Cargando…

COVID-19 in young and middle-aged adults: predictors of poor outcome and clinical differences

INTRODUCTION: Young and middle-aged adults are the largest group of patients infected with SARS-CoV-2 and some of them develop severe disease. OBJECTIVE: To investigate clinical manifestations in adults aged 18–65 years hospitalized for COVID-19 and identify predictors of poor outcome. Secondary obj...

Descripción completa

Detalles Bibliográficos
Autores principales: Tabernero, Eva, Ruiz, Luis A., España, Pedro P., Méndez, Raúl, Serrano, Leyre, Santos, Borja, Uranga, Ane, González, Paula, Garcia, Patricia, Torres, Antoni, Menendez, Rosario, Zalacain, Rafael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8406039/
https://www.ncbi.nlm.nih.gov/pubmed/34463951
http://dx.doi.org/10.1007/s15010-021-01684-9
_version_ 1783746442319364096
author Tabernero, Eva
Ruiz, Luis A.
España, Pedro P.
Méndez, Raúl
Serrano, Leyre
Santos, Borja
Uranga, Ane
González, Paula
Garcia, Patricia
Torres, Antoni
Menendez, Rosario
Zalacain, Rafael
author_facet Tabernero, Eva
Ruiz, Luis A.
España, Pedro P.
Méndez, Raúl
Serrano, Leyre
Santos, Borja
Uranga, Ane
González, Paula
Garcia, Patricia
Torres, Antoni
Menendez, Rosario
Zalacain, Rafael
author_sort Tabernero, Eva
collection PubMed
description INTRODUCTION: Young and middle-aged adults are the largest group of patients infected with SARS-CoV-2 and some of them develop severe disease. OBJECTIVE: To investigate clinical manifestations in adults aged 18–65 years hospitalized for COVID-19 and identify predictors of poor outcome. Secondary objectives: to explore differences compared to the disease in elderly patients and the suitability of the commonly used community-acquired pneumonia prognostic scales in younger populations. METHODS: Multicenter prospective registry of consecutive patients hospitalized for COVID-19 pneumonia aged 18–65 years between March and May 2020. We considered a composite outcome of “poor outcome” including intensive care unit admission and/or use of noninvasive ventilation, continuous positive airway pressure or high flow nasal cannula oxygen and/or death. RESULTS: We identified 513 patients < 65 years of age, from a cohort of 993 patients. 102 had poor outcomes (19.8%) and 3.9% died. 78% and 55% of patients with poor outcomes were classified as low risk based on CURB and PSI scores, respectively. A multivariate Cox regression model identified six independent factors associated with poor outcome: heart disease, absence of chest pain or anosmia, low oxygen saturation, high LDH and lymphocyte count < 800/mL. CONCLUSIONS: COVID-19 in younger patients carries significant morbidity and differs in some respects from this disease in the elderly. Baseline heart disease is a relevant risk factor, while anosmia and pleuritic pain are associated to better prognosis. Hypoxemia, LDH and lymphocyte count are predictors of poor outcome. We consider that CURB and PSI scores are not suitable criteria for deciding admission in this population.
format Online
Article
Text
id pubmed-8406039
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Springer Berlin Heidelberg
record_format MEDLINE/PubMed
spelling pubmed-84060392021-08-31 COVID-19 in young and middle-aged adults: predictors of poor outcome and clinical differences Tabernero, Eva Ruiz, Luis A. España, Pedro P. Méndez, Raúl Serrano, Leyre Santos, Borja Uranga, Ane González, Paula Garcia, Patricia Torres, Antoni Menendez, Rosario Zalacain, Rafael Infection Original Paper INTRODUCTION: Young and middle-aged adults are the largest group of patients infected with SARS-CoV-2 and some of them develop severe disease. OBJECTIVE: To investigate clinical manifestations in adults aged 18–65 years hospitalized for COVID-19 and identify predictors of poor outcome. Secondary objectives: to explore differences compared to the disease