tetano
Editor, Senior Moderator
EBioMedicine
. 2022 Aug 8;83:104208.
doi: 10.1016/j.ebiom.2022.104208. Online ahead of print.
Phenotypes of disease severity in a cohort of hospitalized COVID-19 patients: Results from the IMPACC study
Al Ozonoff[SUP] 1 [/SUP], Joanna Schaenman[SUP] 2 [/SUP], Naresh Doni Jayavelu[SUP] 3 [/SUP], Carly E Milliren[SUP] 1 [/SUP], Carolyn S Calfee[SUP] 4 [/SUP], Charles B Cairns[SUP] 5 [/SUP], Monica Kraft[SUP] 6 [/SUP], Lindsey R Baden[SUP] 7 [/SUP], Albert C Shaw[SUP] 8 [/SUP], Florian Krammer[SUP] 9 [/SUP], Harm van Bakel[SUP] 9 [/SUP], Denise A Esserman[SUP] 8 [/SUP], Shanshan Liu[SUP] 1 [/SUP], Ana Fernandez Sesma[SUP] 9 [/SUP], Viviana Simon[SUP] 9 [/SUP], David A Hafler[SUP] 8 [/SUP], Ruth R Montgomery[SUP] 8 [/SUP], Steven H Kleinstein[SUP] 8 [/SUP], Ofer Levy[SUP] 7 [/SUP], Christian Bime[SUP] 6 [/SUP], Elias K Haddad[SUP] 5 [/SUP], David J Erle[SUP] 4 [/SUP], Bali Pulendran[SUP] 10 [/SUP], Kari C Nadeau[SUP] 10 [/SUP], Mark M Davis[SUP] 10 [/SUP], Catherine L Hough[SUP] 11 [/SUP], William B Messer[SUP] 11 [/SUP], Nelson I Agudelo Higuita[SUP] 12 [/SUP], Jordan P Metcalf[SUP] 12 [/SUP], Mark A Atkinson[SUP] 13 [/SUP], Scott C Brakenridge[SUP] 13 [/SUP], David Corry[SUP] 14 [/SUP], Farrah Kheradmand[SUP] 14 [/SUP], Lauren I R Ehrlich[SUP] 15 [/SUP], Esther Melamed[SUP] 15 [/SUP], Grace A McComsey[SUP] 16 [/SUP], Rafick Sekaly[SUP] 16 [/SUP], Joann Diray-Arce[SUP] 1 [/SUP], Bjoern Peters[SUP] 17 [/SUP], Alison D Augustine[SUP] 18 [/SUP], Elaine F Reed[SUP] 2 [/SUP], Matthew C Altman[SUP] 3 [/SUP], Patrice M Becker[SUP] 18 [/SUP], Nadine Rouphael[SUP] 19 [/SUP], IMPACC study group members
Collaborators, Affiliations
Abstract
Background: Better understanding of the association between characteristics of patients hospitalized with coronavirus disease 2019 (COVID-19) and outcome is needed to further improve upon patient management.
Methods: Immunophenotyping Assessment in a COVID-19 Cohort (IMPACC) is a prospective, observational study of 1164 patients from 20 hospitals across the United States. Disease severity was assessed using a 7-point ordinal scale based on degree of respiratory illness. Patients were prospectively surveyed for 1 year after discharge for post-acute sequalae of COVID-19 (PASC) through quarterly surveys. Demographics, comorbidities, radiographic findings, clinical laboratory values, SARS-CoV-2 PCR and serology were captured over a 28-day period. Multivariable logistic regression was performed.
Findings: The median age was 59 years (interquartile range [IQR] 20); 711 (61%) were men; overall mortality was 14%, and 228 (20%) required invasive mechanical ventilation. Unsupervised clustering of ordinal score over time revealed distinct disease course trajectories. Risk factors associated with prolonged hospitalization or death by day 28 included age ≥ 65 years (odds ratio [OR], 2.01; 95% CI 1.28-3.17), Hispanic ethnicity (OR, 1.71; 95% CI 1.13-2.57), elevated baseline creatinine (OR 2.80; 95% CI 1.63- 4.80) or troponin (OR 1.89; 95% 1.03-3.47), baseline lymphopenia (OR 2.19; 95% CI 1.61-2.97), presence of infiltrate by chest imaging (OR 3.16; 95% CI 1.96-5.10), and high SARS-CoV2 viral load (OR 1.53; 95% CI 1.17-2.00). Fatal cases had the lowest ratio of SARS-CoV-2 antibody to viral load levels compared to other trajectories over time (p=0.001). 589 survivors (51%) completed at least one survey at follow-up with 305 (52%) having at least one symptom consistent with PASC, most commonly dyspnea (56% among symptomatic patients). Female sex was the only associated risk factor for PASC.
Interpretation: Integration of PCR cycle threshold, and antibody values with demographics, comorbidities, and laboratory/radiographic findings identified risk factors for 28-day outcome severity, though only female sex was associated with PASC. Longitudinal clinical phenotyping offers important insights, and provides a framework for immunophenotyping for acute and long COVID-19.
Funding: NIH.
Keywords: Antibody; COVID-19; SARS-CoV-2; Viral load.
