Predictors of critical COVID-19 in an Iranian population: Age and disabilities play a special role

Background: Ever since coronavirus disease 2019 (COVID-19) has emerged as a global public health problem, risk factors for severe disease have been reported in studies from Western countries. However, apart from studies of Chinese origin, few reports are available on COVID-19 severity among the Asian population. This study investigates potential risk factors for development of critical COVID-19 in an Iranian population. Methods: In this retrospective cohort study, we included all adults with COVID-19 from 2 tertiary centers in Iran who had been diagnosed between February 20 and April 1, 2020, in either inpatient or outpatient settings. “Critical COVID-19” was proposed when a hospitalized patient was scheduled for admission to intensive care unit, assisted by mechanical ventilation, or pronounced dead. We used univariable and multivariable logistic and linear regression models to explore the potential risk factors associated with critical COVID-19, admission to hospital, and length of hospital stay. Results: Of the 590 recruited patients, 427 (72.4%) were hospitalized, 186 (31.5%) had critical COVID-19, and 107 (18.2%) died. In the multivariable regression analysis, age >60 years and physical/mental disabilities were associated with critical COVID-19 (odds ratio (OR), 2.33 and 7.03; 95% CI, 1.51-3.60 and 2.88-17.13, respectively); and history of renal, heart, or liver failure was associated with both COVID-19 hospitalization (OR, 4.13; 95% CI 1.91-8.95; p<0.001) and length of hospital stay (Beta 1.90; 95% CI, 0.76-3.04; p=0.001). Conclusion: Age >60 years and physical/mental disabilities can predict development of critical COVID-19 in the Iranian population. Also, the presence of renal, heart, or liver failure might predict both COVID-19 hospitalization and length of hospital stay.