Predictors of Worse Prognosis in Young and Middle-Aged Adults Hospitalized with COVID-19 Pneumonia: A Multi-Center Italian Study (COVID-UNDER50)

Bonifazi, Martina; Mei, Federico; Skrami, Edlira; Latini, Lara Letizia; Amico, Donatella; Balestro, Elisabetta; Bini, Francesco; Bonifazi, Floriano; Caminati, Antonella; Candoli, Piero; Cinti, Saverio; Contucci, Susanna; Di Marco Berardino, Alessandro; Harari, Sergio; Levi, Guido; Lococo, Sara; Menditto, Vincenzo; Marchetti, Giampietro; Piciucchi, Sara; Poletti, Venerino; Ravaglia, Claudia; Saetta, Marina; Svegliati-Baroni, Gianluca; Tomassetti, Sara; Tamburrini, Mario; Zanforlin, Alessandro; Zuccon, Umberto; Zuccatosta, Lina; Gasparini, Stefano; Carle, Flavia

Obesity as well as metabolic and cardiovascular comorbidities are established, significant predictors of worse prognosis in the overall COVID-19 population, but limited information is available on their roles in young and middle-aged adults (aged ≤ 50 years). The main objectives of the present Italian multi-center study were to describe clinical characteristics and role of selected prognostic predictors in a large cohort of young and middle-aged hospitalized patients. Nine pulmonology units, across north and center of Italy, were involved in this retrospective study. Comorbidities were classified according to their known or potential association with COVID-19. A total of 263 subjects were included. The prevalence of obesity was 25.9%, mechanical ventilation (MV) was needed in 27.7%, and 28 in-hospital deaths occurred (10.6%). Obesity and older age were the only independent, significant predictors for MV. Comorbidities, such as hypertension, diabetes, asthma, and increased D-dimer levels were significantly associated with higher mortality risk, regardless of age, body mass index, and MV. Obesity in young and middle-aged adults is a strong predictor of a more complicated COVID-19, without, however, evidence of a significant effect on in-hospital mortality. Selected comorbidities, including hypertension, diabetes and asthma, significantly impact survival even in a younger population, suggesting the need for prompt recognition of these conditions.