Figure 1
Participating countries and contribution to patient recruitment.
Table 1
Demographics and comorbidities by continent.
| VARIABLE | OVERALL, n = 4899, (%) | AFRICA, n = 551, (%) | AMERICAS, n = 2188, (%) | ASIA, n = 1654, (%) | EUROPE, n = 506, (%) | p-VALUE |
|---|---|---|---|---|---|---|
| Age, years, median, IQR | 59 (47–69) | 55 (43–67) | 60 (48–70) | 58 (46–68) | 60 (48–70) | <0.001 |
| Age <40, years | 679 (13.9%) | 98 (17.8%) | 240 (11%) | 264 (16%) | 77 (15.2%) | <0.001 |
| Age 40–64, years | 2476 (50.5%) | 292 (53%) | 1127 (51.5%) | 819 (49.5%) | 238 (47%) | <0.001 |
| Age 65–79, years | 1376 (28.1%) | 130 (23.6%) | 626 (28.6%) | 483 (29.2%) | 137 (27.1%) | <0.001 |
| Age ≥80, years | 368 (7.5%) | 31 (5.6%) | 195 (8.9%) | 88 (5.3%) | 54 (10.7%) | <0.001 |
| Hypertension | 2284 (46.6%) | 269 (48.8%) | 1021 (46.7%) | 711 (43.0%) | 283 (55.9%) | <0.001 |
| Diabetes Mellitus | 1458 (29.8%) | 137 (24.9%) | 586 (26.8%) | 618 (37.4%) | 117 (23.1%) | <0.001 |
| Obesity | 761 (23.4%) | 66 (28%) | 455 (31.1%) | 114 (9.6%) | 126 (34.3%) | <0.001 |
| Chronic Kidney Disease | 401 (8.2%) | 37 (6.7%) | 183 (8.4%) | 113 (6.8%) | 68 (13.4%) | <0.001 |
| Coronary Artery Disease | 552 (11.3%) | 25 (4.5%) | 183 (8.4%) | 253 (15.3%) | 91 (18%) | <0.001 |
| Atrial Fibrillation | 144 (2.9%) | 3 (0.5%) | 76 (3.5%) | 19 (1.1%) | 46 (9.1%) | <0.001 |
| Heart Failure | 271 (5.5%) | 18 (3.3%) | 121 (5.5%) | 63 (3.8%) | 69 (13.6%) | <0.001 |
| Cancer | 121 (2.5%) | 3 (0.5%) | 74 (3.4%) | 19 (1.1%) | 25 (4.9%) | <0.001 |
| Smoking* | 1201 (24.5%) | 81 (14.7%) | 396 (18.1%) | 479 (29.0%) | 245 (48.4%) | <0.001 |
[i] IQR = Interquartile range.
*Smoking History or Current Smoking Status.
Table 2
Clinical characteristics by continent.
