tetano
Editor, Senior Moderator
Infect Dis Now
. 2022 Feb 13;S2666-9919(22)00032-X.
doi: 10.1016/j.idnow.2022.02.001. Online ahead of print.
Factors associated with hospital admission and adverse outcome for COVID-19: role of social factors and medical care
A-L Beaumont[SUP] 1 [/SUP], D Vignes[SUP] 2 [/SUP], R Sterpu[SUP] 3 [/SUP], G Bussone[SUP] 3 [/SUP], I Kansau[SUP] 3 [/SUP], C Pignon[SUP] 3 [/SUP], R Ben Ismail[SUP] 3 [/SUP], M Favier[SUP] 3 [/SUP], J-L Molitor[SUP] 3 [/SUP], D Braham[SUP] 3 [/SUP], R Fior[SUP] 3 [/SUP], S Roy[SUP] 4 [/SUP], M Mion[SUP] 5 [/SUP], L Meyer[SUP] 6 [/SUP], M Andronikof[SUP] 7 [/SUP], C Damoisel[SUP] 8 [/SUP], P Chagué[SUP] 9 [/SUP], J-C Aurégan[SUP] 10 [/SUP], N Bourgeois-Nicolaos[SUP] 11 [/SUP], C Guillet-Caruba[SUP] 11 [/SUP], J-P Téglas[SUP] 12 [/SUP], S Abgrall[SUP] 13 [/SUP]
Affiliations
Abstract
Background: Beyond sex, age, and various comorbidities, geographical origin and socio-economic deprivation are associated with Coronavirus Disease (COVID-19) morbidity and mortality in the general population. We aimed to assess factors associated with severe forms of COVID-19 after a hospital emergency department visit, focusing on socio-economic factors.
Methods: Patients with laboratory-confirmed COVID-19 attending the emergency department of Béclère Hospital (France) in March-April 2020 were included. Postal addresses were used to obtain two geographical deprivation indices at the neighborhood level. Factors associated with hospitalization and factors associated with adverse outcomes, i.e. mechanical ventilation or death, were studied using logistic and Cox analyses, respectively.
Results: Among 399 included patients, 321 were hospitalized. Neither geographical origin nor socio-economic deprivation was associated with any of the outcomes. Being male, older, overweight or obese, diabetic, or having a neuropsychiatric disorder were independent risk factors for hospitalization. Among 296 patients hospitalized at Béclère Hospital, 91 experienced an adverse outcome. Older age, being overweight or obese, desaturation and extent of chest CT scan lesions >25% at admission (aHR 2.2 [95%CI, 1.3-3.5]) and higher peak CRP levels and acute kidney failure (aHR 2.0 [1.2-3.3]) during follow-up were independently associated with adverse outcomes, whereas treatment with hydrocortisone reduced the risk of mechanical ventilation or death by half (aHR 0.5 [0.3-0.8]).
Conclusion: No association between geographical origin or socio-economic deprivation and the occurrence of a severe form of COVID-19 was observed in our population after arrival to the emergency department. Empirical corticosteroid use with hydrocortisone had a strong protective impact.
Keywords: COVID-19; corticosteroids; geographical origin; socio-economic deprivation.
. 2022 Feb 13;S2666-9919(22)00032-X.
doi: 10.1016/j.idnow.2022.02.001. Online ahead of print.
Factors associated with hospital admission and adverse outcome for COVID-19: role of social factors and medical care
A-L Beaumont[SUP] 1 [/SUP], D Vignes[SUP] 2 [/SUP], R Sterpu[SUP] 3 [/SUP], G Bussone[SUP] 3 [/SUP], I Kansau[SUP] 3 [/SUP], C Pignon[SUP] 3 [/SUP], R Ben Ismail[SUP] 3 [/SUP], M Favier[SUP] 3 [/SUP], J-L Molitor[SUP] 3 [/SUP], D Braham[SUP] 3 [/SUP], R Fior[SUP] 3 [/SUP], S Roy[SUP] 4 [/SUP], M Mion[SUP] 5 [/SUP], L Meyer[SUP] 6 [/SUP], M Andronikof[SUP] 7 [/SUP], C Damoisel[SUP] 8 [/SUP], P Chagué[SUP] 9 [/SUP], J-C Aurégan[SUP] 10 [/SUP], N Bourgeois-Nicolaos[SUP] 11 [/SUP], C Guillet-Caruba[SUP] 11 [/SUP], J-P Téglas[SUP] 12 [/SUP], S Abgrall[SUP] 13 [/SUP]
Affiliations
- PMID: 35172217
- DOI: 10.1016/j.idnow.2022.02.001
Abstract
Background: Beyond sex, age, and various comorbidities, geographical origin and socio-economic deprivation are associated with Coronavirus Disease (COVID-19) morbidity and mortality in the general population. We aimed to assess factors associated with severe forms of COVID-19 after a hospital emergency department visit, focusing on socio-economic factors.
Methods: Patients with laboratory-confirmed COVID-19 attending the emergency department of Béclère Hospital (France) in March-April 2020 were included. Postal addresses were used to obtain two geographical deprivation indices at the neighborhood level. Factors associated with hospitalization and factors associated with adverse outcomes, i.e. mechanical ventilation or death, were studied using logistic and Cox analyses, respectively.
Results: Among 399 included patients, 321 were hospitalized. Neither geographical origin nor socio-economic deprivation was associated with any of the outcomes. Being male, older, overweight or obese, diabetic, or having a neuropsychiatric disorder were independent risk factors for hospitalization. Among 296 patients hospitalized at Béclère Hospital, 91 experienced an adverse outcome. Older age, being overweight or obese, desaturation and extent of chest CT scan lesions >25% at admission (aHR 2.2 [95%CI, 1.3-3.5]) and higher peak CRP levels and acute kidney failure (aHR 2.0 [1.2-3.3]) during follow-up were independently associated with adverse outcomes, whereas treatment with hydrocortisone reduced the risk of mechanical ventilation or death by half (aHR 0.5 [0.3-0.8]).
Conclusion: No association between geographical origin or socio-economic deprivation and the occurrence of a severe form of COVID-19 was observed in our population after arrival to the emergency department. Empirical corticosteroid use with hydrocortisone had a strong protective impact.
Keywords: COVID-19; corticosteroids; geographical origin; socio-economic deprivation.