽  
Vol 71 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Surya P Bhatt ◽  
James M Wells ◽  
Gregory L Kinney ◽  
George R Washko ◽  
Matthew Budoff ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Negative Binomial ◽  
Airflow Obstruction ◽  
Chronic Obstructive ◽  
Severe Exacerbation ◽  
Copd Exacerbations ◽  
Gold Stage ◽  
Β Blocker ◽  
Β Blockers

BackgroundWhile some retrospective studies have suggested that β-blocker use in patients with COPD is associated with a reduction in the frequency of acute exacerbations and lower mortality, there is concern that their use in patients with severe COPD on home oxygen may be harmful.MethodsSubjects with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2–4 COPD participating in a prospective follow-up of the COPDGene cohort, a multicentre observational cohort of current and former smokers were recruited. Total and severe exacerbation rates were compared between groups categorised by β-blocker use on longitudinal follow-up using negative binomial regression analyses, after adjustment for demographics, airflow obstruction, %emphysema on CT, respiratory medications, presence of coronary artery disease, congestive heart failure and coronary artery calcification, and after adjustment for propensity to prescribe β-blockers.Results3464 subjects were included. During a median of 2.1 years of follow-up, β-blocker use was associated with a significantly lower rate of total (incidence risk ratio (IRR) 0.73, 95% CI 0.60 to 0.90; p=0.003) and severe exacerbations (IRR 0.67, 95% CI 0.48 to 0.93; p=0.016). In those with GOLD stage 3 and 4 and on home oxygen, use of β-blockers was again associated with a reduction in the rate of total (IRR 0.33, 95% CI 0.19 to 0.58; p<0.001) and severe exacerbations (IRR 0.35, 95% CI 0.16 to 0.76; p=0.008). Exacerbation reduction was greatest in GOLD stage B. There was no difference in all-cause mortality with β-blocker use.Conclusionsβ-Blockers are associated with a significant reduction in COPD exacerbations regardless of severity of airflow obstruction. The findings of this study should be tested in a randomised, placebo-controlled trial.Trial registration number(ClinicalTrials.gov NCT00608764).

scholarly journals Reduction of corticosteroid use in outpatient treatment of exacerbated COPD – Study protocol for a randomized, double-blind, non-inferiority study (The “RECUT”-Trial)

2019 ◽  
Author(s):  
Pascal Urwyler ◽  
Maria Boesing ◽  
Kristin Abig ◽  
Marco Cattaneo ◽  
Thomas Dieterle ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Day Treatment ◽  
Corticosteroid Treatment ◽  
Double Blind ◽  
Corticosteroid Dose ◽  
Copd Exacerbations ◽  
Copd Patients

Abstract Background Chronic obstructive pulmonary disease (COPD) is a major public health issue affecting approximately four to seven percent of the Swiss population. According to current inpatient guidelines, systemic corticosteroids are important in the treatment of acute COPD exacerbations and should be given for five to seven days. Several studies suggest that corticosteroids accelerate the recovery of the FEV1 (forced expiratory volume in one second), enhance oxygenation, decrease duration of hospitalization and improve clinical outcome. However, the additional therapeutic benefit on FEV1 recovery appears to be most apparent in the first three to five days. No data are available on the minimal necessary corticosteroid dose and treatment duration in primary care patients with acute COPD exacerbations. Given that many COPD patients are treated on an outpatient basis, there is an urgent need to improve evidence about COPD management in this setting. The aim of this study is to investigate whether a three-day treatment with orally administered corticosteroids is non-inferior to a five-day treatment in acute exacerbations of COPD in a primary care setting. Methods The proposed study is a prospective, double-blind, randomized controlled trial conducted in a primary care setting, including an anticipated number of 470 patients with acutely exacerbated COPD. Participants are randomised to receive systemic corticosteroid treatment of 40 mg prednisone daily for five days (conventional arm, n = 235), or for three days, followed by two days of placebo (experimental arm, n = 235). Antibiotic treatment for seven days is given to all patients with CRP ≥ 50 mg/l, known diagnosis of bronchiectasis, or presenting with Anthonisen Type-I exacerbation. Additional treatment after inclusion is left at the discretion of the treating general practitioner. Follow-up visits are performed on days three and seven by the treating general practitioners, followed by telephone interviews on days 30, 90 and 180 after inclusion into the study. Primary endpoint is the time to next exacerbation during a six-months follow-up period, which includes re-exacerbation during index exacerbation. Discussion This study is designed to assess whether a three-day course of corticosteroid treatment is not inferior to the current conventional five-day treatment course in outpatients with exacerbated COPD regarding time to next exacerbation. Depending on the results, this trial might lead to a further reduction of cumulative corticosteroid dose in COPD patients.

