Risk factors for severe illness in hospitalized Covid-19 patients at a regional hospital.

Justin J Turcotte,Jane Rhule,Barry R Meisenberg,Michaline West,Eileen B Macdonald,Nandakumar Menon,Sadaf S Qureshi,James H Macdonald,Marcia B Fowler,Yu Ru Kou

doi:10.1371/journal.pone.0237558

Justin J Turcotte, Jane Rhule + Show 8 more

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https://doi.org/10.1371/journal.pone.0237558

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Journal: PloS one	Publication Date: Aug 12, 2020
Citations: 33	License type: CC BY 4.0

Affiliation: Anne Arundel Medical Center

Abstract

BackgroundThe Covid-19 pandemic threatens to overwhelm scarce clinical resources. Risk factors for severe illness must be identified to make efficient resource allocations.ObjectiveTo evaluate risk factors for severe illness.DesignRetrospective, observational case series.SettingSingle-institution.ParticipantsFirst 117 consecutive patients hospitalized for Covid-19 from March 1 to April 12, 2020.ExposureNone.Main outcomes and measuresIntensive care unit admission or death.ResultsIn-hospital mortality was 24.8% and average total length of stay was 11.82 days (95% CI: 10.01 to 13.63 days). 30.8% of patients required intensive care unit admission and 29.1% required mechanical ventilation. Multivariate regression identified the amount of supplemental oxygen required at admission (OR: 1.208, 95% CI: 1.011–1.443, p = .037), sputum production (OR: 6.734, 95% CI: 1.630–27.812, p = .008), insulin dependent diabetes mellitus (OR: 11.873, 95% CI: 2.218–63.555, p = .004) and chronic kidney disease (OR: 4.793, 95% CI: 1.528–15.037, p = .007) as significant risk factors for intensive care unit admission or death. Of the 48 patients who were admitted to the intensive care unit or died, this occurred within 3 days of arrival in 42%, within 6 days in 71%, and within 9 days in 88% of patients.ConclusionsAt our regional medical center, patients with Covid-19 had an average length of stay just under 12 days, required ICU care in 31% of cases, and had a 25% mortality rate. Patients with increased sputum production and higher supplemental oxygen requirements at admission, and insulin dependent diabetes or chronic kidney disease may be at increased risk for severe illness. A model for predicting intensive care unit admission or death with excellent discrimination was created that may aid in treatment decisions and resource allocation. Early identification of patients at increased risk for severe illness may lead to improved outcomes in patients hospitalized with Covid-19.

Highlights

In December 2019, China reported deaths attributed to the flu-like syndrome Covid-19 [1]
In-hospital mortality was 24.8% and average total length of stay was 11.82 days. 30.8% of patients required intensive care unit admission and 29.1% required mechanical ventilation
At our regional medical center, patients with Covid-19 had an average length of stay just under 12 days, required ICU care in 31% of cases, and had a 25% mortality rate

Summary

Introduction

In December 2019, China reported deaths attributed to the flu-like syndrome Covid-19 [1]. The primary objective of this analysis was to identify risk factors for severe illness, defined as ICU admission or death. Garg et al concluded that underlying medical comorbidities, older age, diabetes, obesity, and male sex identified biological vulnerabilities for more severe Covid-19 outcomes [4]. In the largest cohort study to date of 17 million adults in England, Williamson et al demonstrated Covid-19 death was associated with male gender, older age, deprivation, diabetes, severe asthma, and multiple other comorbidities [6]. Multiple studies have proposed models for predicting severe illness based upon demographic, comorbidity and radiologic data. Risk factors for severe illness must be identified to make efficient resource allocations.

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