| VARIABLE | n FOR ANALYSIS | OVERALL, n (%)/MEDIAN (IQR) | AFRICA, n (%)/MEDIAN (IQR) | AMERICAS, n (%)/MEDIAN (IQR) | ASIA, n (%)/MEDIAN (IQR) | EUROPE, n (%)/MEDIAN (IQR) | p-VALUE |
|---|---|---|---|---|---|---|---|
| Vital signs at admission | |||||||
| Respiratory rate (respirations per minute) | 4050 | 22 (20–26) | 24 (21–28) | 23 (20–28) | 22 (20–24) | 20 (18–22) | <0.001 |
| Heart rate (beats per minute) | 4821 | 92 (80–105) | 94 (81–105) | 93 (81–107) | 91 (80–104) | 88 (80–99) | <0.001 |
| Systolic blood pressure (mmHg) | 4828 | 128 (115–140) | 133 (121–148) | 127 (113–140) | 125 (114–140) | 130 (120–140) | <0.001 |
| Diastolic blood pressure (mmHg) | 4829 | 79 (70–85) | 83 (72–91) | 75 (69–84) | 80 (70–85) | 80 (70–86) | <0.001 |
| Temperature (Celcius) | 4683 | 37 (36.5–38) | 36.6 (36.2–37.1) | 37 (36.4–37.9) | 37.1 (36.6–38) | 37.6 (37.0–38.2) | <0.001 |
| Oxygen saturation (%) | 4592 | 93 (88–96) | 93 (88–96) | 91 (85–95) | 95 (92–97) | 94 (91–96) | <0.001 |
| Cardiovascular complications | |||||||
| Arrhythmia | 4899 | 299 (6.1%) | 11 (2%) | 216 (9.9%) | 24 (1.5%) | 48 (9.5%) | <0.001 |
| Myocarditis | 4899 | 48 (1%) | 5 (0.9%) | 27 (1.2%) | 14 (0.8%) | 2 (0.4%) | 0.3 |
| Pulmonary embolism | 4899 | 156 (3.2%) | 6 (1.1%) | 98 (4.5%) | 29 (1.8%) | 23 (4.5%) | <0.001 |
| Acute coronary syndrome | 4899 | 113 (2.3%) | 5 (0.9%) | 69 (3.2%) | 27 (1.6%) | 12 (2.4%) | 0.002 |
| Acute heart failure | 4899 | 286 (5.8%) | 20 (3.6%) | 183 (8.4%) | 61 (3.7%) | 22 (4.3%) | <0.001 |
| Pulmonary findings | |||||||
| Lung Infiltrates | 3188* | 2730 (85.6%) | 127 (90.7%) | 1790 (88.0%) | 647 (80.8%) | 166 (77.6%) | <0.001 |
| Pleural effusion | 3188* | 288 (9%) | 20 (14.3%) | 215 (10.6%) | 29 (3.6%) | 24 (11.2%) | <0.001 |
| In-hospital treatment | |||||||
| Inotropes/Vasopressors | 4899 | 795 (16.2%) | 17 (3.1%) | 685 (31.3%) | 60 (3.6%) | 33 (6.5%) | <0.001 |
| Corticosteroid | 4899 | 3438 (70.2%) | 364 (66.1%) | 1586 (72.5%) | 1096 (66.3%) | 392 (77.5%) | <0.001 |
| Anticoagulant/Antiplatelet | 4899 | 3346 (68.3%) | 195 (35.4%) | 1955 (89.4%) | 814 (49.2%) | 382 (75.5%) | <0.001 |
| Invasive mechanical ventilation | 4899 | 919 (18.8%) | 26 (4.7%) | 784 (35.8%) | 74 (4.5%) | 35 (6.9%) | <0.001 |
| Clinical outcomes | |||||||
| ICU admission | 4899 | 2075 (42.4%) | 102 (18.5%) | 1303 (59.6%) | 589 (35.6%) | 81 (16%) | <0.001 |
| In-hospital mortality | 4899 | 934 (19.2%) | 91 (16.9%) | 587 (26.9%) | 226 (13.7%) | 30 (6%) | <0.001 |
[i] ICU = Intensive care unit. IQR = Interquartile range. *Missing data due to unavailability of radiological imaging in 1,711 patients.
Figure 2
Intensive care unit admission rate and mortality rate by continent.
ICU: Intensive care unit.
Figure 3
Heatmap of factors associated with in-hospital COVID-19 mortality by continent.
aRR: adjusted relative risk. For each value, the aRR is presented along with its 95% confidence interval. In these statistical models, 4,873 (99.4%) patients were included in the ‘Global’ model, 537 in Africa, 2,180 in the Americas, 1,652 in Asia, and 504 in Europe.
