Risk Factors for Intensive Care Unit Admission and In-hospital Mortality Among Hospitalized Adults Identified through the US Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET)

• Type of Material: Article
• Authors: Lindsay Kim, Centers for Disease Control and Prevention; hikhaS Garg, Centers for Disease Control and Prevention; Alissa O'Halloran, Centers for Disease Control and Prevention; Michael Whitaker, Centers for Disease Control and Prevention; Pham Huong, Centers for Disease Control and Prevention; Evan Anderson, Emory University; Isaac Armistead, University of Colorado; Nancy M. Bennett, University of Rochester; Laurie Billing, Ohio Department of Health; Kathryn Como-Sabetti, Minnesota Department of Health; Mary Hill, Salt Lake County Health Department; Sue Kim, Michigan Department of Community Health; Maya L. Monroe, Maryland Department of Health and Mental Hygiene; Alison Muse, New York State Department of Health; Arthur L. Reingold, University of California Berkeley; William Schaffner, Vanderbilt University; Melissa Sutton, Oregon Health Authority; H. Keipp Talbot, Vanderbilt University; Salina M. Torres, New Mexico Department of Health; Kimberly Yousey-Hindes, Yale University; Rachel Holstein, Centers for Disease Control and Prevention; Charisse Cummings, Centers for Disease Control and Prevention; Lynette Brammer, Centers for Disease Control and Prevention; Aron Hall, Centers for Disease Control and Prevention; Alicia M. Fry, Centers for Disease Control and Prevention; Gayle E. Langley, Centers for Disease Control and Prevention
• Language: English
• Date: 2021-05-01
• Publisher: Oxford University Press
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © Published by Oxford University Press for the Infectious Diseases Society of America 2020.
• Final Published Version (URL): http://dx.doi.org/10.1093/cid/ciaa1012
• Title of Journal or Parent Work: Clinical Infectious Diseases
• Volume: 72
• Issue: 9
• Start Page: E206
• End Page: E214
• Grant/Funding Information: This work was supported by the Centers of Disease Control and Prevention through an Emerging Infections Program cooperative agreement (grant CK17–1701) and through a Council of State and Territorial Epidemiologists cooperative agreement (grant NU38OT000297–02–00).
• Keywords: Science & Technology; Infectious Diseases; surveillance; Immunology; Life Sciences & Biomedicine; Microbiology; SARS-CoV-2; mortality; COVID-19; hospitalization
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health; Health Sciences, Immunology; Biology, Microbiology

Abstract

Background Currently, the United States has the largest number of reported coronavirus disease 2019 (COVID-19) cases and deaths globally. Using a geographically diverse surveillance network, we describe risk factors for severe outcomes among adults hospitalized with COVID-19. Methods We analyzed data from 2,491 adults hospitalized with laboratory-confirmed COVID-19 during March 1–May 2, 2020 identified through the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network comprising 154 acute care hospitals in 74 counties in 13 states. We used multivariable analyses to assess associations between age, sex, race and ethnicity, and underlying conditions with intensive care unit (ICU) admission and in-hospital mortality. Results Ninety-two percent of patients had ≥1 underlying condition; 32% required ICU admission; 19% invasive mechanical ventilation; and 17% died. Independent factors associated with ICU admission included ages 50-64, 65-74, 75-84 and ≥85 years versus 18-39 years (adjusted risk ratio (aRR) 1.53, 1.65, 1.84 and 1.43, respectively); male sex (aRR 1.34); obesity (aRR 1.31); immunosuppression (aRR 1.29); and diabetes (aRR 1.13). Independent factors associated with in-hospital mortality included ages 50-64, 65-74, 75-84 and ≥85 years versus 18-39 years (aRR 3.11, 5.77, 7.67 and 10.98, respectively); male sex (aRR 1.30); immunosuppression (aRR 1.39); renal disease (aRR 1.33); chronic lung disease (aRR 1.31); cardiovascular disease (aRR 1.28); neurologic disorders (aRR 1.25); and diabetes (aRR 1.19). Conclusion In-hospital mortality increased markedly with increasing age. Aggressive implementation of prevention strategies, including social distancing and rigorous hand hygiene, may benefit the population as a whole, as well as those at highest risk for COVID-19-related complications.