{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T12:32:39Z","timestamp":1788784359485,"version":"build-2803163510"},"reference-count":28,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,11,14]],"date-time":"2022-11-14T00:00:00Z","timestamp":1668384000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Aims: Patients suffering from viral pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are at risk of developing acute respiratory distress syndrome (ARDS). ARDS is a serious complication of COVID-19 that requires early recognition and comprehensive management. Little is known about the concomitant prevalence of both entities in Germany. Thus, we sought to analyze predictors and regional trends of case fatality in patients with COVID-19 and ARDS in Germany. Methods: We analyzed data on the characteristics, comorbidities and in-hospital outcomes for all hospitalized patients with COVID-19 and compared those with and without ARDS in Germany in 2020. Results: Overall, 176,137 hospitalized patients with confirmed COVID-19 were included in this analysis; among these, 11,594 (6.6%) suffered from ARDS. Most patients with ARDS were treated in hospitals in urban areas (n = 6485); proportion rate of mechanical ventilation was higher (45.9%) compared to those treated in hospitals of suburban (36.1%) or rural areas (32.0%). Proportion of ARDS grew exponentially with age until the sixth decade of life. Case-fatality rate was considerably higher in COVID-19 patients with ARDS compared to those without (48.3% vs. 15.8%; p &lt; 0.001). Independent predictors of in-hospital case fatality with an OR &gt; 3 were age \u2265 70 years, severe ARDS, severe liver disease, acute renal failure, stroke, dialysis treatment, shock and necessity of ECMO. Conclusions: The case fatality of COVID-19 patients with ARDS is dramatically high and shows relevant regional disparities. Our findings may help to draw more attention to predictors for in-hospital case fatality in patients hospitalized with COVID-19 and suffering from ARDS.<\/jats:p>","DOI":"10.3390\/v14112515","type":"journal-article","created":{"date-parts":[[2022,11,14]],"date-time":"2022-11-14T02:34:58Z","timestamp":1668393298000},"page":"2515","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Case Fatality of Hospitalized Patients with COVID-19 Infection Suffering from Acute Respiratory Distress Syndrome in Germany"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9295-6223","authenticated-orcid":false,"given":"Ingo","family":"Sagoschen","sequence":"first","affiliation":[{"name":"Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0820-9584","authenticated-orcid":false,"given":"Karsten","family":"Keller","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany"},{"name":"Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany"},{"name":"Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1446-8101","authenticated-orcid":false,"given":"Johannes","family":"Wild","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5503-4150","authenticated-orcid":false,"given":"Thomas","family":"M\u00fcnzel","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany"},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Hobohm","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany"},{"name":"Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical Characteristics of Coronavirus Disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China","volume":"395","author":"Huang","year":"2020","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1016\/S1473-3099(20)30314-5","article-title":"Investigation of a COVID-19 outbreak in Germany resulting from a single travel-associated primary case: A case series","volume":"20","author":"Buchholz","year":"2020","journal-title":"Lancet Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1186\/s13054-020-02911-9","article-title":"Acute respiratory failure in COVID-19: Is it \u201ctypical\u201d ARDS?","volume":"24","author":"Li","year":"2020","journal-title":"Crit. Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.1016\/S0140-6736(20)31189-2","article-title":"Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: A prospective cohort study","volume":"395","author":"Cummings","year":"2020","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"113","DOI":"10.4187\/respcare.04716","article-title":"Past and Present ARDS Mortality Rates: A Systematic Review","volume":"62","author":"Jor","year":"2017","journal-title":"Respir. Care"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1513\/AnnalsATS.202007-772OC","article-title":"Validating Measures of Disease Severity in Acute Respiratory Distress Syndrome","volume":"18","author":"Sedhai","year":"2021","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1164\/rccm.201004-0549OC","article-title":"Early identification of patients at risk of acute lung injury: Evaluation of lung injury prediction score in a multicenter cohort study","volume":"183","author":"Gajic","year":"2011","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_9","first-page":"2526","article-title":"Acute respiratory distress syndrome: The Berlin Definition","volume":"307","author":"Rubenfeld","year":"2012","journal-title":"JAMA"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"54","DOI":"10.5694\/mja2.50674","article-title":"COVID-19 acute respiratory distress syndrome (ARDS): Clinical features and differences from typical pre-COVID-19 ARDS","volume":"213","author":"Gibson","year":"2020","journal-title":"Med. J. Aust."