Abstract
The identification of factors predisposing to severe COVID-19 in young adults remains partially characterized. Low birth weight (LBW) alters cardiovascular and lung development and predisposes to adult disease. We hypothesized that LBW is a risk factor for severe COVID-19 in non-elderly subjects. We analyzed a prospective cohort of 397 patients (18–70 years) with laboratory-confirmed SARS-CoV-2 infection attended in a tertiary hospital, where 15% required admission to Intensive Care Unit (ICU). Perinatal and current potentially predictive variables were obtained from all patients and LBW was defined as birth weight ≤ 2.500 g. Age (adjusted OR (aOR) 1.04 [1–1.07], P = 0.012), male sex (aOR 3.39 [1.72–6.67], P < 0.001), hypertension (aOR 3.37 [1.69–6.72], P = 0.001), and LBW (aOR 3.61 [1.55–8.43], P = 0.003) independently predicted admission to ICU. The area under the receiver-operating characteristics curve (AUC) of this model was 0.79 [95% CI, 0.74–0.85], with positive and negative predictive values of 29.1% and 97.6% respectively. Results were reproduced in an independent cohort, from a web-based survey in 1822 subjects who self-reported laboratory-positive SARS-CoV-2 infection, where 46 patients (2.5%) needed ICU admission (AUC 0.74 [95% CI 0.68–0.81]). LBW seems to be an independent risk factor for severe COVID-19 in non-elderly adults and might improve the performance of risk stratification algorithms.
Highlights
The identification of factors predisposing to severe COVID-19 in young adults remains partially characterized
Results were reproduced in an independent cohort, from a web-based survey in 1822 subjects who self-reported laboratory-positive SARS-CoV-2 infection, where 46 patients (2.5%) needed Intensive Care Unit (ICU) admission (AUC 0.74 [95% confidence interval (95% CI) 0.68–0.81])
The latter were older, more frequently males, had a higher body mass index (BMI) and a higher prevalence of hypertension. They were born with Low birth weight (LBW) (18.3 vs. 9.5%, p = 0.041) and suffered fetal growth restriction (25 vs. 14.8%, p = 0.043) more often
Summary
The identification of factors predisposing to severe COVID-19 in young adults remains partially characterized. We hypothesized that LBW is a risk factor for severe COVID-19 in non-elderly subjects. Results were reproduced in an independent cohort, from a web-based survey in 1822 subjects who self-reported laboratory-positive SARS-CoV-2 infection, where 46 patients (2.5%) needed ICU admission (AUC 0.74 [95% CI 0.68–0.81]). We hypothesized that LBW could increase the risk of developing severe illness in non-elderly adults with COVID-19. To test this hypothesis, we designed a prospective study in confirmed COVID-19 patients (18–70 years) admitted to our institution, a public, tertiary, referral, university hospital in Spain (development dataset) and validated the model in an independent cohort of self-reported laboratoryconfirmed COVID-19 subjects recruited through a web-based survey (validation dataset)
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