Trends and Risk Factors of In-Hospital Mortality of Patients With COVID-19 in Germany: Results of a Large Nationwide Inpatient Sample

Background: Unselected data of hospitalised, nationwide patients with COVID-19 is still sparse, but of outstanding interest not to exceed hospital capacities and to avoid overloading of national health care systems. Thus, we sought to analyse seasonal/regional trends and predictors of in-hospital fatality and mechanical ventilation (MV) in patients with COVID-19 in Germany.Methods: We used the German nationwide inpatient sample to analyse all hospitalised patients with confirmed COVID-19 diagnosis in Germany between Jan 1 st and December 31 st , 2020.Findings: We analysed data of 176,137 hospitalisations with confirmed COVID-19-infection. Among those, 31,607 (17.9%) died and in-hospital fatality grew exponentially with age. Overall, age ≥70 years (OR 5.91, 95%CI 5.70-6.13, P<0.001), pneumonia (OR 4.58, 95%CI 4.42-4.74, P<0.001) and acute respiratory distress syndrome (OR 8.51, 95%CI 8.12-8.92, P<0.001) were strong predictors of in-hospital death. Most COVID-19-patients were treated in hospitals in urban areas (n=92,971) associated with lowest case-fatality (17.5%) as compared to hospitals in suburban (18.3%) or rural areas (18.8%). MV demand was highest in November and December 2020 (32.3%, 20.3%) in patients between 6 th and 8 th age-decade. In the first age-decade, 78 of 1861 children (4.2%) with COVID-19-infection aged were treated with MV and five of them died (0.3%).Interpretation: The results of our study indicate seasonal and regional variations concerning number of COVID-19-patients, necessity of MV and case-fatality. These findings may help to ensure a flexible allocation of intensive care (human) resources, which is essential for managing enormous societal challenges worldwide to avoid overloaded regional health care systems.Funding Information: No funding. Declaration of Interests: LH received lecture/consultant fees from MSD and Actelion, outside the submitted work. ISa reports no conflict of interests. SB received lecture/consultant fees from Bayer HealthCare, Concept Medical, BTG Pharmaceuticals, INARI, Boston Scientific, and LeoPharma; institutional grants from Boston Scientific, Bentley, Bayer HealthCare, INARI, Medtronic, Concept Medical, Bard, and Sanofi; and economical support for travel/congress costs from Daiichi Sankyo, BTG Pharmaceuticals, and Bayer HealthCare, outside the submitted work. ISc reports no conflict of interests. CEK reports having from Amarin Germany, Amgen GmbH, Bayer Vital, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Leo Pharma, MSD Sharp & Dohme, Novartis Pharma, Pfizer Pharma GmbH, Sanofi-Aventis GmbH. SK reports institutional grants and personal lecture/advisory fees from Bayer AG, Daiichi Sankyo, and Boston Scientific; institutional grants from Inari Medical; and personal lecture/advisory fees from MSD and Bristol Myers Squibb/Pfizer. TM reports no conflict of interests. TM is PI of the DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany. KK reports no conflict of interests. Ethics Approval Statement: Since our study did not comprise direct access by the investigators to individual patient data but only an access to summarised results provided by the RDC, approval by an ethics committee as well as patients’ informed consent were not required, in accordance with German law.