Characterizing Risk Factors for Hospitalization and Clinical Characteristics in a Cohort of COVID-19 Patients Enrolled in the GENCOV Study

Abstract

The GENCOV study aims to identify patient factors which affect COVID-19 severity and outcomes. Here, we aimed to evaluate patient characteristics, acute symptoms and their persistence, and associations with hospitalization. Participants were recruited at hospital sites across the Greater Toronto Area in Ontario, Canada. Patient-reported demographics, medical history, and COVID-19 symptoms and complications were collected through an intake survey. Regression analyses were performed to identify associations with outcomes including hospitalization and COVID-19 symptoms. In total, 966 responses were obtained from 1106 eligible participants (87% response rate) between November 2020 and May 2022. Increasing continuous age (aOR: 1.05 [95%CI: 1.01-1.08]) and BMI (aOR: 1.17 [95%CI: 1.10-1.24]), non-White/European ethnicity (aOR: 2.72 [95%CI: 1.22-6.05]), hypertension (aOR: 2.78 [95%CI: 1.22-6.34]), and infection by viral variants (aOR: 5.43 [95%CI: 1.45-20.34]) were identified as risk factors for hospitalization. Several symptoms including shortness of breath and fever were found to be more common among inpatients and tended to persist for longer durations following acute illness. Sex, age, ethnicity, BMI, vaccination status, viral strain, and underlying health conditions were associated with developing and having persistent symptoms. By improving our understanding of risk factors for severe COVID-19, our findings may guide COVID-19 patient management strategies by enabling more efficient clinical decision making.

Keywords: COVID-19; SARS-CoV-2; clinical characteristics; comorbidities; hospitalization; risk factors; symptoms.

Figure A1

GENCOV participant recruitment period, stratified by patient hospitalization status. The proportion of participants recruited on any given date is expressed as a percentage (%).

Figure 1

COVID-19 symptom durations reported by all respondents (in weeks). n values and percentages indicated next to each symptom reflect the number and proportion of participants who experienced a given symptom out of the entire cohort. Percentages indicated on bars represent the proportion of symptomatic participants who reported a given symptom duration.

Figure 2

COVID-19 symptom duration (in weeks) stratified by hospitalization status. Comparisons of symptom duration between patient groups were performed using the Mann–Whitney U test. Symptoms reported by >10% of each patient group were included for analysis. n values and percentages indicated below each symptom reflect the total number and proportion of participants out of each patient group who experienced a given symptom. Percentages indicated on bars represent the proportion of symptomatic participants from each patient group who reported a given symptom duration.

Figure 3

Associations between symptom prevalence and patient characteristics including sex (male (reference) vs. female), age, BMI, ethnicity (White/European (reference) vs. Non-White/European), viral variant (wild-type (reference) vs. viral variant), vaccination status (unvaccinated (reference) vs. vaccinated), and underlying medical conditions (none (reference) vs. any). Adjusted odds ratios and 95% confidence intervals for each covariate were calculated using a multiple logistic regression model. Adjusted odds ratios correspond to the odds of experiencing a given symptom in the comparator group relative to the reference group (for categorical variables), or for a one-year increase in age or one-unit increase in BMI. Statistically significant associations are indicated by asterisks (*).

Figure 3

Associations between symptom prevalence and patient characteristics including sex (male (reference) vs. female), age, BMI, ethnicity (White/European (reference) vs. Non-White/European), viral variant (wild-type (reference) vs. viral variant), vaccination status (unvaccinated (reference) vs. vaccinated), and underlying medical conditions (none (reference) vs. any). Adjusted odds ratios and 95% confidence intervals for each covariate were calculated using a multiple logistic regression model. Adjusted odds ratios correspond to the odds of experiencing a given symptom in the comparator group relative to the reference group (for categorical variables), or for a one-year increase in age or one-unit increase in BMI. Statistically significant associations are indicated by asterisks (*).

Figure 4

Associations between symptom duration and patient characteristics including sex (males (reference) vs. females), age, BMI, ethnicity (White/European (reference) vs. Non-White/European), viral variant (wild-type (reference) vs. viral variant), vaccination status (unvaccinated (reference) vs. vaccinated), and underlying medical conditions (none (reference) vs. any). Regression coefficients and 95% confidence intervals were calculated using an interval regression model. Regression coefficients correspond to the difference in symptom duration (in weeks) compared to the reference group (for categorical variables), or for a one-year increase in age or one-unit increase in BMI. Statistically significant associations are indicated by asterisks (*).

Figure 4

Associations between symptom duration and patient characteristics including sex (males (reference) vs. females), age, BMI, ethnicity (White/European (reference) vs. Non-White/European), viral variant (wild-type (reference) vs. viral variant), vaccination status (unvaccinated (reference) vs. vaccinated), and underlying medical conditions (none (reference) vs. any). Regression coefficients and 95% confidence intervals were calculated using an interval regression model. Regression coefficients correspond to the difference in symptom duration (in weeks) compared to the reference group (for categorical variables), or for a one-year increase in age or one-unit increase in BMI. Statistically significant associations are indicated by asterisks (*).