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Acute Respiratory Distress Syndrome Network (2000). Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N. Engl. J. Med., 342, 1301\u20131308.","DOI":"10.1056\/NEJM200005043421801"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1007\/s00134-020-06033-2","article-title":"COVID-19 pneumonia: Different respiratory treatments for different phenotypes?","volume":"46","author":"Gattinoni","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2187","DOI":"10.1007\/s00134-020-06281-2","article-title":"Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: A matched cohort study","volume":"46","author":"Chiumello","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.1016\/S2213-2600(20)30525-7","article-title":"Pathophysiology of COVID-19-associated acute respiratory distress syndrome\u2014Authors\u2019 reply","volume":"9","author":"Grasselli","year":"2021","journal-title":"Lancet Respir. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2200","DOI":"10.1007\/s00134-020-06192-2","article-title":"Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS","volume":"46","author":"Ferrando","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/S2213-2600(20)30459-8","article-title":"Ventilation management and clinical outcomes in invasively ventilated patients with COVID-19 (PRoVENT-COVID): A national, multicentre, observational cohort study","volume":"9","author":"Botta","year":"2021","journal-title":"Lancet Respir. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1016\/S2213-2600(20)30316-7","article-title":"Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 920 German hospitals: An observational study","volume":"8","author":"Karagiannidis","year":"2020","journal-title":"Lancet Respir. Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Hobohm, L., Sagoschen, I., Barco, S., Schmidtmann, I., Espinola-Klein, C., Konstantinides, S., M\u00fcnzel, T., and Keller, K. (2022). Trends and Risk Factors of In-Hospital Mortality of Patients with COVID-19 in Germany: Results of a Large Nationwide Inpatient Sample. Viruses, 14.","DOI":"10.3390\/v14020275"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Masters, R.K.A.L., and Woolf, S.H. (2022). Changes in life expectancy between 2019 and 2021: United states and 19 peer countries. medRxiv.","DOI":"10.1101\/2022.04.05.22273393"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1001\/jama.2016.0291","article-title":"Epidemiology, Patterns of Care, and Mortality for Patients with Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries","volume":"315","author":"Bellani","year":"2016","journal-title":"JAMA"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1080\/17476348.2020.1804365","article-title":"Mortality in COVID-19 patients with acute respiratory distress syndrome and corticosteroids use: A systematic review and meta-analysis","volume":"14","author":"Hasan","year":"2020","journal-title":"Expert Rev. Respir. Med."},{"key":"ref_22","first-page":"271","article-title":"The Characteristics of 50 Hospitalized COVID-19 Patients with and Without ARDS","volume":"117","author":"Dreher","year":"2020","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_23","first-page":"E311","article-title":"Case fatality rate of COVID-19: A systematic review and meta-analysis","volume":"62","author":"Alimohamadi","year":"2021","journal-title":"J. Prev. Med. Hyg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"154021","DOI":"10.1016\/j.jcrc.2022.154021","article-title":"Clinical characteristics, respiratory management, and determinants of oxygenation in COVID-19 ARDS: A prospective cohort study","volume":"71","author":"Estenssoro","year":"2022","journal-title":"J. Crit. Care"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1770","DOI":"10.1007\/s00134-003-1948-z","article-title":"Gender-based differences in children with sepsis and ARDS: The ESPNIC ARDS Database Group","volume":"29","author":"Bindl","year":"2003","journal-title":"Intensive Care Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1016\/S0140-6736(21)01960-7","article-title":"Extracorporeal membrane oxygenation for COVID-19: Evolving outcomes from the international Extracorporeal Life Support Organization Registry","volume":"398","author":"Barbaro","year":"2021","journal-title":"Lancet"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1016\/S0140-6736(20)32008-0","article-title":"Extracorporeal membrane oxygenation support in COVID-19: An international cohort study of the Extracorporeal Life Support Organization registry","volume":"396","author":"Barbaro","year":"2020","journal-title":"Lancet"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"829771","DOI":"10.3389\/fmed.2022.829771","article-title":"Comparison of COVID-19 Induced Respiratory Failure and Typical ARDS: Similarities and Differences","volume":"9","author":"Lu","year":"2022","journal-title":"Front. Med."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/14\/11\/2515\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:17:31Z","timestamp":1760145451000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/14\/11\/2515"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,14]]},"references-count":28,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["v14112515"],"URL":"https:\/\/doi.org\/10.3390\/v14112515","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,14]]}}}