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. 2021 Aug 20;3(8):e0514.
doi: 10.1097/CCE.0000000000000514. eCollection 2021 Aug.

Risk Factors for Critical Coronavirus Disease 2019 and Mortality in Hospitalized Young Adults: An Analysis of the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) Coronavirus Disease 2019 Registry

Sandeep Tripathi  1 , Imran A Sayed  2 , Heda Dapul  3 , Jeremy S McGarvey  4 , Jennifer A Bandy  5 , Karen Boman  6 , Vishakha K Kumar  6 , Vikas Bansal  7 , Lynn Retford  7 , Sreekanth Cheruku  8 , Margit Kaufman  9 , Smith F Heavner  10 , Valerie C Danesh  11 , Catherine A St Hill  12 , Ashish K Khanna  13   14 , Utpal Bhalala  15 , Rahul Kashyap  7 , Ognjen Gajic  7 , Allan J Walkey  16 , Katja M Gist  2
Affiliations

Risk Factors for Critical Coronavirus Disease 2019 and Mortality in Hospitalized Young Adults: An Analysis of the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) Coronavirus Disease 2019 Registry

Sandeep Tripathi et al. Crit Care Explor. .

Abstract

Importance: Even with its proclivity for older age, coronavirus disease 2019 has been shown to affect all age groups. However, there remains a lack of research focused primarily on the young adult population.

Objectives: To describe the epidemiology and outcomes of coronavirus disease 2019 and identify the risk factors associated with critical illness and mortality in hospitalized young adults.

Design settings and participants: A retrospective cohort study of the Society of Critical Care Medicine's Viral Infection and Respiratory Illness Universal Study registry. Patients 18-40 years old, hospitalized from coronavirus disease 2019 from March 2020 to April 2021, were included in the analysis.

Main outcomes and measures: Critical illness was defined as a composite of mortality and 21 predefined interventions and complications. Multivariable logistic regression was used to assess associations with critical illness and mortality.

Results: Data from 4,005 patients (152 centers, 19 countries, 18.6% non-U.S. patients) were analyzed. The median age was 32 years (interquartile range, 27-37 yr); 51% were female, 29.4% Hispanic, and 42.9% had obesity. Most patients (63.2%) had comorbidities, the most common being hypertension (14.5%) and diabetes (13.7%). Hospital and ICU mortality were 3.2% (129/4,005) and 8.3% (109/1,313), respectively. Critical illness occurred in 25% (n = 996), and 34.3% (n = 1,376) were admitted to the ICU. Older age (p = 0.03), male sex (adjusted odds ratio, 1.83 [95% CI, 1.2-2.6]), and obesity (adjusted odds ratio, 1.6 [95% CI, 1.1-2.4]) were associated with hospital mortality. In addition to the above factors, the presence of any comorbidity was associated with critical illness from coronavirus disease 2019. Multiple sensitivity analyses, including analysis with U.S. patients only and patients admitted to high-volume sites, showed similar risk factors.

Conclusions: Among hospitalized young adults, obese males with comorbidities are at higher risk of developing critical illness or dying from coronavirus disease 2019.

Keywords: coronavirus disease 2019; intensive care; mortality risk; outcomes; young adults.

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Conflict of interest statement

Dr. Kumar is currently funded by funding the Gordon and Betty Moore Foundation, Centers for Disease Control and Prevention Foundation through the University of Washington, and Janssen Research & Development, LLC. Dr. Khanna is currently funded by a Clinical and Translational Science Institute National Institutes of Health (NIH)/National Center for Advancing Translational Science KL2 TR001421 award for a trial on continuous postoperative hemodynamic and saturation monitoring and is a site principal investigator (PI) (institutional funding) for a randomized trial of cytokine filtration in severe coronavirus disease 2019 (COVID-19) and a prospective observational trial of blood volume assessment and capillary permeability in COVID-19. He is funded for his position on the steering committee for the SILtuximab in Viral Acute Respiratory distress syndrome study. His institution also received funding for the Society of Critical Care Medicine (SCCM) Viral Infection and Respiratory Illness Universal Study (VIRUS) Electronic Medical Records (EMR) automation pilot. Dr. Bhalala is currently funded by the NIH (Site-PI for Stress Hydrocortisone in Pediatric Septic Shock—R01HD096901), The Children’s Hospital of Philadelphia (Site PI for Pediatric Resuscitation Quality Collaborative), Voelcker Pilot Grant (PI for the project on Prearrest Electrocardiographic Changes), The Children’s Hospital of San Antonio Endowed Chair Funds for ancillary projects related to SCCM VIRUS (COVID-19) Registry, and SCCM VIRUS EMR automation pilot. Dr. Kashyap receives funding from the NIH/National Heart, Lung and Blood Institute: R01HL 130881, UG3/UH3HL 141722; Gordon and Betty Moore Foundation and Janssen Research & Development, LLC; and royalties from Ambient Clinical Analytics. Inc. Dr. Gajic receives funding from the Agency of Healthcare Research and Quality R18HS 26609-2, NIH/National Heart, Lung and Blood Institute: R01HL 130881, UG3/UH3HL 141722; Department of Defense DOD W81XWH; American Heart Association Rapid Response Grant—COVID-19; and royalties from Ambient Clinical Analytics. Inc. Dr. Walkey currently receives funding from the NIH/National Heart, Lung and Blood Institute grants R01HL151607, R01HL139751, R01HL136660, Agency of Healthcare Research and Quality, R01HS026485, Boston Biomedical Innovation Center/NIH/NHLBI 5U54HL119145-07, and royalties from UpToDate. The remaining authors have disclosed that they do not have any conflicts of interest.

Figures

Figure 1.
Figure 1.
Consort flow diagram of the study cohort. (The total number of patients is approximate as it reflects the number of entries in the registry on the week of data extraction for analysis.) COVID-19 = coronavirus disease 2019, VIRUS = Viral Infection and Respiratory Illness Universal Study.
Figure 2.
Figure 2.
Forest plot for the adjusted odds ratio (aOR) of critical coronavirus disease 2019 (A) and mortality (B) in hospitalized young adults. Results are from separate regression models for each outcome and contain all the categorical variables listed in the figures. Five levels of race and ethnicity entered in the model. Of a total of 20 comparative groups, only two are shown. Age was entered in the respective models as a continuous variable and not shown in the figure. aOR for critical illness per unit increase in age 1.01 (95% CI, 1.004–1.03; p = 0.007). aOR for mortality per unit increase in age 1.03 (95% CI, 1.002–1.06; p = 0.03). Obesity is not included as a comorbidity in the composite category of any comorbidity. Variance inflation factor less than 5 for all variables included in the model.
See this image and copyright information in PMC

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