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1.
Archivos de bronconeumologia ; 2022.
Article in English | EuropePMC | ID: covidwho-1801724

ABSTRACT

Introduction The COVID-19 pandemic created tremendous challenges for health-care systems. Intensive care units (ICU) were hit with a large volume of patients requiring ICU admission, mechanical ventilation, and other organ support with very high mortality. The Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CIBERES), a network of Spanish researchers to investigate in respiratory disease, commissioned the current proposal in response to the Instituto de Salud Carlos III (ISCIII) call. Methods CIBERESUCICOVID is a multicenter, observational, prospective/retrospective cohort study of patients with COVID-19 admitted to Spanish ICUs. Several work packages were created, including study population and ICU data collection, follow-up, biomarkers and miRNAs, data management and quality. Results This study included 6102 consecutive patients admitted to 55 ICUs homogeneously distributed throughout Spain and the collection of blood samples from more than 1000 patients. We enrolled a large population of COVID-19 ICU-admitted patients including baseline characteristics, ICU and MV data, treatments complications, and outcomes. The in-hospital mortality was 31%, and 76% of patients required invasive mechanical ventilation. A 3-6 month and 1 year follow-up was performed. Few deaths after 1 year discharge were registered. Low anti-SARS-CoV-2 S antibody levels predict mortality in critical COVID-19. These antibodies contribute to prevent systemic dissemination of SARS-CoV-2. The severity of COVID-19 impacts the circulating miRNA profile. Plasma miRNA profiling emerges as a useful tool for risk-based patient stratification in critically ill COVID-19 patients. Conclusions We present the methodology used in a large multicenter study sponsored by ISCIII to determine the short- and long-term outcomes in patients with COVID-19 admitted to more than 50 Spanish ICUs.

3.
Archivos de Bronconeumología ; 2022.
Article in English | ScienceDirect | ID: covidwho-1797169
4.
Archivos de Bronconeumología ; 2022.
Article in English | ScienceDirect | ID: covidwho-1797167

ABSTRACT

Introduction: The COVID-19 pandemic created tremendous challenges for health-care systems. Intensive care units (ICU) were hit with a large volume of patients requiring ICU admission, mechanical ventilation, and other organ support with very high mortality. The Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CIBERES), a network of Spanish researchers to investigate in respiratory disease, commissioned the current proposal in response to the Instituto de Salud Carlos III (ISCIII) call. Methods: CIBERESUCICOVID is a multicenter, observational, prospective/retrospective cohort study of patients with COVID-19 admitted to Spanish ICUs. Several work packages were created, including study population and ICU data collection, follow-up, biomarkers and miRNAs, data management and quality. Results: This study included 6102 consecutive patients admitted to 55 ICUs homogeneously distributed throughout Spain and the collection of blood samples from more than 1000 patients. We enrolled a large population of COVID-19 ICU-admitted patients including baseline characteristics, ICU and MV data, treatments complications, and outcomes. The in-hospital mortality was 31%, and 76% of patients required invasive mechanical ventilation. A 3-6 month and 1 year follow-up was performed. Few deaths after 1 year discharge were registered. Low anti-SARS-CoV-2 S antibody levels predict mortality in critical COVID-19. These antibodies contribute to prevent systemic dissemination of SARS-CoV-2. The severity of COVID-19 impacts the circulating miRNA profile. Plasma miRNA profiling emerges as a useful tool for risk-based patient stratification in critically ill COVID-19 patients. Conclusions: We present the methodology used in a large multicenter study sponsored by ISCIII to determine the short- and long-term outcomes in patients with COVID-19 admitted to more than 50 Spanish ICUs. RESUMEN Introducción: La pandemia de COVID-19 ha supuesto un enorme reto para los sistemas sanitarios. Las unidades de cuidados intensivos (UCI) se han visto afectadas por un gran volumen de pacientes que requerían ingreso en la UCI, ventilación mecánica y otras asistencias de órganos con gran mortalidad. El Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CIBERES), una red de investigadores españoles para el estudio de enfermedades respiratorias, encargó la presente propuesta en respuesta a la convocatoria del Instituto de Salud Carlos III (ISCIII). Métodos: CIBERESUCICOVID es un estudio de cohortes multicéntrico, observacional, prospectivo/retrospectivo de pacientes con COVID-19 ingresados en UCI españolas. Se crearon varios paquetes de trabajo: población de estudio y recogida de datos en la UCI, seguimiento, biomarcadores y miRNA, gestión de datos y calidad. Resultados: Este estudio incluyó a 6.102 pacientes consecutivos ingresados en 55 UCI distribuidas homogéneamente por toda España, y se recogieron muestras de sangre de más de 1.000 pacientes. Se incluyó a una amplia población de pacientes ingresados en UCI de COVID-19, y se registraron las características basales, los datos de la UCI y la ventilación mecánica, las complicaciones de los tratamientos y los resultados. La mortalidad hospitalaria fue del 31%, y el 76% de los pacientes requirieron ventilación mecánica invasiva. Se realizó un seguimiento de 3-6 meses y de 1 año. Se registraron pocas muertes después del alta a 1 año. Las bajas cifras de anticuerpos anti-SARS-CoV-2 S predicen la mortalidad en la COVID-19 crítica. Estos anticuerpos contribuyen a prevenir la diseminación sistémica del SARS-CoV-2. La gravedad de la COVID-19 influye en el perfil de miRNA circulantes. El perfil de miRNA plasmático emerge como un dato útil para la estratificación basada en el riesgo de los pacientes con COVID-19 en estado crítico. Conclusiones: Se presenta la metodología utilizada en un gran estudio multicéntrico patrocinado por el ISCIII para determinar los resultados a corto y largo plazo en pacientes con COVID-19 ingresados en más de 50 UCI españolas.

