bims-covirf 2021-12-26 papers

Issue of 2021–12–26
five papers selected by
Catherine Rycroft, BresMed

Am J Emerg Med. 2021 Dec 11. pii: S0735-6757(21)00982-7. [Epub ahead of print]52 166-173

Characteristics, risk factors, and outcomes associated with readmission in COVID-19 patients: A systematic review and meta-analysis.

Abolfazl Akbari, Amirhossein Fathabadi, Mahya Razmi, Ahmadreza Zarifian, Mahdi Amiri, Alireza Ghodsi, Elnaz Vafadar Moradi.

BACKGROUND: We aimed to determine the characteristics, risk factors, and outcomes associated with readmission in COVID-19 patients.
METHODS: PubMed, Embase, Web of Science, and Scopus databases were searched to retrieve articles on readmitted COVID-19 patients, available up to September 25, 2021. All studies comparing characteristics of readmitted and non-readmitted COVID-19 patients were included. We also included articles reporting the reasons for readmission in COVID-19 patients. Data were pooled and meta-analyzed using random or fixed-effect models, as appropriate. Subgroup analyses were conducted based on the place and duration of readmission.
RESULTS: Our meta-analysis included 4823 readmitted and 63,413 non-readmitted COVID-19 patients. The re-hospitalization rate was calculated at 9.3% with 95% Confidence Interval (CI) [5.5%-15.4%], mostly associated with respiratory or cardiac complications (48% and 14%, respectively). Comorbidities including cerebrovascular disease (Odds Ratio (OR) = 1.812; 95% CI [1.547-2.121]), cardiovascular (2.173 [1.545-3.057]), hypertension (1.608 [1.319-1.960]), ischemic heart disease (1.998 [1.495-2.670]), heart failure (2.556 [1.980-3.300]), diabetes (1.588 [1.443-1.747]), cancer (1.817 [1.526-2.162]), kidney disease (2.083 [1.498-2.897]), chronic pulmonary disease (1.601 [1.438-1.783]), as well as older age (1.525 [1.175-1.978]), male sex (1.155 [1.041-1.282]), and white race (1.263 [1.044-1.528]) were significantly associated with higher readmission rates (P < 0.05 for all instances). The mortality rate was significantly lower in readmitted patients (OR = 0.530 [0.329-0.855], P = 0.009).
CONCLUSIONS: Male sex, white race, comorbidities, and older age were associated with a higher risk of readmission among previously admitted COVID-19 patients. These factors can help clinicians and policy-makers predict, and conceivably reduce the risk of readmission in COVID-19 patients.

Keywords: COVID-19; Emergency department; Hospital; Meta-analysis; Readmission; Risk factor; Systematic review

DOI: https://doi.org/10.1016/j.ajem.2021.12.012

Pediatrics. 2021 Dec 22. pii: e2021053418. [Epub ahead of print]

Risk Factors for Severe COVID-19 in Children.

OBJECTIVES: Describe population-based rates and risk factors for severe coronavirus disease 2019 (COVID-19) (ie, ICU admission, invasive mechanical ventilation, or death) among hospitalized children.
METHODS: During March 2020 to May 2021, the COVID-19-Associated Hospitalization Surveillance Network identified 3106 children hospitalized with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection in 14 states. Among 2293 children primarily admitted for COVID-19, multivariable generalized estimating equations generated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) of the associations between demographic and medical characteristics abstracted from medical records and severe COVID-19. We calculated age-adjusted cumulative population-based rates of severe COVID-19 among all children.
RESULTS: Approximately 30% of hospitalized children had severe COVID-19; 0.5% died during hospitalization. Among hospitalized children aged <2 years, chronic lung disease (aRR: 2.2; 95% CI: 1.1-4.3), neurologic disorders (aRR: 2.0; 95% CI: 1.5‒2.6), cardiovascular disease (aRR: 1.7; 95% CI: 1.2‒2.3), prematurity (aRR: 1.6; 95% CI: 1.1‒2.2), and airway abnormality (aRR: 1.6; 95% CI: 1.1‒2.2) were associated with severe COVID-19. Among hospitalized children aged 2 to 17 years, feeding tube dependence (aRR: 2.0; 95% CI: 1.5‒2.5), diabetes mellitus (aRR: 1.9; 95% CI: 1.6‒2.3) and obesity (aRR: 1.2; 95% CI: 1.0‒1.4) were associated with severe COVID-19. Severe COVID-19 occurred among 12.0 per 100 000 children overall and was highest among infants, Hispanic children, and non-Hispanic Black children.
CONCLUSIONS: Results identify children at potentially higher risk of severe COVID-19 who may benefit from prevention efforts, including vaccination. Rates establish a baseline for monitoring changes in pediatric illness severity after increased availability of COVID-19 vaccines and the emergence of new variants.

