Pre-existing traits associated with Covid-19 illness severity

Ebinger, Joseph E.; Achamallah, Natalie; Ji, Hongwei; Claggett, Brian L.; Sun, Nancy; Botting, Patrick; Nguyen, Trevor-Trung; Luong, Eric; Kim, Elizabeth H.; Park, Eunice; Liu, Yunxian; Rosenberry, Ryan; Matusov, Yuri; Zhao, Steven; Pedraza, Isabel; Zaman, Tanzira; Thompson, Michael; Raedschelders, Koen; Berg, Anders H.; Grein, Jonathan D.; Noble, Paul W.; Chugh, Sumeet S.; Bairey Merz, C. Noel; Marbán, Eduardo; Van Eyk, Jennifer E.; Solomon, Scott D.; Albert, Christine M.; Chen, Peter; Cheng, Susan

IMPORTANCE: Certain individuals, when infected by SARS-CoV-2, tend to develop the more severe forms of Covid-19 illness for reasons that remain unclear. OBJECTIVE: To determine the demographic and clinical characteristics associated with increased severity of Covid-19 infection. DESIGN: Retrospective observational study. We curated data from the electronic health record, and used multivariable logistic regression to examine the association of pre-existing traits with a Covid-19 illness severity defined by level of required care: need for hospital admission, need for intensive care, and need for intubation. SETTING: A large, multihospital healthcare system in Southern California. PARTICIPANTS: All patients with confirmed Covid-19 infection (N = 442). RESULTS: Of all patients studied, 48% required hospitalization, 17% required intensive care, and 12% required intubation. In multivariable-adjusted analyses, patients requiring a higher levels of care were more likely to be older (OR 1.5 per 10 years, P<0.001), male (OR 2.0, P = 0.001), African American (OR 2.1, P = 0.011), obese (OR 2.0, P = 0.021), with diabetes mellitus (OR 1.8, P = 0.037), and with a higher comorbidity index (OR 1.8 per SD, P<0.001). Several clinical associations were more pronounced in younger compared to older patients (P(interaction)<0.05). Of all hospitalized patients, males required higher levels of care (OR 2.5, P = 0.003) irrespective of age, race, or morbidity profile. CONCLUSIONS AND RELEVANCE: In our healthcare system, greater Covid-19 illness severity is seen in patients who are older, male, African American, obese, with diabetes, and with greater overall comorbidity burden. Certain comorbidities paradoxically augment risk to a greater extent in younger patients. In hospitalized patients, male sex is the main determinant of needing more intensive care. Further investigation is needed to understand the mechanisms underlying these findings.