Impact on disease mortality of clinical, biological, and virological characteristics at hospital admission and overtime in COVID-19 patients.

Little is known on the association between clinical factors and coronavirus disease 2019 (COVID-19) more than 15 days after diagnosis. We conducted a multicentric prospective cohort of COVID-19 hospitalized patients to describe clinical, biological, and virological characteristics at hospital admission and over time, according to mortality up to Day 60 after admission. For the analysis of risk factors of survival, analyses assessing associations between mortality and demographic characteristics or comorbidities were performed using a Cox regression model. Between January 24 and March 15, 2020, 246 patients with reverse-transcriptase polymerase chain reactions virologically confirmed COVID-19 were enrolled. In multivariate analysis, mortality at Day 60 (n = 42 patients, 17.1% [95% confidence interval, 12.6-22.4]) was associated with older age (adjusted hazard ratio [aHR] for age ≥ 65 years: 5.22 [2.56-10.63, p < .001]), gender (aHR for male: 2.97 [1.47-5.99, p = .002]), chronic pulmonary disease (aHR: 4.84 [2.32-10.07, p < .001]), obesity (aHR: 3.32 [1.70-6.52, p < .001]), and diabetes (aHR: 1.98 [1.01-3.89, p = .048]). The median nasopharyngeal viral load at admission was 6.4 log10 copies/ml and was associated with mortality regardless of clinical risk factors. Viral load decreased with time elapsed since symptoms onset. Our study confirmed that mortality was associated with clinical characteristics at admission. The viral load at admission was significantly lower in patients admitted late after the onset of symptoms in both dead and alive patients. Our results could improve earlier identification of patients with increased risk of mortality and adapted management.