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Severe Outcomes Relatively Common in Hospitalized COVID-19 Patients 18-34

While younger people usually have milder cases of COVID-19 than older ones, that is not always the case. A new study found that morbid obesity, male sex and a range of co-morbidities significantly increase risk of death and need for intensive care treatment in patients 18-34. Here are more details.

BOSTON – Evidence that older patients have greater mortality and morbidity from COVID-19 does not mean that younger people only have mild cases, a new study emphasizes.

A research letter in JAMA Internal Medicine focused on 3,222 patients, 18-34 years old, hospitalized with novel coronavirus infection and found that 21% of them ended up in intensive care.

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2770542

Researchers from Brigham and Women's Hospital analyzed records from 419 hospitals using the Premier Healthcare Database also determined that 10% required mechanical ventilation and 2.7% died. While lower than mortality rates in the oldest patients, according to the study team, that rate was nearly double the death rate of patients in the same age group hospitalized with acute myocardial infarction.

"There was a significant rate of adverse outcomes," explained Jonathan Cunningham, MD, a Cardiovascular Medicine fellow at the Brigham and first author on the letter. "Even though a 2.7 percent death rate is lower than for older patients, it's high for young people who typically do well even when hospitalized for other conditions."

The researchers also say they were surprised that to discover that 57% of young patients hospitalized for COVID-19 were Black or Hispanic.

With a mean age of 28.3, the majority, 57.6%, also were men. Of those, 36.8% were obese, 24.5% were morbidly obese and 18.2% had diabetes, while 16.1% had hypertension.

Researchers report that vasopressors or inotropes were used for 217 patients (7%), central venous catheters for 283 (9%), and arterial catheters for 192 (6%). With the median length of stay at 4 days (interquartile range, 2-7 days), 3% of those who survived hospitalization were discharged to a post-acute care facility.

Results indicate that morbid obesity (adjusted odds ratio [OR], 2.30; 95% CI, 1.77-2.98; vs no obesity; P < .001) and hypertension (adjusted OR, 2.36; 95% CI, 1.79-3.12; P < .001) were common and -- with male sex (adjusted OR, 1.53; 95% CI, 1.20-1.95; P = .001) -- were associated with greater risk of death or mechanical ventilation.

On the other hand, odds of death or mechanical ventilation did not appear to be affected much by race and ethnicity.

While morbid obesity was present in 140 patients (41%) who died or required ventilation, diabetes was associated with increased risk of this outcome in univariable analysis (OR, 1.82; 95% CI, 1.41-2.36; P < .001) but did not reach statistical significance after adjustment (adjusted OR, 1.31; 95% CI, 0.99-1.73; P = .06).

“Patients with multiple risk factors (morbid obesity, hypertension, and diabetes) faced risks similar to 8862 middle-aged (age 35-64 years) nonpregnant adults with COVID-19 infection without these conditions,” the study notes.

"We know nothing about the total denominator of patients who got an infection," said corresponding author Scott Solomon, MD, director of noninvasive cardiology in the Division of Cardiovascular Medicine at the Brigham. "We think the vast majority of people in this age range have self-limited disease and don't require hospitalization. But if you do, the risks are really substantial."