bims-covirf 2021-01-31 papers

Issue of 2021–01–31
five papers selected by
Catherine Rycroft, BresMed

J Infect Dis. 2020 Dec 16. pii: jiaa767. [Epub ahead of print]

Natural history of COVID-19: Risk factors for hospitalizations and deaths among >26 million U.S. Medicare beneficiaries.

Hector S Izurieta, David J Graham, Yixin Jiao, Mao Hu, Yun Lu, Yue Wu, Yoganand Chillarige, Michael Wernecke, Mikhail Menis, Douglas Pratt, Jeffrey Kelman, Richard Forshee.

BACKGROUND: Evaluate risk factors for severe COVID-19 outcomes among Medicare beneficiaries during the pandemic's early phase.
METHODS: Retrospective cohort study covering Medicare fee-for-service (FFS) beneficiaries. We separated out elderly residents in nursing homes (NH) and those with end-stage renal disease (ESRD) from the primary study population of individuals ages ≥65. Outcomes included COVID-19 hospital encounters and COVID-19-associated deaths. We estimated adjusted odds ratios (ORs) using logistic regression.
RESULTS: We analyzed 25,333,329 elderly non-NH non-ESRD beneficiaries, 653,966 elderly NH residents, and 292,302 ESRD patients. COVID-related death rates (per 10,000) were much higher among elderly NH residents (275.7) and ESRD patients (60.8) than the primary study population (5.0). Regression-adjusted clinical predictors of death among the primary population included immunocompromised status (OR: 1.43), frailty index conditions such as cognitive impairment (3.16) as well as other comorbidities including congestive heart failure (1.30). Demographics-related risk factors included male sex (1.77), older age (OR: 3.09 for 80-year-old vs. 65-year-old), Medicaid dual-eligibility status (2.17) and racial/ethnic minority. Compared to Whites, ORs were higher for Blacks (2.47), Hispanics (3.11), and Native Americans (5.82). Results for COVID-19 hospital encounters were consistent.
CONCLUSIONS: Frailty, comorbidities, and race/ethnicity were strong risk factors of COVID-19 hospitalization and death among the U.S. elderly.

Keywords: COVID-19; disease severity; epidemics; risk factors

DOI: https://doi.org/10.1093/infdis/jiaa767

Prev Med Rep. 2021 Mar;21 101319

Comorbidities might be a risk factor for the incidence of COVID-19: Evidence from a web-based survey.

Mohammad Rahanur Alam, Md Ruhul Kabir, Sompa Reza.

The global pandemic of COVID-19 is posing the biggest threat to humanity through its ubiquitous effect of unfathomable magnitude. Although COVID-19 is a viral disease, there might be an association between different comorbidities and the occurrence of the disease. Our study aims to determine the association between the COVID-19 infection and pre-existing comorbidities such as asthma, diabetes, liver disease, lung disease, heart disease, kidney disease, hypertension, and obesity through a web-based self-reported survey. Univariate and multivariate logistic regression analyses were done using these risk factors as independent variables. A total of 780,961 participants from 183 different countries and territories participated in this study. Among them, 1516 participants were diagnosed with COVID-19 prior to this study. A significant risk association was observed for age above 60 years, female gender, as well as different pre-existing disease conditions such as diabetes, kidney disease, liver disease, and heart diseases. Asthma and diabetes were the major dominant comorbidities among patients, and patients with existing diabetes were more likely to develop the disease than others who did not diagnose as diseased. Therefore, older adults, females, as well as people with comorbidities such as diabetes mellitus, heart disease, kidney disease, and liver disease are the most vulnerable population for COVID-19. However, further studies should be carried out to explain the pathway of these risk associations.

Keywords: COVID-19; Comorbidity; Diabetes mellitus; Heart diseases; Kidney diseases; Liver diseases

DOI: https://doi.org/10.1016/j.pmedr.2021.101319

PLoS One. 2021 ;16(1): e0246182

Early risk markers for severe clinical course and fatal outcome in German patients with COVID-19.

