Predictors at admission of mechanical ventilation and death in an observational cohort of adults hospitalized with COVID-19

• Authors: Brendan R. Jackson, Centers for Disease Control and Prevention; Jeremy A. W. Gold, Centers for Disease Control and Prevention; Pavithra Natarajan, Centers for Disease Control and Prevention; John Rossow, Centers for Disease Control and Prevention; Robyn Fanfair, Centers for Disease Control and Prevention; Juliana Da Silva, Centers for Disease Control and Prevention; Karen K. Wong, Centers for Disease Control and Prevention; Sean D. Browning, Centers for Disease Control and Prevention; Sapna Bamrah Morris, Centers for Disease Control and Prevention; David Murphy, Emory University
• Journal Title: CLINICAL INFECTIOUS DISEASES
• Publisher: Oxford University Press (OUP) | 2020-09-24
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1093/cid/ciaa1459
• Subjects: Health Sciences, Immunology; Biology, Virology
• Keywords: COVID-19; SARS-CoV-2; hospitalization; mortality; angiotensin receptor antagonists

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.