Table 3
Logistic regression analysis of factors associated with in-hospital COVID-19 mortality by continent.
| VARIABLE | OVERALL, n = 4873, aOR (95% CI) | AFRICA, n = 537, aOR (95% CI) | AMERICAS, n = 2180, aOR (95% CI) | ASIA, n = 1652, aOR (95% CI) | EUROPE, n = 504, aOR (95% CI) |
|---|---|---|---|---|---|
| Age 40–64, years | 2.22 (1.56–3.22, p < 0.001) | 1.89 (0.74–5.70, p = 0.212) | 1.87 (1.18–3.05, p = 0.009) | 3.29 (1.57–8.07, p = 0.004) | 1.13 (0.15–24.36, p = 0.917) |
| Age 65–79, years | 4.56 (3.18–6.68, p < 0.001) | 5.90 (2.25–18.26, p = 0.001) | 4.83 (3.01–7.98, p < 0.001) | 4.20 (1.97–10.41, p = 0.001) | 3.18 (0.47–66.34, p = 0.318) |
| Age ≥80, years | 7.60 (5.02–11.70, p < 0.001) | 10.76 (3.33–38.78, p < 0.001) | 10.95 (6.30–19.48, p < 0.001) | 3.98 (1.56–11.11, p = 0.005) | 10.63 (1.45–232.01, p = 0.048) |
| Diabetes Mellitus | 1.24 (1.03–1.48, p = 0.019) | 1.66 (0.94–2.89, p = 0.075) | 1.05 (0.81–1.36, p = 0.701) | 1.07 (0.77–1.48, p = 0.684) | 3.38 (1.37–8.52, p = 0.008) |
| Chronic Kidney Disease | 1.65 (1.26–2.17, p < 0.001) | 1.63 (0.68–3.66, p = 0.253) | 1.75 (1.18–2.60, p = 0.006) | 2.43 (1.45–3.99, p = 0.001) | 0.47 (0.14–1.41, p = 0.201) |
| Myocarditis | 2.67 (1.34–5.30, p = 0.005) | 2.67 (1.34–5.30, p = 0.005) | 1.04 (0.40–2.64, p = 0.940) | 13.70 (3.72–59.18, p < 0.001) | 14.01 (0.37–591.44, p = 0.124) |
| Decompensated heart failure | 3.23 (2.41–4.32, p < 0.001) | 1.19 (0.36–3.68, p = 0.763) | 3.00 (2.06–4.38, p < 0.001) | 6.76 (3.66–12.56, p < 0.001) | 1.71 (0.44–6.10, p = 0.422) |
| Lung infiltrates | 1.71 (1.41–2.08, p < 0.001) | 1.20 (0.62–2.27, p = 0.585) | 1.20 (0.62–2.27, p = 0.585) | 2.46 (1.78–3.41, p < 0.001) | 1.75 (0.66–4.61, p = 0.258) |
| Pleural effusion | 1.49 (1.11–2.00, p = 0.008) | 2.10 (0.64–6.75, p = 0.212) | 1.58 (1.11–2.23, p = 0.010) | 1.15 (0.42–2.94, p = 0.770) | 3.59 (0.72–15.70, p = 0.100) |
| Invasive mechanical ventilation | 8.42 (6.98–10.20, p < 0.001) | 18.32 (6.75–55.86, p < 0.001) | 11.15 (8.68–14.42, p < 0.001) | 6.59 (3.88–11.25, p < 0.001) | 12.09 (4.26–35.26, p < 0.001) |
| Corticosteroid | 1.53 (1.25–1.88, p < 0.001) | 2.09 (1.10–4.14, p = 0.028) | 1.16 (0.89–1.53, p = 0.272) | 3.00 (1.94–4.80, p < 0.001) | 0.85 (0.26–3.18, p = 0.794) |
| Anticoagulation/Antiplatelet | 0.74 (0.60–0.91, p = 0.004) | 0.68 (0.37–1.22, p = 0.202) | 0.64 (0.43–0.96, p = 0.028) | 1.16 (0.83–1.61, p = 0.393) | 2.75 (0.67–15.04, p = 0.192) |
[i] aORR = Adjusted odds ratio. CI = Confidence interval. First, candidate variables were assessed using univariate analysis. Variables with a p < 0.25 or considered clinically significant were selected for evaluation in the logistic regression model. A backward selection method was then applied to determine the final model for all participants. Finally, this analysis was stratified by continent.