Presentation of COVID-19 among the va greater Los Angeles population

ABSTRACT

Introduction: Few studies have examined the presentation and survival of veterans affected by COVID-19. This is the largest cohort study to investigate the presenting manifestations of COVID-19 and their implications on outcomes for this unique population. Method: A retrospective review of 99 COVID-19 patients admitted to the Veterans Affairs Greater Los Angeles Healthcare System, encompassing 3 campuses and serving 1.4 million veterans, from March 2020 to October 2020 was performed. Clinical data including age, race, comorbidities, presenting symptoms, and hospital course were collected. Outcome measures included the need for intubation or tracheotomy and overall survival. Statistical analyses were performed using Kaplan-Meier survival curves, Cox proportional hazard ratios, and χ2 tests. Results: The mean age was 75.1 years (SD ± 10.2 years). The most common presenting symptoms were cough (34.6%), dyspnea (33.7%), and fever (32.7%). Seventeen patients (16.8%) were intubated, and 6 patients (6.1%) underwent tracheotomy. A total of 33 patients (33.3%) died from COVID-19. Dyspnea as a presenting symptom was significantly correlated with worse overall survival (P = .009), even after controlling for comorbidities such as diabetes and chronic lung disease. Dyspneic patients were most likely to require intubation (P < .001) or tracheotomy (P = .001) as compared with other symptoms. In addition, greater disease severity on presentation and use of supplemental oxygen, both associated with dyspnea, were significantly associated with decreased overall survival (P < .001;P < .001). Interestingly, 3 patients who presented for a ground-level fall secondary to dizziness passed away from complications of COVID-19 pneumonia. This presenting complaint was not seen in patients who survived. Conclusion: This is the largest study of COVID-19 presentation and survival among veterans. Dyspnea was the presenting symptom most predictive of need for intubation, tracheotomy, and overall survival. Dizziness predicted poorer outcomes, possibly due to bedbound status predisposing patients to pulmonary complications.