Clinical Characteristics and Risk Factors of Respiratory Failure in a Cohort of Young Patients Requiring Hospital Admission with SARS-CoV2 Infection in Spain: Results of the Multicenter SEMI-COVID-19 Registry

Abstract

Background Age is a risk factor for COVID severity. Most studies performed in hospitalized patients with SARS-CoV2 infection have shown an over-representation of older patients and consequently few have properly defined COVID-19 in younger patients who require hospital admission. The aim of the present study was to analyze the clinical characteristics and risk factors for the development of respiratory failure among young (18 to 50 years) hospitalized patients with COVID-19. Methods This retrospective nationwide cohort study included hospitalized patients from 18 to 50 years old with confirmed COVID-19 between March 1, 2020, and July 2, 2020. All patient data were obtained from the SEMI-COVID Registry. Respiratory failure was defined as the ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2 ratio) ≤200 mmHg or the need for mechanical ventilation and/or high-flow nasal cannula or the presence of acute respiratory distress syndrome. Results During the recruitment period, 15,034 patients were included in the SEMI-COVID-19 Registry, of whom 2327 (15.4%) were younger than 50 years. Respiratory failure developed in 343 (14.7%), while mortality occurred in 2.3%. Patients with respiratory failure showed a higher incidence of major adverse cardiac events (44 (13%) vs 14 (0.8%), p <0.001), venous thrombosis (23 (6.7%) vs 14 (0.8%), p <0.001), mortality (43 (12.5%) vs 7 (0.4%), p <0.001), and longer hospital stay (15 (9–24) vs 6 (4–9), p <0.001), than the remaining patients. In multivariate analysis, variables associated with the development of respiratory failure were obesity (odds ratio (OR), 2.42; 95% confidence interval (95% CI), 1.71 to 3.43; p <0.0001), alcohol abuse (OR, 2.40; 95% CI, 1.26 to 4.58; p =0.0076), sleep apnea syndrome (SAHS) (OR, 2.22; 95% CI, 1.07 to 3.43; p =0.032), Charlson index ≥1 (OR, 1.77; 95% CI, 1.25 to 2.52; p =0.0013), fever (OR, 1.58; 95% CI, 1.13 to 2.22; p =0.0075), lymphocytes ≤1100 cells/μL (OR, 1.67; 95% CI, 1.18 to 2.37; p =0.0033), LDH >320 U/I (OR, 1.69; 95% CI, 1.18 to 2.42; p =0.0039), AST >35 mg/dL (OR, 1.74; 95% CI, 1.2 to 2.52; p =0.003), sodium <135 mmol/L (OR, 2.32; 95% CI, 1.24 to 4.33; p =0.0079), and C-reactive protein >8 mg/dL (OR, 2.42; 95% CI, 1.72 to 3.41; p <0.0001). Conclusions Young patients with COVID-19 requiring hospital admission showed a notable incidence of respiratory failure. Obesity, SAHS, alcohol abuse, and certain laboratory parameters were independently associated with the development of this complication. Patients who suffered respiratory failure...

Association of patient characteristics with clinical outcomes in a cohort of hospitalised patients with SARS-CoV-2 infection in a Greek referral centre for COVID-19

“…According to previous reports, older age, male sex, presence of comorbidities including hypertension, CVD, COPD, CKD, cancer and immunosuppression were more common in patients deceased, probably as a result of more severe disease and higher rates of respiratory failure requiring intubation and ICU admission [3,4,[20][21][22][23][12][13][14][15][16][17][18][19]. With regard to comorbidities, the results of this study revealed an association of CKD and immunosuppression with COVID-19 related mortality as previously reported [17,[24][25][26].…”

Validation of the RIM Score-COVID in the Spanish SEMI-COVID-19 Registry

“…Several previous studies have published clinical scores that attempt to predict the risk of worse outcomes in patients with COVID-19 [ 16 , 17 , 24 – 28 ]. However, some of these studies have methodological limitations, including small patient samples, an unrepresentative selection of the control group, or short or incomplete follow-up periods [ 28 ].…”

“…Over 24,000 patients over 18 years of age were included. Several studies derived from the SEMI-COVID-19 Registry have reported clinical characteristics with prognostic value [ 4 , 14 – 16 ] as well as prognostic scores [ 17 , 18 ]. However, since the start of the pandemic, multiple factors have changed the course of disease because the clinical management [ 20 ], available resources, and treatments indicated have evolved since the beginning of the pandemic [ 19 , 21 ].…”

Impact of Alcohol Misuse on Requirements for Critical Care Services and Development of Hospital Delirium in Patients With COVID-19 pneumonia

“…Early in the COVID-19 pandemic, rates of alcohol use disorders (AUDs) accelerated for multiple reasons including increased isolation, use of alcohol as a coping mechanism, and lack of readily available abstinence resources (1–3). Prior investigations have demonstrated dose-dependent associations between alcohol misuse and poorer outcomes in patients hospitalized with pneumonia including increased risk for prolonged hospital and ICU lengths of stay and development of the acute respiratory distress syndrome (ARDS) (4–15). While changes in alcohol consumption have been consistently observed during the COVID-19 pandemic, the impact of alcohol misuse on healthcare outcomes related to COVID-19 are conflicted.…”

“…Prior investigations have demonstrated dose-dependent associations between alcohol misuse and poorer outcomes in patients hospitalized with pneumonia including increased risk for prolonged hospital and ICU lengths of stay and development of the acute respiratory distress syndrome (ARDS) (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). While changes in alcohol consumption have been consistently observed during the COVID-19 pandemic, the impact of alcohol misuse on healthcare outcomes related to COVID-19 are conflicted.…”