COVID-19 Survival - The COVIVA Study (COVIVA)

Coronavirus Disease 19 Survival - The COVIVA Study

The COVID-19 pandemic poses a major and imminent challenge for health care systems regarding patient triage and allocation of limited resources worldwide. The involved pathogenetic mechanisms as well as the clinical value of established and emerging biomarkers for early risk prediction are largely unknown.

To fill these gaps in knowledge, investigators designed the prospective, interdisciplinary, observational, case-control "COronaVIrus surviVAl (COVIVA)" study platform, aiming to deliver an open-source platform to i) perform extensive clinical and biomarker phenotyping in COVID-19 suspects presenting to the emergency department (ED) as well as admitted to the intensive care unit, ii) compare clinical and biomarker profiles of COVID-19 patients with a control group, iii) derive and validate personalized risk prediction models for early clinical decision support, and iv) explore pathophysiological mechanisms including but not limited to inflammatory, immunological and cardiovascular pathways.

Blood samples (serum) are routinely collected for bio banking both in cases and controls. Patients are followed 30 days after discharge. Personalized risk prediction models will be derived and validated based on advanced statistical models including machine-based learning incorporating a variety of clinical parameters and biomarker signatures (including digitally stored in-hospital data, e.g. imaging, ECG, ventilation parameters). Close cooperation with multiple other national and international COVID-19 cohorts is endorsed.

The personalized risk prediction models from the COVIVA study will support clinicians in the most challenging process of limited resource allocation in a timely fashion. In addition, pathophysiological mechanisms and differences in mild and severe variants of COVID-19 as well as in the control group can be extensively studied in a multidisciplinary approach.

Study Overview

• Status: Completed
• Conditions: COVID-19; SARS-CoV 2

Detailed Description

Background: The current COVID-19 pandemic poses a major and imminent challenge for health care systems regarding patient triage and allocation of limited resources worldwide, but also in Switzerland. Data from severly affected countries impressively demonstrate that COVID-19 fatality rates rapidly increase in times of overloaded health care services. Cardiovascular comorbidity seems to be associated with impaired outcome, e.g. with admission to intensive care unit (ICU) or death. However, a direct causal relation is questionable and pathophysiological mechanisms of the cardiovascular involvement such as the renin-angiotensin-aldosterone system are poorly understood. The clinical value of established and emerging biomarkers is largely unknown. Accordingly, early and reliable personalized risk prediction represents a major unmet clinical need, as it may allow evidence-based clinical decision aid for most effective resource allocation in the common fight against the COVID-19 pandemic.

Aims: To fill these gaps in knowledge, investigators designed the "COronaVIrus surviVAl (COVIVA)" study. With this study, investigators aim to deliver an open-source platform to i) perform extensive clinical and biomarker phenotyping in COVID-19 suspects presenting to the emergency department (ED) and in COVID-19 patients with subsequent ICU admission, ii) compare clinical and biomarker profiles of COVID-19 patients with a control group, iii) derive and validate personalized risk prediction models for early clinical decision support, and iv) explore pathophysiological mechanisms including inflammatory and cardiovascular pathways.

Methodology: The COVIVA study is an ongoing, prospective, interdisciplinary, observational, case-control study with active enrolment of consecutive patients with clinical suspicion of COVID-19 triaged to the Emergency Department (ED) of the University Hospital in Basel, Switzerland. Patients with a positive nasopharyngeal swab test for severe acute respiratory syndrome (SARS)-CoV-2 will serve as cases while the remainders will serve as controls. Detailed clinical patient's phenotyping (e.g. comorbidities, medications, symptoms, vitals, ECG and imaging data), extended laboratory analyses and blood sampling for bio banking are performed once in all patients (cases and control) at time of ED presentation and serially thereafter in the subset of COVID-19 patients with subsequent need for ICU admission. Primary outcome measure is in-hospital mortality; secondary outcome measures include the need for ICU admission, invasive mechanical ventilation, hemodynamic support, 30-day post-discharge mortality, length of hospital and ICU stay, resource use and quality of life 30 days after discharge and its composites. Personalized risk prediction models will be derived and validated based on advanced statistical models including machine-based learning incorporating a variety of clinical parameters and biomarker signatures (including digitally stored in-hospital data, e.g. imaging, ECG, ventilation parameters). Close cooperation with multiple other national and international COVID-19 cohorts is endorsed.