scholarly journals The airway microbiota and exacerbations of COPD

2020 ◽  
Vol 6 (3) ◽  
pp. 00168-2020
Author(s):  
Elise Orvedal Leiten ◽  
Rune Nielsen ◽  
Harald Gotten Wiker ◽  
Per Sigvald Bakke ◽  
Einar Marius Hjellestad Martinsen ◽  
...  
Keyword(s):  
Group Differences ◽  
Lower Airway ◽  
Bacterial Dna ◽  
Copd Exacerbations ◽  
Telephone Interviews ◽  
Β Diversity ◽  
16S Rna ◽  
Significant Difference ◽  
Severe Copd

AimThe aim of this study was to investigate whether the compositionality of the lower airway microbiota predicts later exacerbation risk in persons with COPD in a cohort study.Materials and methodsWe collected lower airways microbiota samples by bronchoalveolar lavage and protected specimen brushes, and oral wash samples from 122 participants with COPD. Bacterial DNA was extracted from all samples, before we sequenced the V3-V4 region of the 16S RNA gene. The frequency of moderate and severe COPD exacerbations was surveyed in telephone interviews and in a follow-up visit. Compositional taxonomy and α and β diversity were compared between participants with and without later exacerbations.ResultsThe four most abundant phyla were Firmicutes, Bacteroidetes, Proteobacteria and Fusobacteria in both groups, and the four most abundant genera were Streptococcus, Veillonella, Prevotella and Gemella. The relative abundances of different taxa showed a large variation between samples and individuals, and no statistically significant difference of either compositional taxonomy, or α or β diversity could be found between participants with and without COPD exacerbations within follow-up.ConclusionThe findings from the current study indicate that individual differences in the lower airway microbiota in persons with COPD far outweigh group differences between frequent and nonfrequent COPD exacerbators, and that the compositionality of the microbiota is so complex as to present large challenges for use as a biomarker of later exacerbations.

scholarly journals β2-Adrenergic Receptor (ADRB2) Gene Polymorphisms and Risk of COPD Exacerbations: The Rotterdam Study

2019 ◽  
Vol 8 (11) ◽  
pp. 1835 ◽  
Author(s):  
Leila Karimi ◽  
Lies Lahousse ◽  
Mohsen Ghanbari ◽  
Natalie Terzikhan ◽  
André G. Uitterlinden ◽  
...  
Keyword(s):  
Adrenergic Receptor ◽  
Chronic Obstructive ◽  
Copd Exacerbation ◽  
Rotterdam Study ◽  
Copd Exacerbations ◽  
Copd Patients ◽  
Β2 Adrenergic Receptor ◽  
Adrb2 Gene ◽  
Β2 Agonists

The role of the β2-adrenergic receptor (ADRB2) gene in patients with chronic obstructive pulmonary disease (COPD) is unclear. We investigated the association between ADRB2 variants and the risk of exacerbations in COPD patients treated with inhaled β2-agonists. Within the Rotterdam Study, a population-based cohort study, we followed 1,053 COPD patients until the first COPD exacerbation or end of follow-up and extracted rs1042713 (16Arg > Gly) and rs1042714 (27Gln > Glu) in ADRB2. Exposure to inhaled β2-agonists was categorised into current, past or non-use on the index date (date of COPD exacerbation for cases and on the same day of follow-up for controls). COPD exacerbations were defined as acute episodes of worsening symptoms requiring systemic corticosteroids and/or antibiotics (moderate exacerbations), or hospitalization (severe exacerbations). The associations between ADRB2 variants and COPD exacerbations were assessed using Cox proportional hazards models, adjusting for age, sex, use of inhaled corticosteroids, daily dose of β2-agonists, and smoking. In current users of β2-agonists, the risk of COPD exacerbation decreased by 30% (hazard ratio (HR); 0.70, 95% CI: 0.59–0.84) for each copy of the Arg allele of rs1042713 and by 20% (HR; 0.80, 95% CI: 0.69–0.94) for each copy of the Gln allele of rs1042714. Furthermore, current users carrying the Arg16/Gln27 haplotype had a significantly lower risk (HR; 0.70, 95% CI: 0.59–0.85) of COPD exacerbation compared to the Gly16/Glu27 haplotype. In conclusion, we observed that the Arg16/Gln27 haplotype in ADRB2 was associated with a reduced risk of COPD exacerbation in current users of inhaled β2-agonists.

