tetano
Editor, Senior Moderator
Clin Infect Dis
. 2020 Sep 24;ciaa1459.
doi: 10.1093/cid/ciaa1459. Online ahead of print.
Predictors at admission of mechanical ventilation and death in an observational cohort of adults hospitalized with COVID-19
Brendan R Jackson[SUP] 1 2 [/SUP], Jeremy A W Gold[SUP] 1 3 [/SUP], Pavithra Natarajan[SUP] 1 [/SUP], John Rossow[SUP] 1 2 3 [/SUP], Robyn Neblett Fanfair[SUP] 1 2 [/SUP], Juliana da Silva[SUP] 1 [/SUP], Karen K Wong[SUP] 1 2 [/SUP], Sean D Browning[SUP] 1 4 [/SUP], Sapna Bamrah Morris[SUP] 1 2 [/SUP], Jessica Rogers-Brown[SUP] 1 4 [/SUP], Alfonso C Hernandez-Romieu[SUP] 1 2 3 5 [/SUP], Christine M Szablewski[SUP] 1 2 3 6 [/SUP], Nadine Oosmanally[SUP] 6 [/SUP], Melissa Tobin-D'Angelo[SUP] 6 [/SUP], Cherie Drenzek[SUP] 6 [/SUP], David J Murphy[SUP] 5 [/SUP], Julie Hollberg[SUP] 5 [/SUP], James M Blum[SUP] 5 7 [/SUP], Robert Jansen[SUP] 8 [/SUP], David W Wright[SUP] 5 8 [/SUP], William M SeweSll[SUP] 9 [/SUP], Jack D Owens[SUP] 9 [/SUP], Benjamin Lefkove[SUP] 10 [/SUP], Frank W Brown[SUP] 5 10 [/SUP], Deron C Burton[SUP] 1 2 [/SUP], Timothy M Uyeki[SUP] 1 [/SUP], Stephanie R Bialek[SUP] 1 2 [/SUP], Priti R Patel[SUP] 1 2 [/SUP], Beau B Bruce[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Coronavirus disease (COVID-19) can cause severe illness and death. Predictors of poor outcome collected on hospital admission may inform clinical and public health decisions.
Methods: We conducted a retrospective observational cohort investigation of 297 adults admitted to eight academic and community hospitals in Georgia, United States, during March 2020. Using standardized medical record abstraction, we collected data on predictors including admission demographics, underlying medical conditions, outpatient antihypertensive medications, recorded symptoms, vital signs, radiographic findings, and laboratory values. We used random forest models to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CI) for predictors of invasive mechanical ventilation (IMV) and death.
Results: Compared with age <45 years, ages 65-74 years and ≥75 years were predictors of IMV (aOR 3.12, CI 1.47-6.60; aOR 2.79, CI 1.23-6.33) and the strongest predictors for death (aOR 12.92, CI 3.26-51.25; aOR 18.06, CI 4.43-73.63). Comorbidities associated with death (aORs from 2.4 to 3.8, p <0.05) included end-stage renal disease, coronary artery disease, and neurologic disorders, but not pulmonary disease, immunocompromise, or hypertension. Pre-hospital use vs. non-use of angiotensin receptor blockers (aOR 2.02, CI 1.03-3.96) and dihydropyridine calcium channel blockers (aOR 1.91, CI 1.03-3.55) were associated with death.
Conclusions: After adjustment for patient and clinical characteristics, older age was the strongest predictor of death, exceeding comorbidities, abnormal vital signs, and laboratory test abnormalities. That coronary artery disease, but not chronic lung disease, was associated with death among hospitalized patients warrants further investigation, as do associations between certain antihypertensive medications and death.
Keywords: COVID-19; SARS-CoV-2; angiotensin receptor antagonists; hospitalization; mortality.
. 2020 Sep 24;ciaa1459.
doi: 10.1093/cid/ciaa1459. Online ahead of print.
Predictors at admission of mechanical ventilation and death in an observational cohort of adults hospitalized with COVID-19
Brendan R Jackson[SUP] 1 2 [/SUP], Jeremy A W Gold[SUP] 1 3 [/SUP], Pavithra Natarajan[SUP] 1 [/SUP], John Rossow[SUP] 1 2 3 [/SUP], Robyn Neblett Fanfair[SUP] 1 2 [/SUP], Juliana da Silva[SUP] 1 [/SUP], Karen K Wong[SUP] 1 2 [/SUP], Sean D Browning[SUP] 1 4 [/SUP], Sapna Bamrah Morris[SUP] 1 2 [/SUP], Jessica Rogers-Brown[SUP] 1 4 [/SUP], Alfonso C Hernandez-Romieu[SUP] 1 2 3 5 [/SUP], Christine M Szablewski[SUP] 1 2 3 6 [/SUP], Nadine Oosmanally[SUP] 6 [/SUP], Melissa Tobin-D'Angelo[SUP] 6 [/SUP], Cherie Drenzek[SUP] 6 [/SUP], David J Murphy[SUP] 5 [/SUP], Julie Hollberg[SUP] 5 [/SUP], James M Blum[SUP] 5 7 [/SUP], Robert Jansen[SUP] 8 [/SUP], David W Wright[SUP] 5 8 [/SUP], William M SeweSll[SUP] 9 [/SUP], Jack D Owens[SUP] 9 [/SUP], Benjamin Lefkove[SUP] 10 [/SUP], Frank W Brown[SUP] 5 10 [/SUP], Deron C Burton[SUP] 1 2 [/SUP], Timothy M Uyeki[SUP] 1 [/SUP], Stephanie R Bialek[SUP] 1 2 [/SUP], Priti R Patel[SUP] 1 2 [/SUP], Beau B Bruce[SUP] 1 [/SUP]
Affiliations
- PMID: 32971532
- DOI: 10.1093/cid/ciaa1459
Abstract
Background: Coronavirus disease (COVID-19) can cause severe illness and death. Predictors of poor outcome collected on hospital admission may inform clinical and public health decisions.
Methods: We conducted a retrospective observational cohort investigation of 297 adults admitted to eight academic and community hospitals in Georgia, United States, during March 2020. Using standardized medical record abstraction, we collected data on predictors including admission demographics, underlying medical conditions, outpatient antihypertensive medications, recorded symptoms, vital signs, radiographic findings, and laboratory values. We used random forest models to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CI) for predictors of invasive mechanical ventilation (IMV) and death.
Results: Compared with age <45 years, ages 65-74 years and ≥75 years were predictors of IMV (aOR 3.12, CI 1.47-6.60; aOR 2.79, CI 1.23-6.33) and the strongest predictors for death (aOR 12.92, CI 3.26-51.25; aOR 18.06, CI 4.43-73.63). Comorbidities associated with death (aORs from 2.4 to 3.8, p <0.05) included end-stage renal disease, coronary artery disease, and neurologic disorders, but not pulmonary disease, immunocompromise, or hypertension. Pre-hospital use vs. non-use of angiotensin receptor blockers (aOR 2.02, CI 1.03-3.96) and dihydropyridine calcium channel blockers (aOR 1.91, CI 1.03-3.55) were associated with death.
Conclusions: After adjustment for patient and clinical characteristics, older age was the strongest predictor of death, exceeding comorbidities, abnormal vital signs, and laboratory test abnormalities. That coronary artery disease, but not chronic lung disease, was associated with death among hospitalized patients warrants further investigation, as do associations between certain antihypertensive medications and death.
Keywords: COVID-19; SARS-CoV-2; angiotensin receptor antagonists; hospitalization; mortality.