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. 2023 Jun 27;10(7):ofad330.
doi: 10.1093/ofid/ofad330. eCollection 2023 Jul.

Early Outcomes of SARS-CoV-2 Infection in a Multisite Prospective Cohort of Inpatient Veterans

Jennifer M Ross  1   2 , Jonathan D Sugimoto  1 , Andrew Timmons  1 , Jonathan Adams  1 , Katrina Deardoff  1 , Anna Korpak  1 , Cindy Liu  1 , Kathryn Moore  1 , Deanna Wilson  3 , Roger Bedimo  4   5 , Kyong-Mi Chang  6   7 , Kelly Cho  8   9 , Kristina Crothers  1   10 , Eric Garshick  8   11 , J Michael Gaziano  8   9 , Mark Holodniy  3   12 , Christine M Hunt  13   14 , Stuart N Isaacs  6   7 , Elizabeth Le  3 , Barbara E Jones  15   16 , Javeed A Shah  1   2 , Nicholas L Smith  1   17 , Jennifer S Lee  3   18 ; EPIC Investigators
Collaborators, Affiliations

Early Outcomes of SARS-CoV-2 Infection in a Multisite Prospective Cohort of Inpatient Veterans

Jennifer M Ross et al. Open Forum Infect Dis. .

Abstract

Background: Over 870 000 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections have occurred among Veterans Health Administration users, and 24 000 have resulted in death. We examined early outcomes of SARS-CoV-2 infection in hospitalized veterans.

Methods: In an ongoing, prospective cohort study, we enrolled veterans age ≥18 tested for SARS-CoV-2 and hospitalized at 15 Department of Veterans Affairs medical centers between February 2021 and June 2022. We estimated adjusted odds ratios (aORs), adjusted incidence rate ratios (aIRRs), and adjusted hazard ratios (aHRs) for maximum illness severity within 30 days of study entry (defined using the 4-category VA Severity Index for coronavirus disease 2019 [COVID-19]), as well as length of hospitalization and rehospitalization within 60 days, in relationship with demographic characteristics, Charlson comorbidity index (CCI), COVID-19 vaccination, and calendar period of enrollment.

Results: The 542 participants included 329 (61%) who completed a primary vaccine series (with or without booster; "vaccinated"), 292 (54%) enrolled as SARS-CoV-2-positive, and 503 (93%) men, with a mean age of 64.4 years. High CCI scores (≥5) occurred in 61 (44%) vaccinated and 29 (19%) unvaccinated SARS-CoV-2-positive participants. Severe illness or death occurred in 29 (21%; 6% died) vaccinated and 31 (20%; 2% died) unvaccinated SARS-CoV-2-positive participants. SARS-CoV-2-positive inpatients per unit increase in CCI had greater multivariable-adjusted odds of severe illness (aOR, 1.21; 95% CI, 1.01-1.45), more hospitalization days (aIRR, 1.06; 95% CI, 1.03-1.10), and rehospitalization (aHR, 1.07; 95% CI, 1.01-1.12).

Conclusions: In a cohort of hospitalized US veterans with SARS-CoV-2 infection, those with a higher CCI had more severe COVID-19 illness, more hospital days, and rehospitalization, after adjusting for vaccination status, age, sex, and calendar period.

Keywords: COVID-19; comorbidity; rehospitalization; severity; veteran.

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Conflict of interest statement

Potential conflicts of interest. J.D.S. receives funding from the International Vaccine Institute, Seoul, Republic of Korea. R.B. has provided research support to Merck & Co. and consulting services to Merck & Co., Gilead Sciences, Theratechnologies, Shionogi, Janssen, and ViiV Healthcare. C.M.H. has provided consulting services to Adaptive Phage Therapeutics, Akebia, F2G Limited, Intercept, Otsuka, Surrozen, and Palladio. S.N.I. receives payments for contributions to UpToDate on poxviruses and is a shareholder of Johnson & Johnson. All other authors report no potential conflicts.

References

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