scholarly journals HEALTH OUTCOMES IN COPD SMOKERS USING HEATED TOBACCO PRODUCTS: A 3-YEAR FOLLOW-UP

2020 ◽  
Author(s):  
R Polosa ◽  
JB Morjaria ◽  
U Prosperini ◽  
B Busà ◽  
A Pennisi ◽  
...  
Keyword(s):  
Health Impact ◽  
Cigarette Consumption ◽  
Chronic Obstructive ◽  
Data Sets ◽  
Tobacco Products ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Copd Patients

ABSTRACTBackgroundGiven that many patients with chronic obstructive pulmonary disease (COPD) smoke despite their symptoms, it is important to understand the long term health impact of cigarette substitution with heated tobacco products (HTPs). We monitored health parameters for 3-years in COPD patients who substantially attenuated or ceased cigarette consumption after switching to HTPs.MethodsChanges in daily cigarette smoking, annualized disease exacerbations, lung function indices, patients reported outcomes (CAT scores) and 6-minute walk distance (6MWD) from baseline were measured in COPD patients using HTPs at 12, 24 and 36 months. These were compared to a group of age- and sex-matched COPD patients who continued smoking.ResultsComplete data sets were available for 38 patients (19 in each group). Subjects using HTPs had a substantial decrease in annualized COPD exacerbations within the group mean (±SD) from 2.1 (±0.9) at baseline to 1.4 (±0.8), 1.2 (±0.8) and 1.3 (±0.8) at 12-, 24- and 36-month follow-up (p<0.05 for all visits). In addition, substantial and clinically significant improvements in CAT scores and 6MWD were identified at all 3 time points in the HTP cohort. No significant changes were observed in COPD patients who continued smoking.ConclusionsThis study is the first to describe the long-term health effects of HTP use in COPD patients. Consistent improvements in respiratory symptoms, exercise tolerance, quality of life, and rate of disease exacerbations were observed in patients with COPD who abstained from smoking or substantially reduced their cigarette consumption by switching to HTP use.

scholarly journals Effect of β-blockers on the risk of COPD exacerbations according to indication of use: The Rotterdam study

2021 ◽  
pp. 00624-2020
Author(s):  
Leila Karimi ◽  
Lies Lahousse ◽  
Phebe De Nocker ◽  
Bruno H. Stricker ◽  
Guy G. Brusselle ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cox Proportional Hazards ◽  
Rotterdam Study ◽  
Copd Exacerbations ◽  
Copd Patients ◽  
Β Blockers

Observational studies report a reduction of COPD exacerbations in patients treated with β-blockers. In contrast, the BLOCK COPD RCT which excluded COPD patients with cardiovascular (CV) conditions showed an increase in COPD exacerbations. It is unclear whether this discrepancy could be explained by underlying CV comorbidity. We examined whether the association between use of β-blockers and risk of COPD exacerbations differed between patients with and without a CV indication for β-blockers use.Within the Rotterdam Study, we followed COPD subjects until the first COPD exacerbation, or end of follow-up. Cardiovascular indication for β-blocker use was defined as a history of hypertension, coronary heart disease, atrial fibrillation, or heart failure at baseline. The association between β-blockers use and COPD exacerbations was assessed using Cox proportional hazards models adjusted for age, sex, smoking, incident CV disease (i.e., heart failure, hypertension, atrial fibrillation, and coronary heart disease during follow-up), respiratory drugs, and nitrates.In total 1312 COPD patients with a mean age=69.7±9.2 years were included. In patients with a CV indication (n=755, mean age=70.4±8.8 years), current use of cardioselective β-blockers was significantly associated with a reduced risk of COPD exacerbations (HR=0.69, 95% CI: 0.57–0.85). In contrast, in subjects without a CV indication (n=557, mean age=68.8±9.7 years), cardioselective β-blockers was not associated with an altered risk of COPD exacerbations (HR=0.94, 95% CI: 0.55–1.62).Use of cardioselective β-blockers reduced the risk of exacerbations in COPD patients with concomitant cardiovascular diseases. Therefore, the potential benefits of β-blockers might be confined to COPD patients with cardiovascular disease.

scholarly journals Health outcomes in COPD smokers using heated tobacco products: a 3-year follow-up

2021 ◽  
Author(s):  
Riccardo Polosa ◽  
Jaymin B. Morjaria ◽  
Umberto Prosperini ◽  
Barbara Busà ◽  
Alfio Pennisi ◽  
...  
Keyword(s):  
Health Impact ◽  
Cigarette Consumption ◽  
Chronic Obstructive ◽  
Tobacco Products ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Copd Patients ◽  
Patient Reported