5.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-332987

ABSTRACT

Background: Detection of co-infections is important to initiate appropriate antimicrobial therapy. Molecular diagnostic testing identifies pathogens at a greater rate than conventional microbiology. We assessed both bacterial co-infections identified in culture or multiplex PCR FilmArray® Pneumonia Panel (FA-PNEU) in patients infected with SARS-CoV-2 in ICU and the concordance between these techniques.MethodsProspective study of patients with SARS-CoV-2 who were hospitalized for no more than 48 hours, in mechanical ventilation no longer than 24 hours in 8 ICUs in Medellín, Colombia. We studied mini-bronchoalveolar lavage or endotracheal aspirate samples processed in conventional culture and FA-PNEU. Co-infection was defined as the identification of a respiratory pathogen using FA-PNEU or cultures.ResultsOf 110 patients who underwent both methods, FA-PNEU and culture-positive samples comprised 24.54% vs 17.27%, respectively. 18 samples were positive for both techniques, 82 were negative, one was culture-positive with negative FA-PNEU, and 9 were FA-PNEU-positive with negative culture. The two bacteria most frequently detected by FA-PNEU were Staphylococcus aureus (37.5%) and Streptococcus agalactiae (20%) and by culture were Staphylococcus aureus (34.78%) and Klebsiella pneumoniae (26.08%). The overall concordance was 90.1% and by microorganism it was between 92.7% and 100%. Positive predictive values (PPV) were between 50% and 100%, being lower for Enterobacter cloacae and Staphylococcus aureus . Negative predictive values (NPV) were high (between 99.1% and 100%);MecA/C/MREJ had a specificity of 94.55% and a NPV of 100%.ConclusionsThe overall concordance was 90.1%, and it was between 92.7% and 100% by microorganisms. The positive qualitative agreement was between 50% and 100%, with a very high NPV.

6.
Research Square ; 2022.
Article in English | EuropePMC | ID: covidwho-1786481

ABSTRACT

Background: Detection of co-infections is important to initiate appropriate antimicrobial therapy. Molecular diagnostic testing identifies pathogens at a greater rate than conventional microbiology. We assessed both bacterial co-infections identified in culture or multiplex PCR FilmArray® Pneumonia Panel (FA-PNEU) in patients infected with SARS-CoV-2 in ICU and the concordance between these techniques.MethodsProspective study of patients with SARS-CoV-2 who were hospitalized for no more than 48 hours, in mechanical ventilation no longer than 24 hours in 8 ICUs in Medellín, Colombia. We studied mini-bronchoalveolar lavage or endotracheal aspirate samples processed in conventional culture and FA-PNEU. Co-infection was defined as the identification of a respiratory pathogen using FA-PNEU or cultures.ResultsOf 110 patients who underwent both methods, FA-PNEU and culture-positive samples comprised 24.54% vs 17.27%, respectively. 18 samples were positive for both techniques, 82 were negative, one was culture-positive with negative FA-PNEU, and 9 were FA-PNEU-positive with negative culture. The two bacteria most frequently detected by FA-PNEU were Staphylococcus aureus (37.5%) and Streptococcus agalactiae (20%) and by culture were Staphylococcus aureus (34.78%) and Klebsiella pneumoniae (26.08%). The overall concordance was 90.1% and by microorganism it was between 92.7% and 100%. Positive predictive values (PPV) were between 50% and 100%, being lower for Enterobacter cloacae and Staphylococcus aureus . Negative predictive values (NPV) were high (between 99.1% and 100%);MecA/C/MREJ had a specificity of 94.55% and a NPV of 100%.ConclusionsThe overall concordance was 90.1%, and it was between 92.7% and 100% by microorganisms. The positive qualitative agreement was between 50% and 100%, with a very high NPV.

