Pre-existing traits associated with Covid-19 illness severity

• Published in: PloS one Vol. 15; no. 7; p. e0236240
• Main Authors: Ebinger, Joseph E, Achamallah, Natalie, Ji, Hongwei, Claggett, Brian L, Sun, Nancy, Botting, Patrick, Nguyen, Trevor-Trung, Luong, Eric, Kim, Elizabeth H, Park, Eunice, Liu, Yunxian, Rosenberry, Ryan, Matusov, Yuri, Zhao, Steven, Pedraza, Isabel, Zaman, Tanzira, Thompson, Michael, Raedschelders, Koen, Berg, Anders H, Grein, Jonathan D, Noble, Paul W, Chugh, Sumeet S, Bairey Merz, C Noel, Marbán, Eduardo, Van Eyk, Jennifer E, Solomon, Scott D, Albert, Christine M, Chen, Peter, Cheng, Susan
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 23.07.2020; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; African Americans; Age Factors; Aged; Aged, 80 and over; Betacoronavirus; Biology and Life Sciences; Cardiology; Child; Comorbidity; Coronavirus Infections - epidemiology; Coronaviruses; COVID-19; Critical care; Critical Care - statistics & numerical data; Diabetes; Diabetes Mellitus; Electronic health records; Electronic medical records; Female; Health care; Health risks; Heart; Hospitalization - statistics & numerical data; Hospitals; Humans; Illnesses; Infections; Information systems; Intubation; Los Angeles - epidemiology; Male; Medicine; Medicine and Health Sciences; Middle Aged; Morbidity; Obesity; Pandemics; Patients; People and places; Pneumonia, Viral - epidemiology; Regression analysis; Retrospective Studies; Risk Factors; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; State court decisions; Streisand, Barbra; Viral diseases; Young Adult; Los Angeles; Los Angeles California; California; United States > US; Massachusetts; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0236240

Certain individuals, when infected by SARS-CoV-2, tend to develop the more severe forms of Covid-19 illness for reasons that remain unclear. To determine the demographic and clinical characteristics associated with increased severity of Covid-19 infection. 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. A large, multihospital healthcare system in Southern California. All patients with confirmed Covid-19 infection (N = 442). 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. 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.