Predictive Factors For Severe And Critical Coronavirus Disease-19 In Young Adults

Abstract

Purpose: Advanced age is associated with a poor prognosis in Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The present study investigated the predictive factors for disease severity in young adults. Method: Our study is a descriptive cross-sectional study. A total of 399 patients with SARS-CoV-2 aged under 60 who had been hospitalized at our hospital were retrospectively evaluated. Patients were stratified into mild, moderate, severe, and critical groups according to their respiratory rate, SpO2, and PaO2/FiO2 levels. The relationship between the signs and symptoms on hospital admission and the disease severity was evaluated. Results: The patients were classified as mild (n:112), moderate (n:192), severe and critical (n:95) according to disease severity. The mean age was 44. 43 of 399 patients were followed in the intensive care unit, and 17 patients died. According to the binary logistic regression analysis, advanced age, hypertension, dyspnea on admission, elevated CRP, decreased lymphocyte and eosinophil count, multiple bilateral ground glass appearances, and consolidation independently predicted the severity of the disease. Conclusion: The signs and symptoms should be evaluated in detail also in young patients with SARS-CoV-2. If risk factors are detected, they should be monitored more closely to predict a poor prognosis..

Keywords

• SARS-CoV-2
• Young adult
• Prognostic factors

Project Number

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Genç Erişkinlerde Şiddetli Ve Kritik Coronavirüs 19 Hastalığı Gelişimini Öngördüren Faktörler.

Abstract

Amaç: Coronavirus disease 2019 (COVID 19) seyrinde ileri yaş varlığı hastalığın kötü gidişi ile ilişkilidir. Biz bu çalışmada 60 yaş altı genç hastalarda hastalığın şiddetini öngördüren faktörleri göstermeyi amaçladık. Gereç ve Yöntemler: Çalışmamızda mart – temmuz 2020 tarihleri arasında hastanemizde yatarak takip edilen COVID-19 tanılı 399 hasta retrospektif olarak değerlendirildi. Hastalara COVID-19 tanısı WHO güncel önerilerine göre konuldu. Hastaların hastaneye başvuru sırasındaki semptom ve bulguları ile hastalığın şiddeti arasındaki ilişki değerlendirildi. Bulgular: Hastalığın şiddetine göre; hastaların 112 ’si hafif, 192 ‘si orta ve 95 ’i şiddetli ve kritik olarak değerlendirildi. Hastaların hepsi 60 yaş ve altında olup ortalama yaş 44’ dü. Binary logistic regression analizine göre ileri yaş, hipertansiyon varlığı, hastaneye başvuru anında nefes darlığı olması, CRP yüksekliği, lenfosit ve eozinofil düşüklüğü , akciğer tomografisinde multipl bilateral buzlu cam tutulumu ve konsolidasyon varlığının hastalık ağırlığını bağımsız olarak öngördürdüğü saptandı. Sonuç: COVID-19 ile başvuran genç hastalarda da semptom ve bulgular ayrıntılı değerlendirilmeli ve risk faktörleri saptanırsa kötü gidiş öngörülerek hastalar daha yakından takip edilmelidir

Keywords

• SARS-CoV-2
• Genç yetişkin
• Prognostik faktörler

Supporting Institution

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Project Number

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Thanks

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References

1. 1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020; 382:727–33.
2. 2. World Health Organization. WHO Coronavirus (COVID- 19) Dashboard. Available at Accessed April 14, 2021.
3. 3. Pormohammad A, Ghorbani S, Khatami A, Farzi R, Baradaran B, Turner DL, et al. Comparison of confirmed COVID-19 with SARS and MERS cases - Clinical characteristics, laboratory findings, radiographic signs and outcomes: A systematic review and meta-analysis. Rev Med Virol. 2020;30(4):e2112.
4. 4. Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. [The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China]. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(2):145-151.
5. 5. Zhou C, Huang Z, Tan W, Li X, Yin W, Xiao Y, et al. Predictive factors of severe coronavirus disease 2019 in previously healthy young adults: a single-center, retrospective study. Respir Res. 2020 Jun 22;21(1):157.
6. 6. World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected: interim guidance.. Available at Published January 28, 2020.
7. 7. Lin L, Li TS. Interpretation of guidelines for the diagnosis and treatment of novel coronavirus (2019-nCoV) infection by the National Health Commission (trial version 5). Zhonghua Yi Xue Za Zhi. 2020;100:805–7.
8. 8. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020 Mar 17;323(11):1061-1069.