. 2022 Aug 8;83:104208.
doi: 10.1016/j.ebiom.2022.104208. Online ahead of print.
Phenotypes of disease severity in a cohort of hospitalized COVID-19 patients: Results from the IMPACC study
Al Ozonoff[SUP] 1 [/SUP], Joanna Schaenman[SUP] 2 [/SUP], Naresh Doni Jayavelu[SUP] 3 [/SUP], Carly E Milliren[SUP] 1 [/SUP], Carolyn S Calfee[SUP] 4 [/SUP], Charles B Cairns[SUP] 5 [/SUP], Monica Kraft[SUP] 6 [/SUP], Lindsey R Baden[SUP] 7 [/SUP], Albert C Shaw[SUP] 8 [/SUP], Florian Krammer[SUP] 9 [/SUP], Harm van Bakel[SUP] 9 [/SUP], Denise A Esserman[SUP] 8 [/SUP], Shanshan Liu[SUP] 1 [/SUP], Ana Fernandez Sesma[SUP] 9 [/SUP], Viviana Simon[SUP] 9 [/SUP], David A Hafler[SUP] 8 [/SUP], Ruth R Montgomery[SUP] 8 [/SUP], Steven H Kleinstein[SUP] 8 [/SUP], Ofer Levy[SUP] 7 [/SUP], Christian Bime[SUP] 6 [/SUP], Elias K Haddad[SUP] 5 [/SUP], David J Erle[SUP] 4 [/SUP], Bali Pulendran[SUP] 10 [/SUP], Kari C Nadeau[SUP] 10 [/SUP], Mark M Davis[SUP] 10 [/SUP], Catherine L Hough[SUP] 11 [/SUP], William B Messer[SUP] 11 [/SUP], Nelson I Agudelo Higuita[SUP] 12 [/SUP], Jordan P Metcalf[SUP] 12 [/SUP], Mark A Atkinson[SUP] 13 [/SUP], Scott C Brakenridge[SUP] 13 [/SUP], David Corry[SUP] 14 [/SUP], Farrah Kheradmand[SUP] 14 [/SUP], Lauren I R Ehrlich[SUP] 15 [/SUP], Esther Melamed[SUP] 15 [/SUP], Grace A McComsey[SUP] 16 [/SUP], Rafick Sekaly[SUP] 16 [/SUP], Joann Diray-Arce[SUP] 1 [/SUP], Bjoern Peters[SUP] 17 [/SUP], Alison D Augustine[SUP] 18 [/SUP], Elaine F Reed[SUP] 2 [/SUP], Matthew C Altman[SUP] 3 [/SUP], Patrice M Becker[SUP] 18 [/SUP], Nadine Rouphael[SUP] 19 [/SUP], IMPACC study group members
Collaborators, Affiliations
- PMID: 35952496
- DOI: 10.1016/j.ebiom.2022.104208
Abstract
Background: Better understanding of the association between characteristics of patients hospitalized with coronavirus disease 2019 (COVID-19) and outcome is needed to further improve upon patient management.
Methods: Immunophenotyping Assessment in a COVID-19 Cohort (IMPACC) is a prospective, observational study of 1164 patients from 20 hospitals across the United States. Disease severity was assessed using a 7-point ordinal scale based on degree of respiratory illness. Patients were prospectively surveyed for 1 year after discharge for post-acute sequalae of COVID-19 (PASC) through quarterly surveys. Demographics, comorbidities, radiographic findings, clinical laboratory values, SARS-CoV-2 PCR and serology were captured over a 28-day period. Multivariable logistic regression was performed.
Findings: The median age was 59 years (interquartile range [IQR] 20); 711 (61%) were men; overall mortality was 14%, and 228 (20%) required invasive mechanical ventilation. Unsupervised clustering of ordinal score over time revealed distinct disease course trajectories. Risk factors associated with prolonged hospitalization or death by day 28 included age ≥ 65 years (odds ratio [OR], 2.01; 95% CI 1.28-3.17), Hispanic ethnicity (OR, 1.71; 95% CI 1.13-2.57), elevated baseline creatinine (OR 2.80; 95% CI 1.63- 4.80) or troponin (OR 1.89; 95% 1.03-3.47), baseline lymphopenia (OR 2.19; 95% CI 1.61-2.97), presence of infiltrate by chest imaging (OR 3.16; 95% CI 1.96-5.10), and high SARS-CoV2 viral load (OR 1.53; 95% CI 1.17-2.00). Fatal cases had the lowest ratio of SARS-CoV-2 antibody to viral load levels compared to other trajectories over time (p=0.001). 589 survivors (51%) completed at least one survey at follow-up with 305 (52%) having at least one symptom consistent with PASC, most commonly dyspnea (56% among symptomatic patients). Female sex was the only associated risk factor for PASC.
Interpretation: Integration of PCR cycle threshold, and antibody values with demographics, comorbidities, and laboratory/radiographic findings identified risk factors for 28-day outcome severity, though only female sex was associated with PASC. Longitudinal clinical phenotyping offers important insights, and provides a framework for immunophenotyping for acute and long COVID-19.
Funding: NIH.
Keywords: Antibody; COVID-19; SARS-CoV-2; Viral load.