8.
Crit Care Med ; 2022 Feb 18.
Article in English | MEDLINE | ID: covidwho-1722615

ABSTRACT

Objectives: To evaluate the sleep and circadian rest-activity pattern of critical COVID-19 survivors 3 months after hospital discharge. Design: Observational, prospective study. Setting: Single-center study. Patients: One hundred seventy-two consecutive COVID-19 survivors admitted to the ICU with acute respiratory distress syndrome. Interventions: Seven days of actigraphy for sleep and circadian rest-activity pattern assessment; validated questionnaires; respiratory tests at the 3-month follow-up. Measurements and Main Results: The cohort included 172 patients, mostly males (67.4%) with a median (25th-75th percentile) age of 61.0 years (52.8-67.0 yr). The median number of days at the ICU was 11.0 (6.00-24.0), and 51.7% of the patients received invasive mechanical ventilation (IMV). According to the Pittsburgh Sleep Quality Index (PSQI), 60.5% presented poor sleep quality 3 months after hospital discharge, which was further confirmed by actigraphy. Female sex was associated with an increased score in the PSQI (p < 0.05) and IMV during ICU stay was able to predict a higher fragmentation of the rest-activity rhythm at the 3-month follow-up (p < 0.001). Furthermore, compromised mental health measured by the Hospital Anxiety and Depression Scale was associated with poor sleep quality (p < 0.001). Conclusions: Our findings highlight the importance of considering sleep and circadian health after hospital discharge. Within this context, IMV during the ICU stay could aid in predicting an increased fragmentation of the rest-activity rhythm at the 3-month follow-up. Furthermore, compromised mental health could be a marker for sleep disruption at the post-COVID period.

9.
Semin Respir Crit Care Med ; 43(1): 60-74, 2022 02.
Article in English | MEDLINE | ID: covidwho-1688937

ABSTRACT

Severe viral infections may result in severe illnesses capable of causing acute respiratory failure that could progress rapidly to acute respiratory distress syndrome (ARDS), related to worse outcomes, especially in individuals with a higher risk of infection, including the elderly and those with comorbidities such as asthma, diabetes mellitus and chronic respiratory or cardiovascular disease. In addition, in cases of severe viral pneumonia, co-infection with bacteria such as Streptococcus pneumoniae and Staphylococcus aureus is related to worse outcomes. Respiratory viruses like influenza, rhinovirus, parainfluenza, adenovirus, metapneumovirus, respiratory syncytial virus, and coronavirus have increasingly been detected. This trend has become more prevalent, especially in critically ill patients, due to the availability and implementation of molecular assays in clinical practice. Respiratory viruses have been diagnosed as a frequent cause of severe pneumonia, including cases of community-acquired pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia. In this review, we will discuss the epidemiology, diagnosis, clinical characteristics, management, and prognosis of patients with severe infections due to respiratory viruses, with a focus on influenza viruses, non-influenza viruses, and coronaviruses.