in elderly patients and the suitability of the commonly used community-acquired pneumonia prognostic scales in younger populations. METHODS: Multicenter prospective registry of consecutive patients hospitalized for COVID-19 pneumonia aged 18–65 years between March and May 2020. We considered a composite outcome of “poor outcome” including intensive care unit admission and/or use of noninvasive ventilation, continuous positive airway pressure or high flow nasal cannula oxygen and/or death. RESULTS: We identified 513 patients < 65 years of age, from a cohort of 993 patients. 102 had poor outcomes (19.8%) and 3.9% died. 78% and 55% of patients with poor outcomes were classified as low risk based on CURB and PSI scores, respectively. A multivariate Cox regression model identified six independent factors associated with poor outcome: heart disease, absence of chest pain or anosmia, low oxygen saturation, high LDH and lymphocyte count < 800/mL. CONCLUSIONS: COVID-19 in younger patients carries significant morbidity and differs in some respects from this disease in the elderly. Baseline heart disease is a relevant risk factor, while anosmia and pleuritic pain are associated to better prognosis. Hypoxemia, LDH and lymphocyte count are predictors of poor outcome. We consider that CURB and PSI scores are not suitable criteria for deciding admission in this population. Springer Berlin Heidelberg 2021-08-31 2022 /pmc/articles/PMC8406039/ /pubmed/34463951 http://dx.doi.org/10.1007/s15010-021-01684-9 Text en © Springer-Verlag GmbH Germany, part of Springer Nature 2021 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Original Paper
Tabernero, Eva
Ruiz, Luis A.
España, Pedro P.
Méndez, Raúl
Serrano, Leyre
Santos, Borja
Uranga, Ane
González, Paula
Garcia, Patricia
Torres, Antoni
Menendez, Rosario
Zalacain, Rafael
COVID-19 in young and middle-aged adults: predictors of poor outcome and clinical differences
title COVID-19 in young and middle-aged adults: predictors of poor outcome and clinical differences
title_full COVID-19 in young and middle-aged adults: predictors of poor outcome and clinical differences
title_fullStr COVID-19 in young and middle-aged adults: predictors of poor outcome and clinical differences
title_full_unstemmed COVID-19 in young and middle-aged adults: predictors of poor outcome and clinical differences
title_short COVID-19 in young and middle-aged adults: predictors of poor outcome and clinical differences
title_sort covid-19 in young and middle-aged adults: predictors of poor outcome and clinical differences
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8406039/
https://www.ncbi.nlm.nih.gov/pubmed/34463951
http://dx.doi.org/10.1007/s15010-021-01684-9
work_keys_str_mv AT taberneroeva covid19inyoungandmiddleagedadultspredictorsofpooroutcomeandclinicaldifferences
AT ruizluisa covid19inyoungandmiddleagedadultspredictorsofpooroutcomeandclinicaldifferences
AT espanapedrop covid19inyoungandmiddleagedadultspredictorsofpooroutcomeandclinicaldifferences
AT mendezraul covid19inyoungandmiddleagedadultspredictorsofpooroutcomeandclinicaldifferences
AT serranoleyre covid19inyoungandmiddleagedadultspredictorsofpooroutcomeandclinicaldifferences
AT santosborja covid19inyoungandmiddleagedadultspredictorsofpooroutcomeandclinicaldifferences
AT urangaane covid19inyoungandmiddleagedadultspredictorsofpooroutcomeandclinicaldifferences
AT gonzalezpaula covid19inyoungandmiddleagedadultspredictorsofpooroutcomeandclinicaldifferences
AT garciapatricia covid19inyoungandmiddleagedadultspredictorsofpooroutcomeandclinicaldifferences
AT torresantoni covid19inyoungandmiddleagedadultspredictorsofpooroutcomeandclinicaldifferences
AT menendezrosario covid19inyoungandmiddleagedadultspredictorsofpooroutcomeandclinicaldifferences
AT zalacainrafael covid19inyoungandmiddleagedadultspredictorsofpooroutcomeandclinicaldifferences