AbstractGiven that many patients with chronic obstructive pulmonary disease (COPD) smoke despite their symptoms, it is important to understand the long-term health impact of cigarette substitution with heated tobacco products (HTPs). We monitored health parameters for 3 years in COPD patients who substantially attenuated or ceased cigarette consumption after switching to HTPs. Changes in daily cigarette smoking, annualized disease exacerbations, lung function indices, patient-reported outcomes (CAT scores) and 6-minute walk distance (6MWD) from baseline were measured in COPD patients using HTPs at 12, 24 and 36 months. These were compared to a group of age- and sex-matched COPD patients who continued smoking. Complete data sets were available for 38 patients (19 in each group). Subjects using HTPs had a substantial decrease in annualized COPD exacerbations within the group mean (± SD) from 2.1 (± 0.9) at baseline to 1.4 (± 0.8), 1.2 (± 0.8) and 1.3 (± 0.8) at 12-, 24- and 36-month follow-up (p < 0.05 for all visits). In addition, substantial and clinically significant improvements in CAT scores and 6MWD were identified at all three time points in the HTP cohort. No significant changes were observed in COPD patients who continued smoking. This study is the first to describe the long-term health effects of HTP use in COPD patients. Consistent improvements in respiratory symptoms, exercise tolerance, quality of life, and rate of disease exacerbations were observed in patients with COPD who abstained from smoking or substantially reduced their cigarette consumption by switching to HTP use.

scholarly journals Reduction of corticosteroid use in outpatient treatment of exacerbated COPD - Study protocol for a randomized, double-blind, non-inferiority study, (The RECUT-trial)

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Pascal Urwyler ◽  
Maria Boesing ◽  
Kristin Abig ◽  
Marco Cattaneo ◽  
Thomas Dieterle ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Day Treatment ◽  
Corticosteroid Treatment ◽  
Type I ◽  
Double Blind ◽  
Copd Exacerbations ◽  
Copd Patients

Abstract Background Chronic obstructive pulmonary disease (COPD) is a major public health issue affecting approximately 4% to 7% of the Swiss population. According to current inpatient guidelines, systemic corticosteroids are important in the treatment of acute COPD exacerbations and should be given for 5 to 7 days. Several studies suggest that corticosteroids accelerate the recovery of FEV1 (forced expiratory volume in 1 second), enhance oxygenation, decrease the duration of hospitalization, and improve clinical outcomes. However, the additional therapeutic benefit regarding FEV1 recovery appears to be most apparent in the first 3 to 5 days. No data are available on the optimum duration of corticosteroid treatment in primary-care patients with acute COPD exacerbations. Given that many COPD patients are treated as outpatients, there is an urgent need to improve the evidence base on COPD management in this setting. The aim of this study is to investigate whether a 3-day treatment with orally administered corticosteroids is non-inferior to a 5-day treatment in acute exacerbations of COPD in a primary-care setting. Methods/design This study is a prospective double-blind randomized controlled trial conducted in a primary-care setting. It is anticipated that 470 patients with acutely exacerbated COPD will be recruited. Participants are randomized to receive systemic corticosteroid treatment of 40 mg prednisone daily for 5 days (conventional arm, n = 235) or for 3 days followed by 2 days of placebo (experimental arm, n = 235). Antibiotic treatment for 7 days is given to all patients with CRP ≥ 50 mg/l, those with a known diagnosis of bronchiectasis, or those presenting with Anthonisen type I exacerbation. Additional treatment after inclusion is left at the discretion of the treating general practitioner. Follow-up visits are performed on days 3 and 7, followed by telephone interviews on days 30, 90, and 180 after inclusion in the study. The primary endpoint is the time to next exacerbation during the 6-month follow-up period. Discussion The study is designed to assess whether a 3-day course of corticosteroid treatment is not inferior to the conventional 5-day treatment course in outpatients with exacerbated COPD regarding time to next exacerbation. Depending on the results, this trial may lead to a reduction in the cumulative corticosteroid dose in COPD patients. Trial registration ClinicalTrials.gov, NCT02386735. Registered on 12 March 2015.

scholarly journals Reduction of corticosteroid use in outpatient treatment of exacerbated COPD – Study protocol for a randomized, double-blind, non-inferiority study (The “RECUT”-Trial)