DOI: https://doi.org/10.1542/peds.2021-053418

Prev Med. 2021 Dec 15. pii: S0091-7435(21)00490-4. [Epub ahead of print] 106917

Fraction of COVID-19 hospitalizations and deaths attributable to chronic diseases.

Francisco Reyes-Sánchez, Ana Basto-Abreu, Rossana Torres-Alvarez, Francisco Canto-Osorio, Romina González-Morales, Dwight Dyer, Ruy López-Ridaura, Christian A Zaragoza-Jiménez, Juan A Rivera, Tonatiuh Barrientos-Gutiérrez.

Evidence shows that chronic diseases are associated with COVID-19 severity and death. This study aims to estimate the fraction of hospitalizations and deaths from COVID-19 attributable to chronic diseases associated to poor nutrition and smoking among adults who tested positive to COVID-19 in Mexico. We analyzed 1,006,541 adults aged ≥20 who tested positive for COVID-19 from March 23 to December 5, 2020. Six chronic diseases were considered: obesity, chronic obstructive pulmonary disease (COPD), hypertension, diabetes, cardiovascular disease, and chronic kidney disease (CKD). We calibrated the database using a bias quantification method to consider undiagnosed disease cases. To estimate the total impact of multiple diseases, we defined a multimorbidity variable according to the number of diseases. Risks of hospitalization and death were estimated with Poisson regression models and used to calculate population attributable fractions (PAFs). Chronic diseases accounted for to 25.4% [95% CI: 24.8%-26.1%], 28.3% (95% CI: 27.8%-28.7%) and 15.3% (95% CI: 14.9%-15.7%) of the hospitalizations among adults below 40, 40-59, and 60 years and older, respectively. For COVID-19-related deaths, 50.1% (95% CI: 48.6%-51.5%), 40.5% (95% CI: 39.7%-41.3%), and 18.7% (95% CI, 18.0%-19.5%) were attributable to chronic diseases in adults under 40, 40-59, and 60 years and older, respectively. Chronic diseases linked to poor nutrition and smoking could have contributed to a large burden of hospitalization and deaths from COVID-19 in Mexico, particularly among younger adults. Medical and structural interventions to curb chronic disease incidence and facilitate disease control are urgently needed.

DOI: https://doi.org/10.1016/j.ypmed.2021.106917

Front Public Health. 2021 ;9 743003

Differential Impact of COVID-19 Risk Factors on Ethnicities in the United States.

Prashant Athavale, Vijay Kumar, Jeremy Clark, Sumona Mondal, Shantanu Sur.

The coronavirus disease (COVID-19) has revealed existing health inequalities in racial and ethnic minority groups in the US. This work investigates and quantifies the non-uniform effects of geographical location and other known risk factors on various ethnic groups during the COVID-19 pandemic at a national level. To quantify the geographical impact on various ethnic groups, we grouped all the states of the US. into four different regions (Northeast, Midwest, South, and West) and considered Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Hispanic, Non-Hispanic Asian (NHA) as ethnic groups of our interest. Our analysis showed that infection and mortality among NHB and Hispanics are considerably higher than NHW. In particular, the COVID-19 infection rate in the Hispanic community was significantly higher than their population share, a phenomenon we observed across all regions in the US but is most prominent in the West. To gauge the differential impact of comorbidities on different ethnicities, we performed cross-sectional regression analyses of statewide data for COVID-19 infection and mortality for each ethnic group using advanced age, poverty, obesity, hypertension, cardiovascular disease, and diabetes as risk factors. After removing the risk factors causing multicollinearity, poverty emerged as one of the independent risk factors in explaining mortality rates in NHW, NHB, and Hispanic communities. Moreover, for NHW and NHB groups, we found that obesity encapsulated the effect of several other comorbidities such as advanced age, hypertension, and cardiovascular disease. At the same time, advanced age was the most robust predictor of mortality in the Hispanic group. Our study quantifies the unique impact of various risk factors on different ethnic groups, explaining the ethnicity-specific differences observed in the COVID-19 pandemic. The findings could provide insight into focused public health strategies and interventions.

