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Risk Factors for Hospitalization, Mechanical Ventilation, or Death Among 10 131 US Veterans With SARS-CoV-2 Infection.
Ioannou, George N; Locke, Emily; Green, Pamela; Berry, Kristin; O'Hare, Ann M; Shah, Javeed A; Crothers, Kristina; Eastment, McKenna C; Dominitz, Jason A; Fan, Vincent S.
  • Ioannou GN; Division of Gastroenterology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle.
  • Locke E; Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
  • Green P; Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
  • Berry K; Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
  • O'Hare AM; Division of Nephrology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle.
  • Shah JA; Division of Allergy and Infectious Disease, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle.
  • Crothers K; Division of Pulmonary and Critical Care, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle.
  • Eastment MC; Division of Allergy and Infectious Disease, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle.
  • Dominitz JA; Division of Gastroenterology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle.
  • Fan VS; Division of Pulmonary and Critical Care, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle.
JAMA Netw Open ; 3(9): e2022310, 2020 09 01.
Article in English | MEDLINE | ID: covidwho-784192
Semantic information from SemMedBD (by NLM)
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2. risk factors PROCESS_OF Patients
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risk factors
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18. Mechanical ventilation TREATS Patients
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19. Nucleic Acids PART_OF 2019 novel coronavirus
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Cessation of life
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ABSTRACT
Importance Identifying independent risk factors for adverse outcomes in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can support prognostication, resource utilization, and treatment.

Objective:

To identify excess risk and risk factors associated with hospitalization, mechanical ventilation, and mortality in patients with SARS-CoV-2 infection. Design, Setting, and

Participants:

This longitudinal cohort study included 88 747 patients tested for SARS-CoV-2 nucleic acid by polymerase chain reaction between Feburary 28 and May 14, 2020, and followed up through June 22, 2020, in the Department of Veterans Affairs (VA) national health care system, including 10 131 patients (11.4%) who tested positive. Exposures Sociodemographic characteristics, comorbid conditions, symptoms, and laboratory test results. Main Outcomes and

Measures:

Risk of hospitalization, mechanical ventilation, and death were estimated in time-to-event analyses using Cox proportional hazards models.

Results:

The 10 131 veterans with SARS-CoV-2 were predominantly male (9221 [91.0%]), with diverse race/ethnicity (5022 [49.6%] White, 4215 [41.6%] Black, and 944 [9.3%] Hispanic) and a mean (SD) age of 63.6 (16.2) years. Compared with patients who tested negative for SARS-CoV-2, those who tested positive had higher rates of 30-day hospitalization (30.4% vs 29.3%; adjusted hazard ratio [aHR], 1.13; 95% CI, 1.08-1.13), mechanical ventilation (6.7% vs 1.7%; aHR, 4.15; 95% CI, 3.74-4.61), and death (10.8% vs 2.4%; aHR, 4.44; 95% CI, 4.07-4.83). Among patients who tested positive for SARS-CoV-2, characteristics significantly associated with mortality included older age (eg, ≥80 years vs <50 years aHR, 60.80; 95% CI, 29.67-124.61), high regional COVID-19 disease burden (eg, ≥700 vs <130 deaths per 1 million residents aHR, 1.21; 95% CI, 1.02-1.45), higher Charlson comorbidity index score (eg, ≥5 vs 0 aHR, 1.93; 95% CI, 1.54-2.42), fever (aHR, 1.51; 95% CI, 1.32-1.72), dyspnea (aHR, 1.78; 95% CI, 1.53-2.07), and abnormalities in the certain blood tests, which exhibited dose-response associations with mortality, including aspartate aminotransferase (>89 U/L vs ≤25 U/L aHR, 1.86; 95% CI, 1.35-2.57), creatinine (>3.80 mg/dL vs 0.98 mg/dL aHR, 3.79; 95% CI, 2.62-5.48), and neutrophil to lymphocyte ratio (>12.70 vs ≤2.71 aHR, 2.88; 95% CI, 2.12-3.91). With the exception of geographic region, the same covariates were independently associated with mechanical ventilation along with Black race (aHR, 1.52; 95% CI, 1.25-1.85), male sex (aHR, 2.07; 95% CI, 1.30-3.32), diabetes (aHR, 1.40; 95% CI, 1.18-1.67), and hypertension (aHR, 1.30; 95% CI, 1.03-1.64). Notable characteristics that were not significantly associated with mortality in adjusted analyses included obesity (body mass index ≥35 vs 18.5-24.9 aHR, 0.97; 95% CI, 0.77-1.21), Black race (aHR, 1.04; 95% CI, 0.88-1.21), Hispanic ethnicity (aHR, 1.03; 95% CI, 0.79-1.35), chronic obstructive pulmonary disease (aHR, 1.02; 95% CI, 0.88-1.19), hypertension (aHR, 0.95; 95% CI, 0.81-1.12), and smoking (eg, current vs never aHR, 0.87; 95% CI, 0.67-1.13). Most deaths in this cohort occurred in patients with age of 50 years or older (63.4%), male sex (12.3%), and Charlson Comorbidity Index score of at least 1 (11.1%). Conclusions and Relevance In this national cohort of VA patients, most SARS-CoV-2 deaths were associated with older age, male sex, and comorbidity burden. Many factors previously reported to be associated with mortality in smaller studies were not confirmed, such as obesity, Black race, Hispanic ethnicity, chronic obstructive pulmonary disease, hypertension, and smoking.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Respiration, Artificial / Veterans / Cause of Death / Coronavirus Infections / Pandemics / Hospitalization Type of study: Etiology study / Incidence study / Observational study / Prognostic study / Risk factors Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: JAMA Netw Open Year: 2020 Document Type: Article

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Respiration, Artificial / Veterans / Cause of Death / Coronavirus Infections / Pandemics / Hospitalization Type of study: Etiology study / Incidence study / Observational study / Prognostic study / Risk factors Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: JAMA Netw Open Year: 2020 Document Type: Article