Predictors of poor prognosis in healthy, young, individuals with SARS-CoV-2 infections

Abstract

Objectives To identify predictors of poor prognosis in previously healthy young individuals admitted with COVID-19. Methods We studied a cohort of patients hospitalized with COVID-19 disease. All patients without comorbidities, no usual treatments and ≤65 years old were selected from an international registry (HOPE-COVID-19, NCT04334291). We focused on baseline variables-symptoms and signs at admission-to analyze risk factors for poor prognosis. The primary endpoint was a composite of major adverse clinical events during hospitalization including mortality, mechanical ventilation, high flow nasal oxygen therapy, prone, sepsis , SIRS, and embolic events. Results Overall, 773 healthy young patients were included. The primary composite endpoint was observed in 29% (225/773) and the overall mortality rate was 3.6% (28/773). In the combined event group, 75% (168/225) of patients were men and the mean age was 49 (±11) years, whereas in the non-combined event group, the prevalence of male gender was 43% (238/548) and the mean age was 42 (±13) years; p<0.001 for both. On admission, respiratory insufficiency and cough were described in 51.4% (114/222), and 76% (170/223) of patients, respectively, in the combined event group, vs. 7.9% (42/533) and 56% (302/543) of patients in the other group; p<0.001 for both. The strongest independent predictor for the combined endpoint was desaturation (SpO2<92%) (OR: 5.40; CI95% 3.34-8.75; p<0.001), followed by tachypnea (OR: 3.17; CI95% 1.93-5.21; p<0.001), male gender (OR: 3.01; CI95% 1.96-4.61; p<0.001), and pulmonary infiltrates on chest X ray at admission (OR: 2.21; CI95% 1.18-4.16; p: 0.014). Conclusions Major adverse clinical events were unexpectedly high considering the baseline characteristics of the cohort. Signs of respiratory compromise at admission, and male gender, were predictive for poor prognosis among young healthy patients hospitalized with COVID-19.

Predictors of Poor Outcome among Critically Ill COVID-19 Patients: A Nationally Representative Sample of the Saudi Arabian Population

“…Moreover, this study found that even younger patients (41–64 years) had a higher risk of the composite outcome compared to patients younger than 40 years. Although several reports have shown that male gender was associated with higher odds of poor outcomes compared to female [ 28 , 29 ], our analysis did not find this result among critically ill patients. In accordance with our finding, a retrospective study including ICU patients from China did not find a difference in the incidence of poor outcomes between males and females [ 30 ].…”

Assessment of Leukocyte Subtypes to High-Density Lipoprotein-Cholesterol (HDL-C) Ratios as predictors of Severity and Mortality in COVID-19 Patients

“…Several comorbidities such as hypertension, CVD, T2D, and non-alcoholic fatty liver disease, which share chronic systemic inflammation and metabolic disturbance, as well as older age, have been recognized as the main risk factors for a poor prognosis in COVID-19 (16). The findings of this study support the view that a comorbid condition diagnosis makes COVID-19 more severe.…”

“…The findings of this study support the view that a comorbid condition diagnosis makes COVID-19 more severe. On the other hand, some healthy young patients also showed unexpectedly high rates of poor outcomes (16). Therefore, exploring new non-invasive, fast, and cost-effective inflammatory and metabolic markers to indicate COVID-19 prognosis has been a focus of researchers.…”

A Simple Prognostic Score for Critical COVID-19 Derived from Patients without Comorbidities Performs Well in Unselected Patients

“…A combination of laboratory parameters indicative of acute inflammation (CRP), cell death (LDH), and hypercoagulable state (fibrinogen), showed good discrimination value for the development of critical COVID-19 in the derivation cohort, which was higher than any of the parameters alone. Our study is one of the very few available studies focusing on patients without pre-existing comorbidities [ 17 , 18 , 19 , 20 , 21 , 22 ] and, to the best of our knowledge, the first one that included patients who were uniformly treated with anticoagulants and corticosteroids/remdesivir in cases with oxygen desaturation [ 14 ].…”