Subject(s)
Respiratory Tract Infections , Virus Diseases , Aged , Coronavirus , Humans , Patient Acuity , Prognosis , Respiratory Tract Infections/diagnosis , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/therapy , Respiratory Tract Infections/virology , Virus Diseases/diagnosis , Virus Diseases/epidemiology , Virus Diseases/therapy
11.
Front Med (Lausanne) ; 8: 756517, 2021.
Article in English | MEDLINE | ID: covidwho-1703379

ABSTRACT

Background: The pathophysiology of COVID-19-related critical illness is not completely understood. Here, we analyzed the microRNA (miRNA) profile of bronchial aspirate (BAS) samples from COVID-19 and non-COVID-19 patients admitted to the ICU to identify prognostic biomarkers of fatal outcomes and to define molecular pathways involved in the disease and adverse events. Methods: Two patient populations were included (n = 89): (i) a study population composed of critically ill COVID-19 and non-COVID-19 patients; (ii) a prospective study cohort composed of COVID-19 survivors and non-survivors among patients assisted by invasive mechanical ventilation (IMV). BAS samples were obtained by bronchoaspiration during the ICU stay. The miRNA profile was analyzed using RT-qPCR. Detailed biomarker and bioinformatics analyses were performed. Results: The deregulation in five miRNA ratios (miR-122-5p/miR-199a-5p, miR-125a-5p/miR-133a-3p, miR-155-5p/miR-486-5p, miR-214-3p/miR-222-3p, and miR-221-3p/miR-27a-3p) was observed when COVID-19 and non-COVID-19 patients were compared. In addition, five miRNA ratios segregated between ICU survivors and nonsurvivors (miR-1-3p/miR-124-3p, miR-125b-5p/miR-34a-5p, miR-126-3p/miR-16-5p, miR-199a-5p/miR-9-5p, and miR-221-3p/miR-491-5p). Through multivariable analysis, we constructed a miRNA ratio-based prediction model for ICU mortality that optimized the best combination of miRNA ratios (miR-125b-5p/miR-34a-5p, miR-199a-5p/miR-9-5p, and miR-221-3p/miR-491-5p). The model (AUC 0.85) and the miR-199a-5p/miR-9-5p ratio (AUC 0.80) showed an optimal discrimination value and outperformed the best clinical predictor for ICU mortality (days from first symptoms to IMV initiation, AUC 0.73). The survival analysis confirmed the usefulness of the miRNA ratio model and the individual ratio to identify patients at high risk of fatal outcomes following IMV initiation. Functional enrichment analyses identified pathological mechanisms implicated in fibrosis, coagulation, viral infections, immune responses and inflammation. Conclusions: COVID-19 induces a specific miRNA signature in BAS from critically ill patients. In addition, specific miRNA ratios in BAS samples hold individual and collective potential to improve risk-based patient stratification following IMV initiation in COVID-19-related critical illness. The biological role of the host miRNA profiles may allow a better understanding of the different pathological axes of the disease.

13.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-316534

ABSTRACT

Background: . Some patients who had previously presented with COVID-19 have been reported to develop persistent COVID-19 symptoms. Whilst this information has been adequately recognised and extensively published with respect to non-critically ill patients, less is known about the prevalence and risk factors and characteristics of persistent COVID_19 . On other hand these patients have very often intensive care unit-acquired pneumonia (ICUAP). A second infectious hit after COVID increases the length of ICU stay and mechanical ventilation and could have an influence in the poor health post-Covid 19 syndrome in ICU discharged patients Methods: This prospective, multicentre and observational study was done across 40 selected ICUs in Spain. Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated three months after hospital discharge. Results: A total of 1,255 ICU patients were scheduled to be followed up at 3 months;however, the final cohort comprised 991 (78.9%) patients. A total of 315 patients developed ICUAP (97% of them had ventilated ICUAP) Patients requiring invasive mechanical ventilation had persistent, post-COVID-19 symptoms than those who did not require mechanical ventilation. Female sex, duration of ICU stay, and development of ICUAP were independent risk factors for persistent poor health post-COVID-19. Conclusions: : Persistent, post-COVID-19 symptoms occurred in more than two-thirds of patients. Female sex, duration of ICU stay and the onset of ICUAP comprised all independent risk factors for persistent poor health post-COVID-19. Prevention of ICUAP could have beneficial effects in poor health post-Covid 19