9. 9. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with SARS-COV-2 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-1062.
10. 10. Mueller AL, McNamara MS, Sinclair DA. Why does SARSCOV- 2 disproportionately affect older people? Aging (Albany NY). 2020;12:9959-81.
11. 11. Liu K, Chen Y, Lin R, Han K. Clinical features of SARSCOV- 2 in elderly patients: A comparison with young and middle-aged patients. J Infect. 2020;80:14-8.
12. 12. Fathi N, Rezaei N. Lymphopenia in COVID-19: Therapeutic opportunities. Cell Biol Int. 2020;44:1792-97.
13. 13. Jeffery LE, Burke F, Mura M, Zheng Y, Qureshi OS, Hewison M, et al. 1, 25‐Dihydroxyvitamin D3 and IL‐2 combine to inhibit T cell production of inflammatory cytokines and promote development of regulatory T cells expressing CTLA‐4 and FoxP3. The Journal of Immunology. 2009;183:5458–67.
14. 14. Luo X, Zhou W, Yan X, Guo T, Wang B, Xia H,et al. Prognostic Value of C-Reactive Protein in Patients With Coronavirus 2019. Clin Infect Dis. 2020;71:2174-79..
15. 15. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020;395:497–506.
16. 16. Parasher A. COVID-19: Current understanding of its pathophysiology, clinical presentation and treatmentPostgraduate Medical Journal Published Online First: 25 September2020.
17. 17. Yang Q, Liu Q, Xu H, Lu H, Liu S, Li H. Imaging of coronavirus disease 2019: A Chinese expert consensus statement. Eur J Radiol. 2020;127:109008.
18. 18. Li K, Wu J, Wu F, Guo D, Chen L, Fang Z et al. The clinical and chest CT features associated with severe and critical SARS-COV-2 pneumonia. Invest Radiol.2020 ;55:327-31.
19. 19. Yuan M, Yin W, Tao Z Tan W, Hu Y. Association of radiologic findings with mortality of patients infected with 2019 novel coronavirus in Wuhan, China. PLoS One. 2020;19:15.
20. 20. Koo HJ, Lim S, Choe J, Choi SH, Sung H, Do KH.. Radiographic and CT features of viral pneumonia. Radiographics. 2018;38:719–39.
21. 21. Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004;203:631–7.
22. 22. Drummond GR, Vinh A, Guzik TJ, Sobey CG. Immune mechanisms of hypertension. Nat Rev Immunol. 2019;19:517–32.
23. 23. Huang S, Wang J, Liu F, Liu J, Cao G, Yang C, et al. COVID‐19 patients with hypertension have more severe disease: a multicenter retrospective observational study. Hypertens Res. 2020;43:824-31.
24. 24. Pranata R, Lim MA, Huang I, Raharjo SB, Lukito AA. Hypertension is associated with increased mortality and severity of disease in COVID‐19 pneumonia: a systematic review, meta‐analysis and meta‐regression. J Renin Angiotensin Aldosterone Syst. 2020 Apr;21(2):1470320320926899.
25. 25. The Novel Coronavirus Pneumonia Emergency Response Epidemiology T. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID- 19) — China, 2020. China CDC Weekly. 2020;2:113– 22.
26. 26. Williamson E, Walker AJ, Bhaskaran KJ, Bacon S, Bates C, Morton CE, et al. Open SAFELY: factors associated with COVID19-related hospital death in the linked electronic health records of 17 million adult NHS patients. Nature. 2020;584:430-36.