Potential significance: The personalized risk prediction models from the COVIVA study will support clinicians in the most challenging process of limited resource allocation in a timely fashion. In addition, pathophysiological mechanisms and differences in mild and severe variants of COVID-19 as well as in the control group can be extensively studied in a multidisciplinary approach.

• Study Type: Observational
• Enrollment (Actual): 1325

Contacts and Locations

Study Locations

• Switzerland
  • Basel, Switzerland, 4031
    • University Hospital Basel

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

All patients with clinical suspicion of COVID-19 or confirmed SARS-CoV2 infection triaged to the Emergency Department (ED) of the University Hospital Basel, Switzerland, are potentially eligible for enrolment in this study. An upstream pre-triage located outside the ED (in a nearby church) routinely performs clinical risk assessment in all patients with clinical suspicion of SARS-CoV-2 infection irrespective of symptoms severity and, if clinically indicated, nasopharyngeal swab testing. While patients with mild symptoms and in good clinical condition are assigned towards outpatient management, patients in poorer clinical conditions and higher likelihood of need for in-patient management are assigned to the ED, where they will be screened for potential COVIVA inclusion.

Description

Inclusion Criteria:

• Clinically suspected or confirmed SARS-CoV-2 infection triaged to the ED
• SARS-CoV-2 swab test performed (result may be pending at time of study enrolment)
• Age ≥18 years
• Patient or legally authorized representative is willing to sign local General consent form

Exclusion Criteria:

• Patient or legally authorized representative is unable or unwilling to participate in the study.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
COVID-19 suspects; Patients presenting with suspected COVID-19 to the emergency department of the University Hospital Basel.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
short-term prognosis	incidence of death during index hospital stay	at 30 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Admission to the intensive care unit (ICU)	Incidence of subsequent ICU admission	at 30 days
Invasive ventilation (Intubation)	Incidence of subsequent intubation	at 30 days
Need for extracorporal membrane oxygenation (ECMO)	Incidence of subsequent ECMO	at 30 days
Hemodynamic support	Incidence of subsequent need for hemodynamic support	at 30 days
Length of ICU stay	Number of days (overnight-stays) spent on the ICU	at 30 days
Acute respiratory distress Syndrome (ARDS)	Incidence o ARDS	at 30 days
Myocardial injury	Incidence of myocardial injury	at 30 days
ST-segment elevation myocardial infarction	Incidence of myocardial infarction	at 30 days
In-hospital resource use	Types and numbers of resources used	at 30 days
EQ-5D questionnaire	Quality of life assessed using the EQ-5D questionnaire resulting in an indexed score ranging from 0 to 1 with higher numbers indicating higher quality of life.	at 30 days

Collaborators and Investigators

• Sponsor: University Hospital, Basel, Switzerland
• Investigators: Principal Investigator: Raphael Twerenbold, MD, Department of Cardiology and Cardiodiovascular Research Institute Basel (CRIB); Principal Investigator: Gabriela Kuster Pfister, MD, Department of Cardiology, University Hospital Basel

Study record dates

Study Major Dates

• Study Start (ACTUAL): March 19, 2020
• Primary Completion (ACTUAL): January 5, 2021
• Study Completion (ACTUAL): June 30, 2021

Study Registration Dates

• First Submitted: April 6, 2020
• First Submitted That Met QC Criteria: April 27, 2020
• First Posted (ACTUAL): April 29, 2020

Study Record Updates

• Last Update Posted (ACTUAL): October 5, 2021
• Last Update Submitted That Met QC Criteria: October 4, 2021
• Last Verified: October 1, 2021

More Information

Terms related to this study

• Keywords: biomarkers; artificial intelligence; biobank; big data; serum; precision medicine; risk prediction; renin-angiotensin-aldosterone system (RAAS); pathomechanisms; resource allocation
• Additional Relevant MeSH Terms: Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Virus Diseases; Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Pneumonia, Viral; Pneumonia; Lung Diseases; COVID-19
• Other Study ID Numbers: UHospital Switz

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No