Pre-existing traits associated with Covid-19 illness severity.

Autor: Ebinger JE; Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Achamallah N; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Ji H; Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.; Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, United States of America., Claggett BL; Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, United States of America., Sun N; Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Botting P; Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Nguyen TT; Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Luong E; Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Kim EH; Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Park E; Enterprise Information Systems Data Intelligence Team, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Liu Y; Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Rosenberry R; Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Matusov Y; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Zhao S; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Pedraza I; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Zaman T; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Thompson M; Enterprise Information Systems Data Intelligence Team, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Raedschelders K; Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Advanced Clinical Biosystems Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Berg AH; Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Grein JD; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Department of Epidemiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Noble PW; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Chugh SS; Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Bairey Merz CN; Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Marbán E; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Van Eyk JE; Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Advanced Clinical Biosystems Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Solomon SD; Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, United States of America., Albert CM; Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Chen P; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America., Cheng S; Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.; Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2020 Jul 23; Vol. 15 (7), pp. e0236240. Date of Electronic Publication: 2020 Jul 23 (Print Publication: 2020).
DOI: 10.1371/journal.pone.0236240
Abstrakt: Importance: Certain individuals, when infected by SARS-CoV-2, tend to develop the more severe forms of Covid-19 illness for reasons that remain unclear.
Objective: To determine the demographic and clinical characteristics associated with increased severity of Covid-19 infection.
Design: Retrospective observational study. We curated data from the electronic health record, and used multivariable logistic regression to examine the association of pre-existing traits with a Covid-19 illness severity defined by level of required care: need for hospital admission, need for intensive care, and need for intubation.
Setting: A large, multihospital healthcare system in Southern California.
Participants: All patients with confirmed Covid-19 infection (N = 442).
Results: Of all patients studied, 48% required hospitalization, 17% required intensive care, and 12% required intubation. In multivariable-adjusted analyses, patients requiring a higher levels of care were more likely to be older (OR 1.5 per 10 years, P<0.001), male (OR 2.0, P = 0.001), African American (OR 2.1, P = 0.011), obese (OR 2.0, P = 0.021), with diabetes mellitus (OR 1.8, P = 0.037), and with a higher comorbidity index (OR 1.8 per SD, P<0.001). Several clinical associations were more pronounced in younger compared to older patients (Pinteraction<0.05). Of all hospitalized patients, males required higher levels of care (OR 2.5, P = 0.003) irrespective of age, race, or morbidity profile.
Conclusions and Relevance: In our healthcare system, greater Covid-19 illness severity is seen in patients who are older, male, African American, obese, with diabetes, and with greater overall comorbidity burden. Certain comorbidities paradoxically augment risk to a greater extent in younger patients. In hospitalized patients, male sex is the main determinant of needing more intensive care. Further investigation is needed to understand the mechanisms underlying these findings.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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