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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
PloS one, 07/2020, Letnik: 15, Številka: 7Journal Article
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.
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