COVID-19 Clinical Phenotypes: Presentation and Temporal Progression of Disease in a Cohort of Hospitalized Adults in Georgia, United States

• Type of Material: Article
• Authors: Juliana F da Silva, Centers for Disease Control and Prevention, Atlanta, GA; Alfonso C Hernandez-Romieu, Centers for Disease Control and Prevention, Atlanta, GA; Sean D Browning, Centers for Disease Control and Prevention, Atlanta, GA; Beau Bruce, Emory University; Pavithra Natarajan, Centers for Disease Control and Prevention, Atlanta, GA; Sapna B Morris, Centers for Disease Control and Prevention, Atlanta, GA; Jeremy AW Gold, Centers for Disease Control and Prevention, Atlanta, GA; Robyn N Fanfair, Centers for Disease Control and Prevention, Atlanta, GA; Jessica Rogers-Brown, Centers for Disease Control and Prevention, Atlanta, GA; John Rossow, Centers for Disease Control and Prevention, Atlanta, GA; Christine M Szablewski, Centers for Disease Control and Prevention, Atlanta, GA; Nadine Oosmanally, Georgia Department of Public Health; Melisssa T D'Angelo, Georgia Department of Public Health; Cherie Drenzek, Georgia Department of Public Health; David Murphy, Emory University; Julie Hollberg, Emory University; James Blum, Emory University; Robert Jansen, Emory University; David Wright, Emory University; William Sewell, Phoebe Putney Memorial Hospital, Albany; Jack Owens, Phoebe Putney Memorial Hospital, Albany; Benjamin Lefkove, Emory Decatur Hospital; Frank Brown, Emory University; Deron C Burton, Centers for Disease Control and Prevention, Atlanta, GA; Timothy M Uyeki, Centers for Disease Control and Prevention, Atlanta, GA; Priti Patel, Emory University; Brendan Jackson, Emory University; Karen Wong, Emory University
• Language: English
• Date: 2021-01-01
• Publisher: OXFORD UNIV PRESS INC
• Publication Version: Final Published Version
• Copyright Statement: Published by Oxford University Press on behalf of Infectious Diseases Society of America 2020.
• License: Creative Commons Universal : Public Domain Dedication
• Final Published Version (URL): http://dx.doi.org/10.1093/ofid/ofaa596
• Title of Journal or Parent Work: OPEN FORUM INFECTIOUS DISEASES
• Volume: 8
• Issue: 1
• Start Page: ofaa596
• End Page: ofaa596
• Grant/Funding Information: This study was supported by the Centers for Disease Control and Prevention.
• Keywords: mortality; multisystem inflammatory syndrome; Infectious Diseases; INFORMATICS; Science & Technology; medical complications; OUTCOMES; Life Sciences & Biomedicine; Microbiology; NEW-YORK-CITY; COVID-19; Immunology; clinical phenotype
• Research Categories: Health Sciences, Epidemiology; Health Sciences, General; Health Sciences, Public Health

Abstract

Background: The epidemiological features and outcomes of hospitalized adults with coronavirus disease 2019 (COVID-19) have been described; however, the temporal progression and medical complications of disease among hospitalized patients require further study. Detailed descriptions of the natural history of COVID-19 among hospitalized patients are paramount to optimize health care resource utilization, and the detection of different clinical phenotypes may allow tailored clinical management strategies. Methods: This was a retrospective cohort study of 305 adult patients hospitalized with COVID-19 in 8 academic and community hospitals. Patient characteristics included demographics, comorbidities, medication use, medical complications, intensive care utilization, and longitudinal vital sign and laboratory test values. We examined laboratory and vital sign trends by mortality status and length of stay. To identify clinical phenotypes, we calculated Gower's dissimilarity matrix between each patient's clinical characteristics and clustered similar patients using the partitioning around medoids algorithm. Results: One phenotype of 6 identified was characterized by high mortality (49%), older age, male sex, elevated inflammatory markers, high prevalence of cardiovascular disease, and shock. Patients with this severe phenotype had significantly elevated peak C-reactive protein creatinine, D-dimer, and white blood cell count and lower minimum lymphocyte count compared with other phenotypes (P < .01, all comparisons). Conclusions: Among a cohort of hospitalized adults, we identified a severe phenotype of COVID-19 based on the characteristics of its clinical course and poor prognosis. These findings need to be validated in other cohorts, as improved understanding of clinical phenotypes and risk factors for their development could help inform prognosis and tailored clinical management for COVID-19.