RISK FACTORS FOR COVID-19 CRITICAL ILLNESS AMONG TWO URBAN PUBLIC HOSPITALS

ABSTRACT

SESSION TITLE Tobacco Use, Risk Factors, and Managing Patients with Pulmonary Diseases SESSION TYPE Rapid Fire Original Inv PRESENTED ON 10/19/2022 1115 am - 1215 pm PURPOSE: COVID-19 disproportionately affects patients who are Hispanic or Black. Risk factors for COVID-19 progression to critical illness – defined as a composite outcome of ICU transfer, need for invasive or non-invasive mechanical ventilation, or in-hospital mortality – have not been fully identified in this patient population. The Harris Health System (HHS) in Houston, Texas serves a unique patient population who are underserved and predominantly Hispanic or Black. We examined the clinical characteristics of adults admitted with COVID-19 to HHS affiliated county hospitals and examined risk factors that predicted progression to critical illness. METHODS: This was an observational cohort study of adult patients with COVID-19 infection admitted from the emergency room between March 2020 and December 2020. We excluded patients who were pregnant or admitted to primary surgical services. We additionally excluded patients who - within the first 24 hours of presentation to the ED - were admitted to the ICU, required mechanical ventilation, or expired. We captured clinical characteristics from the first 24 hours of presentation. We used Lasso logistic regression for variable selection, and included those variables that remained significant in a multiple logistic model predicting progression to critical illness. Discrimination of the model was assessed using 10-fold cross-validated area under the receiver operator characteristic (AUROC) curve. RESULTS: 1777 patients were included in the final analysis. 211 patients progressed to critical illness – 91 (5.1%) died, 148 (8.3%) required invasive or non-invasive mechanical ventilation, and 164 (9.2%) were transferred to the ICU. Several notable risk factors for progression to COVID critical illness included age (adj OR 1.04, 95% CI 1.02, 1.05), body mass index (adj OR 1.04, 95% CI 1.02, 1.06), chronic pulmonary disease (adj OR = 2.07, 95% CI 1.15, 3.72), renal disease (adj OR 2.08, 95% CI 1.28, 3.37), and active malignancy (adj OR 2.20, 95% CI 1.11, 4.37). Compared to patients who did not require oxygen support within the first 24h, those who required high flow nasal cannula were more likely to progress to critical illness (adj OR 4.10, 95% CI 2.39, 7.02). The prediction model demonstrated a 10-fold cross-validated AUROC of 0.79 (95% CI 0.76, 0.81). CONCLUSIONS: In this unique population of underserved and majority Hispanic and Black patients, we identified multiple risk factors that predict patients with COVID-19 at risk of progression to critical illness. CLINICAL IMPLICATIONS We believe that this prediction model has the ability to identify patients with COVID-19 at risk of progression to critical disease and who may benefit from closer monitoring and/or timely initiation of novel interventions. DISCLOSURES No relevant relationships by Hana El Sahly No relevant relationships by Casey Graziani Advisory Committee Member relationship with AstraZeneca, Genentech, GSK, Mylan, Sanofi Please note 2020-2021 by Nicola Hanania, value=Consulting fee Consultant relationship with AstraZeneca, Genentech, GSK, Mylan, Sanofi Please note 2020-2021 by Nicola Hanania, value=Consulting fee Advisory Committee Member relationship with Regeneron, Amgen, and Teva Please note 2020-2021 by Nicola Hanania, value=Consulting fee Consultant relationship with Regeneron, Amgen, and Teva Please note 2020-2021 by Nicola Hanania, value=Consulting fee Removed 08/02/2022 by Nicola Hanania Research support relationship with Boehringer Ingelheim, GSK, Novartis Please note 2020-2021 by Nicola Hanania, value=Grant/Research Support Research support relationship with Sanofi Genzyme and Genentech Please note 2020-2021 by Nicola Hanania, value=Grant/Research Support No relevant relationships by Ang Li No relevant relationships by Dharani Kumari Narendra No relevant relationships by Shital Patel No relevant relationships by Krist n Staggers