SEATTLE — Prognostication, resource utilization and treatment all could be improve by Identifying independent risk factors for adverse outcomes in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), according to a new study.
An article in JAMA Network Open discussed results of a longitudinal cohort study including 88,747 patients tested for SARS-CoV-2 nucleic acid by polymerase chain reaction at the VA between Feb. 28 and May 14, 2020, with follow-up through June 22, 2020. The VA Puget Sound Healthcare System and University of Washington-led researchers point out that 10,131 of the patients (11.4%) tested positive.1
The study team focused on sociodemographic characteristics, comorbid conditions, symptoms and laboratory test results, with the main outcomes and measures defined as risks of hospitalization, mechanical ventilation and death among the patients with positive tests.
The veterans diagnosed 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.
Results indicated that, 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).
The study determined that characteristics significantly associated with mortality among patients who tested positive for SARS-CoV-2 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).
Except for geographic region, the researchers advised that 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),” the authors pointed out.
The study also determined that most deaths in the COVID-19-positive cohort occurred in patients 50 years or older (63.4%), male sex (12.3%), and Charlson Comorbidity Index score of at least 1 (11.1%).
“In this national cohort of VA patients, most SARS-CoV-2 deaths were associated with older age, male sex, and comorbidity burden,” the authors concluded. “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.”
- Ioannou GN, Locke E, Green P, Berry K, O’Hare AM, Shah JA, Crothers K, Eastment MC, Dominitz JA, Fan VS. Risk Factors for Hospitalization, Mechanical Ventilation, or Death Among 10 131 US Veterans With SARS-CoV-2 Infection. JAMA Netw Open. 2020 Sep 1;3(9):e2022310. doi: 10.1001/jamanetworkopen.2020.22310. PMID: 32965502; PMCID: PMC7512055.