Paul Balfanz, Bojan Hartmann, Dirk Müller-Wieland, Michael Kleines, Dennis Häckl, Nils Kossack, Alexander Kersten, Christian Cornelissen, Tobias Müller, Ayham Daher, Robert Stöhr, Johannes Bickenbach, Gernot Marx, Nikolaus Marx, Michael Dreher.

BACKGROUND: Some patients with Corona Virus Disease 2019 (COVID-19) develop a severe clinical course with acute respiratory distress syndrome (ARDS) and fatal outcome. Clinical manifestations and biomarkers in early stages of disease with relevant predictive impact for outcomes remain largely unexplored. We aimed to identify parameters which are significantly different between subgroups.
DESIGN: 125 patients with COVID-19 were analysed. Patients with ARDS (N = 59) or non-ARDS (N = 66) were compared, as well as fatal outcome versus survival in the two groups.
KEY RESULTS: ARDS and non-ARDS patients did not differ with respect to comorbidities or medication on developing a fatal outcome versus survival. Body mass index was higher in patients with ARDS versus non-ARDS (p = 0.01), but not different within the groups in survivors versus non-survivors. Interleukin-6 levels on admission were higher in patients with ARDS compared to non-ARDS as well as in patients with fatal outcome versus survivors, whereas lymphocyte levels were lower in the different subgroups (all p<0.05). There was a highly significant 3.5-fold difference in fever load in non-survivors compared to survivors (p<0.0001). Extrapulmonary viral spread was detected more often in patients with fatal outcome compared to survivors (P = 0.01). Further the detection of SARS-CoV-2 in serum showed a significantly more severe course and an increased risk of death (both p<0.05).
CONCLUSIONS: We have identified early risk markers for a severe clinical course, like ARDS or fatal outcome. This data might help develop a strategy to address new therapeutic options early in patients with COVID-19 and at high risk for fatal outcome.

DOI: https://doi.org/10.1371/journal.pone.0246182

J Investig Med. 2021 Jan 29. pii: jim-2020-001667. [Epub ahead of print]

Factors associated with COVID-19 severity and mortality among Hispanic patients living on the USA-Mexico border.

Jorge Cervantes, Amit Sureen, Gian Galura, Christopher Dodoo, Alok Kumar Dwivedi, Mohammad Bashashati, Marc Zuckerman, Armando Meza.

COVID-19 has ravaged the medical, social, and financial landscape across the world, and the USA-Mexico border is no exception. Although some risk factors for COVID-19 severity and mortality have already been identified in various ethnic cohorts, there remains a paucity of data among Hispanics, particularly those living on borders. Ethnic disparities in COVID-19 outcomes in Hispanic and black populations have been reported. We sought to identify the clinical presentation, treatment, laboratory, and imaging characteristics of 82 Hispanic patients in a county hospital and describe the factors associated with rates of hospitalization, intensive care unit (ICU) admission, and mortality. The most common comorbidities were hypertension (48.8%) and diabetes mellitus (DM) (39%), both found to be associated with hospitalization and mortality, while only DM was associated with increased rate of ICU admission. Multivariable analysis showed that individuals with fever, low oxygen saturation (SpO2), nasal congestion, shortness of breath, and DM had an increased risk of hospitalization. Individuals with fever, decreased levels of SpO2, and advanced age were found to be associated with an increased risk of death. The most common cause of death was respiratory failure (28.9%), followed by shock (17.8%) and acute kidney injury (15.6%). Our findings are critical to developing strategies and identifying at-risk individuals in a Hispanic population living on borders. Research aiming to identify key evidence-based prognostic factors in our patient population will help inform our healthcare providers so that best interventions can be implemented to improve the outcomes of patients with COVID-19.

Keywords: COVID-19; diabetes mellitus; intensive care units

DOI: https://doi.org/10.1136/jim-2020-001667