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Johannes Leiner,1,2 Vincent Pellissier,2 Sebastian König,1,2 Lars Stellmacher,2 Sven Hohenstein,2 Carolin Schanner,2 Stefan Kwast,2 Ralf Kuhlen,3,4 Andreas Bollmann1– 3 1Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Saxony, Germany; 2Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany; 3Helios Health Institute, Berlin, Germany; 4Helios Health, Berlin, GermanyCorrespondence: Johannes Leiner, Heart Centre Leipzig at University of Leipzig, Department of Electrophysiology, Struempellstrasse 39, Leipzig, 04289, Germany, Tel +49 341 865 251573, Email johannes.leiner@helios-gesundheit.deIntroduction: Type 2 diabetes mellitus (T2DM) is a leading cause of chronic kidney disease (CKD) globally. Both conditions substantially worsen patients’ prognosis. Current data on German in-hospital CKD cohorts are scarce. The multinational CaReMe study was initiated to evaluate the current epidemiology and healthcare burden of cardiovascular, renal and metabolic diseases. In this substudy, we share real-world data on CKD inpatients stratified for coexisting T2DM derived from a large German hospital network.Methods: This study used administrative data of inpatient cases from 89 Helios hospitals from 01/01/2016 to 28/02/2022. Data were extracted from ICD-10-encoded discharge diagnoses and OPS-encoded procedures. The first case meeting a previously developed CKD definition (defined by ICD-10- and OPS-codes) was considered the index case for a particular patient. Subsequent hospitalizations were analysed for readmission statistics. Patient characteristics and pre-defined endpoints were stratified for T2DM at index case.Results: In total, 48,011 patients with CKD were included in the present analysis (mean age ± standard deviation, 73.8 ± 13.1 years; female, 44%) of whom 47.9% had co-existing T2DM. Patients with T2DM were older (75 ± 10.6 vs 72.7 ± 14.9 years, p < 0.001), but gender distribution was similar to patients without T2DM. The burden of cardiovascular disease was increased in patients with T2DM, and index and follow-up in-hospital mortality rates were higher. Non-T2DM patients were characterised by more advanced CKD at baseline. Patients with T2DM had consistently higher readmission numbers for all events of interest, except for readmissions due to kidney failure/dialysis, which were more common in non-T2DM patients.Conclusion: In this study, we present recent data on hospitalized patients with CKD in Germany. In this CKD cohort, nearly half had T2DM, which substantially affected cardiovascular disease burden, rehospitalization frequency and mortality. Interestingly, non-diabetic patients had more advanced underlying renal disease, which affected renal outcomes. Keywords: chronic kidney disease, type 2 diabetes mellitus, administrative data, in-hospital mortality, kidney failure, rehospitalization

Johannes Leiner,1,2 Sven Hohenstein,2 Vincent Pellissier,2 Sebastian König,1,2 Claudia Winklmair,3 Irit Nachtigall,4 Andreas Bollmann,1,2,5 Ralf Kuhlen3,5,6 On behalf of the scientific advisory board of the Initiative of Quality Medicine (IQM)1Heart Centre Leipzig at University of Leipzig, Department of Electrophysiology, Leipzig, Germany; 2Real World Evidence and Health Technology Assessment at Helios Health Institute, Berlin, Germany; 3Initiative of Quality Medicine, Berlin, Germany; 4Department of Infectious Diseases and Infection Prevention, HELIOS Hospital Emil-von-Behring, Berlin, Germany and Charité - Universitaetsmedizin Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; 5Helios Health Institute, Berlin, Germany; 6Helios Health, Berlin, GermanyCorrespondence: Ralf Kuhlen, Initiative Qualitaetsmedizin e.V, Alt-Moabit 104, Berlin, 10559, Germany, Tel +49 30 7262 152 - 0, Email ralf.kuhlen@initiative-qualitaetsmedizin.deIntroduction: Reliable surveillance systems to monitor trends of COVID-19 case numbers and the associated healthcare burden play a central role in efficient pandemic management. In Germany, the federal government agency Robert-Koch-Institute uses an ICD-code-based inpatient surveillance system, ICOSARI, to assess temporal trends of severe acute respiratory infection (SARI) and COVID-19 hospitalization numbers. In a similar approach, we present a large-scale analysis covering four pandemic waves derived from the Initiative of Quality Medicine (IQM), a German-wide network of acute care hospitals.Methods: Routine data from 421 hospitals for the years 2019– 2021 with a “pre-pandemic” period (01– 01-2019 to 03– 03-2020) and a “pandemic” period (04– 03-2020 to 31– 12-2021) was analysed. SARI cases were defined by ICD-codes J09-J22 and COVID-19 by ICD-codes U07.1 and U07.2. The following outcomes were analysed: intensive care treatment, mechanical ventilation, in-hospital mortality.Results: Over 1.1 million cases of SARI and COVID-19 were identified. Patients with COVID-19 and additional codes for SARI were at higher risk for adverse outcomes when compared to non-COVID SARI and COVID-19 without any coding for SARI. During the pandemic period, non-COVID SARI cases were associated with 28%, 23% and 27% higher odds for intensive care treatment, mechanical ventilation and in-hospital mortality, respectively, compared to pre-pandemic SARI.Conclusion: The nationwide IQM network could serve as an excellent data source to enhance COVID-19 and SARI surveillance in view of the ongoing pandemic. Future developments of COVID-19/SARI case numbers and associated outcomes should be closely monitored to identify specific trends, especially considering novel virus variants.Graphical Abstract: Keywords: initiative of quality medicine, Germany, COVID-19, SARI, inpatient, hospital network