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Jackson BR, Gold JAW, Natarajan P, Rossow J, Neblett Fanfair R, da Silva J, Wong KK, Browning SD, Bamrah Morris S, Rogers-Brown J, Hernandez-Romieu AC, Szablewski CM, Oosmanally N, Tobin-D'Angelo M, Drenzek C, Murphy DJ, Hollberg J, Blum JM, Jansen R, Wright DW, SeweSll WM, Owens JD, Lefkove B, Brown FW, Burton DC, Uyeki TM, Bialek SR, Patel PR, Bruce BB. Predictors at admission of mechanical ventilation and death in an observational cohort of adults hospitalized with COVID-19. Clin Infect Dis 2020; 73:e4141-e4151. [PMID: 32971532 PMCID: PMC7543323 DOI: 10.1093/cid/ciaa1459] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Indexed: 01/08/2023] Open
Abstract
Background Coronavirus disease (COVID-19) can cause severe illness and death. Predictors of poor outcome collected on hospital admission may inform clinical and public health decisions. Methods We conducted a retrospective observational cohort investigation of 297 adults admitted to eight academic and community hospitals in Georgia, United States, during March 2020. Using standardized medical record abstraction, we collected data on predictors including admission demographics, underlying medical conditions, outpatient antihypertensive medications, recorded symptoms, vital signs, radiographic findings, and laboratory values. We used random forest models to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CI) for predictors of invasive mechanical ventilation (IMV) and death. Results Compared with age <45 years, ages 65–74 years and ≥75 years were predictors of IMV (aOR 3.12, CI 1.47–6.60; aOR 2.79, CI 1.23–6.33) and the strongest predictors for death (aOR 12.92, CI 3.26–51.25; aOR 18.06, CI 4.43–73.63). Comorbidities associated with death (aORs from 2.4 to 3.8, p <0.05) included end-stage renal disease, coronary artery disease, and neurologic disorders, but not pulmonary disease, immunocompromise, or hypertension. Pre-hospital use vs. non-use of angiotensin receptor blockers (aOR 2.02, CI 1.03–3.96) and dihydropyridine calcium channel blockers (aOR 1.91, CI 1.03–3.55) were associated with death. Conclusions After adjustment for patient and clinical characteristics, older age was the strongest predictor of death, exceeding comorbidities, abnormal vital signs, and laboratory test abnormalities. That coronary artery disease, but not chronic lung disease, was associated with death among hospitalized patients warrants further investigation, as do associations between certain antihypertensive medications and death.
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Affiliation(s)
| | - Jeremy A W Gold
- CDC COVID-19 Emergency Response.,Epidemic Intelligence Service, CDC
| | | | - John Rossow
- CDC COVID-19 Emergency Response.,U.S. Public Health Service.,Epidemic Intelligence Service, CDC
| | | | | | - Karen K Wong
- CDC COVID-19 Emergency Response.,U.S. Public Health Service
| | - Sean D Browning
- CDC COVID-19 Emergency Response.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | | | - Jessica Rogers-Brown
- CDC COVID-19 Emergency Response.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Alfonso C Hernandez-Romieu
- CDC COVID-19 Emergency Response.,U.S. Public Health Service.,Epidemic Intelligence Service, CDC.,Emory University School of Medicine
| | - Christine M Szablewski
- CDC COVID-19 Emergency Response.,U.S. Public Health Service.,Epidemic Intelligence Service, CDC.,Georgia Department of Public Health, Atlanta, Georgia
| | | | | | | | | | | | - James M Blum
- Emory University School of Medicine.,Georgia Clinical & Translational Science Alliance, Atlanta, Georgia
| | | | - David W Wright
- Emory University School of Medicine.,Grady Health System, Atlanta, Georgia
| | | | - Jack D Owens
- Phoebe Putney Memorial Hospital, Albany, Georgia
| | | | - Frank W Brown
- Emory University School of Medicine.,Emory Decatur Hospital, Decatur, Georgia
| | - Deron C Burton
- CDC COVID-19 Emergency Response.,U.S. Public Health Service
| | | | | | - Priti R Patel
- CDC COVID-19 Emergency Response.,U.S. Public Health Service
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