14.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-306446

ABSTRACT

Background: Risk factors associated with mortality in patients with coronavirus disease 2019 (COVID-19) on mechanical ventilation are still not fully elucidated. Thus, we aimed to identify patient-level factors, readily available at the bedside, associated with the risk of in-hospital mortality within 28 days from commencement of invasive mechanical ventilation (28-day IMV mortality) in patients with COVID-19. Methods: Prospective observational cohort study in 148 intensive care units in the global COVID-19 Critical Care Consortium . Patients with clinically suspected or laboratory confirmed COVID-19 infection admitted to the intensive care unit (ICU) from February 2 nd through December 29th, 2020, requiring IMV. No study-specific interventions were performed. Patient characteristics and clinical data were assessed upon ICU admission, the commencement of IMV and for 28 days thereafter. We primarily aimed to identify time-independent and time-dependent risk factors for 28-day IMV mortality. Results: : A total of 1713 patients were included in the survival analysis, 588 patients died in hospital within 28 days of commencing IMV (34.3%). Cox-regression analysis identified associations between the hazard of 28-day IMV mortality with age (HR 1.27 per 10-year increase in age, 95% CI 1.17 to 1.37, P<0.001), PEEP upon commencement of IMV (HR 0.78 per 5-cmH 2 O increase, 95% CI 0.66-0.93, P=0.005). Time-dependent parameters associated with 28-day IMV mortality were serum creatinine (HR 1.30 per doubling, 95% CI 1.19-1.42, P<0.001), lactate (HR 1.16 per doubling, 95% CI 1.06-1.27 P=0.001), PaCO 2 (HR 1.31 per doubling, 95% CI 1.05-1.64, P=0.015), pH (HR 0.82 per 0.1 increase, 95% CI 0.74-0.91, P<0.001), PaO 2 /FiO 2 (HR 0.56 per doubling, 95% CI 0.50-0.62, P<0.001) and mean arterial pressure (HR 0.92 per 10 mmHg increase, 95% CI 0.88-0.97, P=0.002). Conclusions: : This international study establishes that in mechanically ventilated patients with COVID-19, older age and clinically relevant variables monitored at the bedside are risk factors for 28-day IMV mortality. Further investigation is warranted to validate any causative roles these parameters might play in influencing clinical outcomes.

15.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-306445

ABSTRACT

Background: Heterogeneous respiratory system static compliance (C RS ) values and levels of hypoxemia in patients with novel coronavirus disease (COVID-19) requiring mechanical ventilation have been reported in previous small-case series or studies conducted at a national level. Methods We designed a retrospective observational cohort study with rapid data gathering from the international COVID-19 Critical Care Consortium study to comprehensively describe the impact of C RS on the ventilatory management and outcomes of COVID-19 patients on mechanical ventilation (MV), admitted to intensive care units (ICU) worldwide. Results We enrolled 318 COVID-19 patients enrolled into the study from January 14th through September 31th, 2020 in 19 countries and stratified into two C RS groups. C RS was calculated as: tidal volume/[airway plateau pressure-positive end-expiratory pressure (PEEP)] and available within 48 h from commencement of MV in 318 patients. Patients were mean ± SD of 58.0 ± 12.2, predominantly from Europe (54%) and males (68%). Median C RS (IQR) was 34.1 mL/cmH 2 O (26.5–45.5) and PaO 2 /FiO 2 was 119 mmHg (87.1–164) and was not correlated with C RS . Female sex presented lower C RS than in males (95% CI: -13.8 to -8.5 P < 0.001) and higher body mass index (34.7 ± 10.9 vs 29.1 ± 6.0, p < 0.001). Median (IQR) PEEP was 12 cmH 2 O (10–15), throughout the range of C RS , while median (IQR) driving pressure was 12.3 (10–15) cmH 2 O and significantly decreased as C RS improved (p < 0.001). No differences were found in comorbidities and clinical management between C RS strata. In addition, 28-day ICU mortality and hospital mortality did not differ between C RS groups. Conclusions This multicentre report provides a comprehensive account of C RS in COVID-19 patients on MV – predominantly males or overweight females, in their late 50 s – admitted to ICU during the first international outbreaks. Phenotypes associated with different C RS upon commencement of MV could not be identified. Trial documentation: Available at https://www.covid-critical.com/study. Trial registration ACTRN12620000421932.

