Predictors for Severe COVID-19 Infection

• Published in: Clinical Infectious Diseases 2020-11, Vol.71 (8), p.1962-1968
• Main Authors: Bhargava, Ashish, Fukushima, Elisa Akagi, Levine, Miriam, Zhao, Wei, Tanveer, Farah, Szpunar, Susanna M, Saravolatz, Louis
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Betacoronavirus; Comorbidity; Coronavirus Infections - epidemiology; COVID-19; Female; Hospitalization - statistics & numerical data; Humans; Major; Male; Middle Aged; Pandemics; Pneumonia, Viral - epidemiology; Retrospective Studies; Risk Assessment; Risk Factors; SARS-CoV-2; Severity of Illness Index
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciaa674

Abstract Background COVID-19 is a pandemic disease caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Predictors for severe COVID-19 infection have not been well defined. Determination of risk factors for severe infection would enable identifying patients who may benefit from aggressive supportive care and early intervention. Methods We conducted a retrospective observational study of 197 patients with confirmed COVID-19 admitted to a tertiary academic medical center. Results Of 197 hospitalized patients, the mean (SD) age of the cohort was 60.6 (16.2) years, 103 (52.3%) were male, and 156 (82.1%) were black. Severe COVID-19 infection was noted in 74 (37.6%) patients, requiring intubation. Patients aged above 60 were significantly more likely to have severe infection. Patients with severe infection were significantly more likely to have diabetes, renal disease, and chronic pulmonary disease and had significantly higher white blood cell counts, lower lymphocyte counts, and increased C-reactive protein (CRP) than patients with nonsevere infection. In multivariable logistic regression analysis, risk factors for severe infection included pre-existing renal disease (odds ratio [OR], 7.4; 95% CI, 2.5–22.0), oxygen requirement at hospitalization (OR, 2.9; 95% CI, 1.3–6.7), acute renal injury (OR, 2.7; 95% CI, 1.3–5.6), and CRP on admission (OR, 1.006; 95% CI, 1.001–1.01). Race, age, and socioeconomic status were not independent predictors. Conclusions Acute or pre-existing renal disease, supplemental oxygen upon hospitalization, and admission CRP were independent predictors for the development of severe COVID-19. Every 1-unit increase in CRP increased the risk of severe disease by 0.06%. Acute or pre-existing renal disease, oxygen requirement at the time of hospitalization, and initial C-reactive protein (CRP) were independent predictors for the development of severe coronavirus disease 2019 infection. Every 1-unit increase in CRP increased the risk of severe disease by 0.06%.