Keywords: COVID-19; Hispanic; diabetes; ethnicity; infection; mortality; risk factors

DOI: https://doi.org/10.3389/fpubh.2021.743003

JAMA Netw Open. 2021 Dec 01. 4(12): e2140568

Metabolic Syndrome and Acute Respiratory Distress Syndrome in Hospitalized Patients With COVID-19.

Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator Group

Importance: Obesity, diabetes, and hypertension are common comorbidities in patients with severe COVID-19, yet little is known about the risk of acute respiratory distress syndrome (ARDS) or death in patients with COVID-19 and metabolic syndrome.
Objective: To determine whether metabolic syndrome is associated with an increased risk of ARDS and death from COVID-19.
Design, Setting, and Participants: This multicenter cohort study used data from the Society of Critical Care Medicine Discovery Viral Respiratory Illness Universal Study collected from 181 hospitals across 26 countries from February 15, 2020, to February 18, 2021. Outcomes were compared between patients with metabolic syndrome (defined as ≥3 of the following criteria: obesity, prediabetes or diabetes, hypertension, and dyslipidemia) and a control population without metabolic syndrome. Participants included adult patients hospitalized for COVID-19 during the study period who had a completed discharge status. Data were analyzed from February 22 to October 5, 2021.
Exposures: Exposures were SARS-CoV-2 infection, metabolic syndrome, obesity, prediabetes or diabetes, hypertension, and/or dyslipidemia.
Main Outcomes and Measures: The primary outcome was in-hospital mortality. Secondary outcomes included ARDS, intensive care unit (ICU) admission, need for invasive mechanical ventilation, and length of stay (LOS).
Results: Among 46 441 patients hospitalized with COVID-19, 29 040 patients (mean [SD] age, 61.2 [17.8] years; 13 059 [45.0%] women and 15713 [54.1%] men; 6797 Black patients [23.4%], 5325 Hispanic patients [18.3%], and 16 507 White patients [57.8%]) met inclusion criteria. A total of 5069 patients (17.5%) with metabolic syndrome were compared with 23 971 control patients (82.5%) without metabolic syndrome. In adjusted analyses, metabolic syndrome was associated with increased risk of ICU admission (adjusted odds ratio [aOR], 1.32 [95% CI, 1.14-1.53]), invasive mechanical ventilation (aOR, 1.45 [95% CI, 1.28-1.65]), ARDS (aOR, 1.36 [95% CI, 1.12-1.66]), and mortality (aOR, 1.19 [95% CI, 1.08-1.31]) and prolonged hospital LOS (median [IQR], 8.0 [4.2-15.8] days vs 6.8 [3.4-13.0] days; P < .001) and ICU LOS (median [IQR], 7.0 [2.8-15.0] days vs 6.4 [2.7-13.0] days; P < .001). Each additional metabolic syndrome criterion was associated with increased risk of ARDS in an additive fashion (1 criterion: 1147 patients with ARDS [10.4%]; P = .83; 2 criteria: 1191 patients with ARDS [15.3%]; P < .001; 3 criteria: 817 patients with ARDS [19.3%]; P < .001; 4 criteria: 203 patients with ARDS [24.3%]; P < .001).
Conclusions and Relevance: These findings suggest that metabolic syndrome was associated with increased risks of ARDS and death in patients hospitalized with COVID-19. The association with ARDS was cumulative for each metabolic syndrome criteria present.

DOI: https://doi.org/10.1001/jamanetworkopen.2021.40568