2019 ◽  
Author(s):  
Pascal Urwyler ◽  
Maria Boesing ◽  
Kristin Abig ◽  
Marco Cattaneo ◽  
Thomas Dieterle ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Day Treatment ◽  
Corticosteroid Treatment ◽  
Double Blind ◽  
Corticosteroid Dose ◽  
Copd Exacerbations ◽  
Copd Patients

Abstract Background Chronic obstructive pulmonary disease (COPD) is a major public health issue affecting approximately four to seven percent of the Swiss population. According to current inpatient guidelines, systemic corticosteroids are important in the treatment of acute COPD exacerbations and should be given for five to seven days. Several studies suggest that corticosteroids accelerate the recovery of the FEV1 (forced expiratory volume in one second), enhance oxygenation, decrease duration of hospitalization and improve clinical outcome. However, the additional therapeutic benefit on FEV1 recovery appears to be most apparent in the first three to five days. No data are available on the minimal necessary corticosteroid dose and treatment duration in primary care patients with acute COPD exacerbations. Given that many COPD patients are treated on an outpatient basis, there is an urgent need to improve evidence about COPD management in this setting. The aim of this study is to investigate whether a three-day treatment with orally administered corticosteroids is non-inferior to a five-day treatment in acute exacerbations of COPD in a primary care setting. Methods The proposed study is a prospective, double-blind, randomized controlled trial conducted in a primary care setting, including an anticipated number of 470 patients with acutely exacerbated COPD. Participants are randomised to receive systemic corticosteroid treatment of 40 mg prednisone daily for five days (conventional arm, n = 235), or for three days, followed by two days of placebo (experimental arm, n = 235). Antibiotic treatment for seven days is given to all patients with CRP ≥ 50 mg/l, known diagnosis of bronchiectasis, or presenting with Anthonisen Type-I exacerbation. Additional treatment after inclusion is left at the discretion of the treating general practitioner. Follow-up visits are performed on days three and seven by the treating general practitioners, followed by telephone interviews on days 30, 90 and 180 after inclusion into the study. Primary endpoint is the time to next exacerbation during a six-months follow-up period, which includes re-exacerbation during index exacerbation. Discussion This study is designed to assess whether a three-day course of corticosteroid treatment is not inferior to the current conventional five-day treatment course in outpatients with exacerbated COPD regarding time to next exacerbation. Depending on the results, this trial might lead to a further reduction of cumulative corticosteroid dose in COPD patients.

scholarly journals High risk groups for severe COVID-19 in a whole of population cohort in Australia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bette Liu ◽  
Paula Spokes ◽  
Wenqiang He ◽  
John Kaldor
Keyword(s):  
Socioeconomic Status ◽  
New South ◽  
Severe Disease ◽  
Risk Groups ◽  
Prevention Strategies ◽  
Complete Case ◽  
Relative Risks ◽  
South Wales ◽  
Hazard Ratios

Abstract Background Increasing age is the strongest known risk factor for severe COVID-19 disease but information on other factors is more limited. Methods All cases of COVID-19 diagnosed from January–October 2020 in New South Wales Australia were followed for COVID-19-related hospitalisations, intensive care unit (ICU) admissions and deaths through record linkage. Adjusted hazard ratios (aHR) for severe COVID-19 disease, measured by hospitalisation or death, or very severe COVID-19, measured by ICU admission or death according to age, sex, socioeconomic status and co-morbidities were estimated. Results Of 4054 confirmed cases, 468 (11.5%) were classified as having severe COVID-19 and 190 (4.7%) as having very severe disease. After adjusting for sex, socioeconomic status and comorbidities, increasing age led to the greatest risk of very severe disease. Compared to those 30–39 years, the aHR for ICU or death from COVID-19 was 4.45 in those 70–79 years; 8.43 in those 80–89 years; 16.19 in those 90+ years. After age, relative risks for very severe disease associated with other factors were more moderate: males vs females aHR 1.40 (95%CI 1.04–1.88); immunosuppressive conditions vs none aHR 2.20 (1.35–3.57); diabetes vs none aHR 1.88 (1.33–2.67); chronic lung disease vs none aHR 1.68 (1.18–2.38); obesity vs not obese aHR 1.52 (1.05–2.21). More comorbidities was associated with significantly greater risk; comparing those with 3+ comorbidities to those with none, aHR 5.34 (3.15–9.04). Conclusions In a setting with high COVID-19 case ascertainment and almost complete case follow-up, we found the risk of very severe disease varies by age, sex and presence of comorbidities. This variation should be considered in targeting prevention strategies.

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