16.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-305826

ABSTRACT

Purpose: We aimed to describe the use of high-flow nasal oxygen (HFNO) in patients with COVID-19 acute respiratory failure and factors associated with a shift to invasive mechanical ventilation. Methods This is a multicentre, observational study from a prospectively collected database of consecutive COVID-19 patients admitted to 36 Spanish and Andorran intensive care units (ICUs) who received HFNO on ICU admission during a 22-week period (March 12-August 13, 2020). Outcomes of interest were factors on the day of ICU admission associated with the need for endotracheal intubation. We used multivariable logistic regression and mixed effects models. A predictive model for endotracheal intubation in patients treated with HFNO was derived and internally validated. Results From a total of 259 patients initially treated with HFNO, 140 patients (54%) required invasive mechanical ventilation. Baseline non-respiratory Sequential Organ Failure Assessment (SOFA) score [odds ratio (OR) 1.78;95% confidence interval (CI) 1.41–2.35], and the ROX index calculated as the ratio of partial pressure of arterial oxygen to inspired oxygen fraction divided by respiratory rate (OR 0.53;95% CI: 0.37–0.72), and pH (OR 0.47;95% CI: 0.24–0.86) were associated with intubation. Hospital site explained 1% of the variability in the likelihood of intubation after initial treatment with HFNO. A predictive model including non-respiratory SOFA score and the ROX index showed excellent performance (AUC 0.88, 95%CI 0.80–0.96). Conclusions Among adult critically ill patients with COVID-19 initially treated with HFNO, the SOFA score and the ROX index may help to identify patients with higher likelihood of intubation.

17.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-305825

ABSTRACT

Purpose: Whether the use of high-flow nasal oxygen in adult patients with COVID-19 associated acute respiratory failure improves clinically relevant outcomes remains unclear. We thus sought to assess the effect of high-flow nasal oxygen on ventilator-free days, compared to early initiation of invasive mechanical ventilation, on adult patients with COVID-19. Methods: : We conducted a multicentre cohort study using a prospectively collected database of patients with COVID-19 associated acute respiratory failure admitted to 36 Spanish and Andorran intensive care units (ICUs). Main exposure was the use of high-flow nasal oxygen (conservative group), while early invasive mechanical ventilation (within the first day of ICU admission;early intubation group) served as the comparator. The primary outcome was ventilator-free days at 28 days. ICU length of stay and all-cause in-hospital mortality served as secondary outcomes. We used propensity score matching to adjust for measured confounding. Results: : Out of 468 eligible patients, a total of 122 matched patients were included in the present analysis (61 for each group). When compared to early intubation, the use of high-flow nasal oxygen was associated with an increase in ventilator-free days (mean difference: 8.0 days;95% confidence interval (CI): 4.4 to 11.7 days), and a reduction in ICU length of stay (mean difference: -8.2 days;95% CI -12.7 to -3.6 days). No difference was observed in all-cause in-hospital mortality between groups (odds ratio: 0.64;95% CI: 0.25 to 1.64). Conclusions: The use of high-flow nasal oxygen upon ICU admission in adult patients with COVID-19 related acute hypoxemic respiratory failure may lead to an increase in ventilator-free days and a reduction in ICU length of stay, when compared to early initiation of invasive mechanical ventilation. Future studies should confirm our findings.

18.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-322368

ABSTRACT

ABSTRACT Young and middle-aged adults are the largest group of patients infected with SARS-CoV-2 and some of them develop severe disease. Objective: To investigate clinical manifestations in adults aged 18-65 years hospitalized for COVID-19 and identify predictors of poor outcome. Secondary objectives: to explore potential differences compared to the disease in elderly patients and the suitability of the commonly used community-acquired pneumonia prognostic scales in younger populations. Methods: Multicenter prospective registry of consecutive patients hospitalized for COVID-19 pneumonia aged 18-65 years between March and May 2020. We considered a composite outcome of “poor outcome” including intensive care unit admission and/or use of noninvasive ventilation, continuous positive airway pressure or high flow nasal cannula oxygen therapies and/or death. Results: We identified 513 patients <65 years of age, from a cohort of 993 patients. 102 had poor outcomes (19.8%) and 3.9% died. 78% and 55% of patients with poor outcomes were classified as low risk based on CURB and PSI scores respectively. A multivariate Cox regression model identified six independent factors associated with poor outcome: heart disease, chest pain, anosmia, low oxygen saturation, high LDH and lymphocyte count <800/mL. Conclusions: COVID-19 in younger patients carries significant morbidity and differs in some respects from this disease the elderly. Baseline heart disease is a relevant risk factor, while anosmia and pleuritic pain are more common and protective. Hypoxemia, LDH and lymphocyte count are predictors of poor outcome. We consider that CURB and PSI scores are not suitable criteria for deciding admission in this population.

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