Abstract
BackgroundClinical outcomes among COVID-19 patients vary greatly with age and underlying comorbidities. We aimed to determine the demographic and clinical factors, particularly baseline chronic conditions, associated with an increased risk of severity in COVID-19 patients from a population-based perspective and using data from electronic health records (EHR).MethodsRetrospective, observational study in an open cohort analyzing all 68,913 individuals (mean age 44.4 years, 53.2% women) with SARS-CoV-2 infection between 15 June and 19 December 2020 using exhaustive electronic health registries. Patients were followed for 30 days from inclusion or until the date of death within that period. We performed multivariate logistic regression to analyze the association between each chronic disease and severe infection, based on hospitalization and all-cause mortality.Results5885 (8.5%) individuals showed severe infection and old age was the most influencing factor. Congestive heart failure (odds ratio -OR- men: 1.28, OR women: 1.39), diabetes (1.37, 1.24), chronic renal failure (1.31, 1.22) and obesity (1.21, 1.26) increased the likelihood of severe infection in both sexes. Chronic skin ulcers (1.32), acute cerebrovascular disease (1.34), chronic obstructive pulmonary disease (1.21), urinary incontinence (1.17) and neoplasms (1.26) in men, and infertility (1.87), obstructive sleep apnea (1.43), hepatic steatosis (1.43), rheumatoid arthritis (1.39) and menstrual disorders (1.18) in women were also associated with more severe outcomes.ConclusionsAge and specific cardiovascular and metabolic diseases increased the risk of severe SARS-CoV-2 infections in men and women, whereas the effects of certain comorbidities are sex specific. Future studies in different settings are encouraged to analyze which profiles of chronic patients are at higher risk of poor prognosis and should therefore be the targets of prevention and shielding strategies.
Highlights
The coronavirus disease 2019 (COVID-19) pandemic was declared a Public Health Emergency of International Concern by the World Health Organization in March 2020 and, since SARS-CoV-2 has affected more than 150 million people and has caused over 3.2 million deaths worldwide [1].Clinical characteristics among COVID-19 patients vary greatly, especially with age [2]
Age and specific cardiovascular and metabolic diseases increased the risk of severe SARSCoV-2 infections in men and women, whereas the effects of certain comorbidities are sex specific
The definition of severity for COVID-19 infection differs across the existing literature, as evidenced by the systematic reviews conducted by Flook et al and Li et al, where some authors followed the international guidelines for community acquired pneumonia or clinical criteria to classify severe cases, while others considered outcomes such as intensive care unit (ICU) admission, invasive ventilation support or death, among others [5, 8]
Summary
The coronavirus disease 2019 (COVID-19) pandemic was declared a Public Health Emergency of International Concern by the World Health Organization in March 2020 and, since SARS-CoV-2 has affected more than 150 million people and has caused over 3.2 million deaths worldwide [1].Clinical characteristics among COVID-19 patients vary greatly, especially with age [2]. Along with other individual features such as functional capacity and autonomy, are key in determining COVID-19 severity in routine clinical practice [9]. Indicators such as mortality and hospitalization can serve as proxy, and aid in decision-making for the allocation of expected resources and the development of mitigation and prevention strategies at a health system level, which have an influence on health results in infected patients [10]. We aimed to determine the demographic and clinical factors, baseline chronic conditions, associated with an increased risk of severity in COVID-19 patients from a population-based perspective and using data from electronic health records (EHR)
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