PATIENT DEMOGRAPHICS, PRE-EXISTING COMORBIDITIES, AND CLINICAL PRESENTATION IMPLICATIONS IN COVID-19 INFECTION OUTCOMES: A MULTI-CENTRIC RETROSPECTIVE STUDY

Abstract

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: Since January 2020, the COVID-19 pandemic has affected more than 32 million Americans and claimed more than 578,000 lives in the United States (US). Cases and deaths are still rising in many parts of the world. Some pre-existing comorbidities are suspected to negatively impact COVID-19 (Coronavirus-19) outcomes. Our study aimed to investigate the impact of patient demographics, comorbidities, and initial presenting symptoms on COVID-19 outcomes. METHODS: A multi-center retrospective cohort analysis was performed involving 4 large urban hospitals within a healthcare network in the Northeastern US. All patients over 18 years of age that were admitted to the hospital with COVID-19 between April and June 2020 were included in this study. We compared comorbid conditions and initial clinical presentation reported in survivors and non-survivors. Comorbid conditions of interest were: hypertension, diabetes, obesity, Chronic Obstructive Pulmonary Disease (COPD), asthma, Congestive Heart Failure (CHF), cancer, immunocompromised status, and end-stage renal disease (ESRD) on hemodialysis. We identified immunocompromised status as acquired immunodeficiency syndrome (AIDS), long-term steroid use, use of biologics, and/or disease-modifying antirheumatic drugs, and transplant recipients. SPSS software was used to perform a regression analysis to adjust for age, gender, hypertension, diabetes, obesity, COPD, asthma, chronic lung diseases (restrictive lung diseases and obstructive sleep apnea), heart failure, HIV, cancer, immunocompromised status, ESRD on hemodialysis. A p-value <0.05 was considered statistically significant. RESULTS: A total of 2174 patients were included in our study. The mortality rate of patients admitted for COVID-19 was 15.55%. Age was associated with higher mortality adjusted Odds Ratio (OR) of 1.05, 95% CI (1.04-1.06), p<0. 001. Female gender was associated with lower mortality with adjusted OR of 0.60, 95% CI (0.46-0.80), p<0. 001. The most common neurological symptom was altered mental status, seen more often in non-survivors 18.64% vs 3.7%, and was associated with higher mortality with OR of 5.96, 95% CI 4.13-8.59, p<0.0001. Other symptoms including fever, shortness of breath, and diarrhea were not associated with higher mortality. The following comorbid conditions were associated with higher mortality: diabetes with adjusted OR of 1.57, 95% CI (1.18- 2.10), p= 0.002, COPD with adjusted OR of 1.61, 95% CI (1.02-2.57), p= 0.04, and cancer with adjusted OR of 1.70, 95% CI (1.02-2.85), p= 0.04. The following comorbid conditions were not associated with higher mortality: hypertension with adjusted OR of 1.28, 95% CI (0.89-1.82), p= 0.18, obesity with adjusted OR of 1.12, 95% CI (0.84-1.50), p= 0.447, asthma with adjusted OR of 0.77, 95% CI (0.42-1.45), p= 0.422, chronic lung diseases with adjusted OR of 2.40, 95% CI (0.43-13.41), p= 0.32, CHF with adjusted OR of 0.85, 95% CI (0.56-1.27), p= 0.42, and Immunocompromised status with adjusted OR of 1.05, 95% CI (0.56-1.99), p= 0.87. CONCLUSIONS: In our study, older age, initial presentation with AMS, and the presence of the following comorbid conditions: diabetes, COPD, and cancer were all associated with higher mortality. The female gender was associated with lower mortality. CLINICAL IMPLICATIONS: Early identification of patients at risk of worse outcomes can help in better triage patients and affect management. DISCLOSURES: No relevant relationships by Mamoon Al Ahmad, source=Web Response No relevant relationships by Stephanie Franco, source=Web Response No relevant relationships by Malik Ghawanmeh, source=Web Response No relevant relationships by Ramez Halaseh, source=Web Response No relevant relationships by Ihab Masri, source=Web Response No relevant relationships by Jennifer Tran, source=Web Response No relevant relationships by Jobin Varghese, source=Web Response