Six traits predict need for mechanical ventilation in patients with COVID-19
Among patients hospitalized for COVID-19 in the United States, male sex, age 60 years and older, obesity, chronic kidney disease, cardiovascular disease and living in the Northeast were associated with an increased risk for mechanical ventilation, data show.
The findings, published in Clinical Infectious Diseases, also indicated that the same characteristics, except for obesity, were linked to an increased risk for mortality.
“This was the first attempt to try and get a broader sense of the risk factors for adverse outcome and how they interacted with one another in a much more specific manner,” Robert S. Brown, Jr., MD, MPH, clinical chief of the division of gastroenterology and hepatology at Weill Cornell Medicine Center, told Healio Primary Care.
Researchers reviewed data from 11,721 patients with COVID-19 who were admitted to 245 hospitals across 38 states between Feb. 15 and April 20. Among all patients, 48 received remdesivir (Gilead) and 4,232 received hydroxychloroquine. In addition:
- 59.9% were aged 60 and older;
- 53.4% were men;
- 46.7% had hypertension;
- 27.8% had diabetes;
- 18.6% had CVD;
- 16.1% had obesity;
- 12.2% had chronic kidney disease; and
- 16.8% of patients needed mechanical ventilation.
Patients who required mechanical ventilation were more likely to be:
- men (63.9% vs. 51.3%);
- over the age of 60 years (67.3% vs. 58.4%);
- have a history of chronic kidney disease (15.2% vs. 11.6%), CVD (22.6% vs. 17.8%) or obesity (18.3% vs. 15.7%); and
- live in the Northeast (52.3%) instead of the Midwest (4.1%), West (12%) or South (31.6%).
“We expected to see older age, obesity and cardiovascular disease as risks,” Brown said. “But I was surprised that chronic lung disease and smoking did not seem to be conferring an increased risk. This requires further investigation.”
Researchers also reported a 21.4% mortality rate among hospitalized patients; this rate increased to 70.5% among those on mechanical ventilation. The odds of death were higher among men (adjusted OR = 1.5; 95% CI, 1.3-1.6) and patients aged 60 years and older (adjusted OR = 7.2; 95% CI, 5.4-9.7). Living in the Northeast and having chronic kidney disease or CVD were also associated with mortality (P < .001).
Brown said the findings can help steer efforts to bring the pandemic under control.
“The most common question I get asked as a clinician is, ‘Do my medical conditions merit working from home?’,” he said. “With this data, I have a better sense of how to quantify patient risk vs. factors such as age and comorbid conditions.”
He said the data can also guide early intervention efforts and vaccination priorities.