The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

Risk factors for progressing to critical illness in patients with hospital-acquired COVID-19

  • Kyung-Eui Lee (Department of Critical Care Medicine, Seoul National University Hospital) ;
  • Jinwoo Lee (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital) ;
  • Sang-Min Lee (Department of Critical Care Medicine, Seoul National University Hospital) ;
  • Hong Yeul Lee (Department of Critical Care Medicine, Seoul National University Hospital)
  • Received : 2023.08.21
  • Accepted : 2023.12.01
  • Published : 2024.05.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background/Aims: Risk factors for progression to critical illness in hospital-acquired coronavirus disease 2019 (COVID-19) remain unknown. Here, we assessed the incidence and risk factors for progression to critical illness and determined their effects on clinical outcomes in patients with hospital-acquired COVID-19. Methods: This retrospective cohort study analyzed patients admitted to the tertiary hospital between January 2020 and June 2022 with confirmed hospital-acquired COVID-19. The primary outcome was the progression to critical illness of hospital-acquired COVID-19. Patients were stratified into high-, intermediate-, or low-risk groups by the number of risk factors for progression to critical illness. Results: In total, 204 patients were included and 37 (18.1%) progressed to critical illness. In the multivariable logistic analysis, patients with preexisting respiratory disease (OR, 3.90; 95% CI, 1.04-15.18), preexisting cardiovascular disease (OR, 3.49; 95% CI, 1.11-11.27), immunocompromised status (OR, 3.18; 95% CI, 1.11-9.16), higher sequential organ failure assessment (SOFA) score (OR, 1.56; 95% CI, 1.28-1.96), and higher clinical frailty scale (OR, 2.49; 95% CI, 1.62-4.13) showed significantly increased risk of progression to critical illness. As the risk of the groups increased, patients were significantly more likely to progress to critical illness and had higher 28-day mortality. Conclusions: Among patients with hospital-acquired COVID-19, preexisting respiratory disease, preexisting cardiovascular disease, immunocompromised status, and higher clinical frailty scale and SOFA scores at baseline were risk factors for progression to critical illness. Patients with these risk factors must be prioritized and appropriately isolated or treated in a timely manner, especially in pandemic settings.

Keywords

Acknowledgement

This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI21C1074).

References

  1. Henry DA, Jones MA, Stehlik P, Glasziou PP. Effectiveness of COVID-19 vaccines: findings from real world studies. Med J Aust 2021;215:149-151.e1. https://doi.org/10.5694/mja2.51182
  2. World Health Organization. Therapeutics and COVID-19: living guideline [Internet]. Geneva: World Health Organization, c2023 [cited 2023 Oct 11]. Available from: https://app.magicapp.org/#/guideline/nBkO1E.
  3. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; 323:1239-1242. https://doi.org/10.1001/jama.2020.2648
  4. Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ 2020;369:m1966.
  5. Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med 2020;180:934-943. https://doi.org/10.1001/jamainternmed.2020.0994
  6. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054-1062. https://doi.org/10.1016/S0140-6736(20)30566-3
  7. Rosenthal N, Cao Z, Gundrum J, Sianis J, Safo S. Risk factors associated with in-hospital mortality in a US national sample of patients with COVID-19. JAMA Netw Open 2020; 3:e2029058.
  8. Mikami T, Miyashita H, Yamada T, et al. Risk factors for mortality in patients with COVID-19 in New York City. J Gen Intern Med 2021;36:17-26. https://doi.org/10.1007/s11606-020-05983-z
  9. Goodacre S, Thomas B, Sutton L, et al. Derivation and validation of a clinical severity score for acutely ill adults with suspected COVID-19: the PRIEST observational cohort study. PLoS One 2021;16:e0245840.
  10. Knight SR, Ho A, Pius R, et al. Risk stratification of patients admitted to hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: development and validation of the 4C Mortality Score. BMJ 2020;370:m3339.
  11. Wu S, Wang Y, Jin X, Tian J, Liu J, Mao Y. Environmental contamination by SARS-CoV-2 in a designated hospital for coronavirus disease 2019. Am J Infect Control 2020;48:910-914. https://doi.org/10.1016/j.ajic.2020.05.003
  12. World Health Organization. Bridging the gap between ethics and decision-making in pandemics: report of the WHO Pandemic Ethics and Policy Summit [Internet]. Geneva: World Health Organization, c2021 [cited 2023 Oct 11]. Available from: https://www.who.int/publications/i/ item/9789240065086.
  13. Wu Y, Kang L, Guo Z, Liu J, Liu M, Liang W. Incubation period of COVID-19 caused by unique SARS-CoV-2 strains: a systematic review and meta-analysis. JAMA Netw Open 2022;5:e2228008.
  14. Rubin LG, Levin MJ, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2014;58:309-318. https://doi.org/10.1093/cid/cit816
  15. Azoulay E, Russell L, Van de Louw A, et al. Diagnosis of severe respiratory infections in immunocompromised patients. Intensive Care Med 2020;46:298-314. https://doi.org/10.1007/s00134-019-05906-5
  16. Ramirez JA, Musher DM, Evans SE, et al. Treatment of community-acquired pneumonia in immunocompromised adults: a consensus statement regarding initial strategies. Chest 2020;158:1896-1911. https://doi.org/10.1016/j.chest.2020.05.598
  17. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005;173:489-495. https://doi.org/10.1503/cmaj.050051
  18. Centers for Disease Control and Prevention. People who are immunocompromised [Internet]. Atlant (GA): Centers for Disease Control and Prevention, c2023 [cited 2023 Oct 11]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/ need-extra-precautions/people-who-are-immunocompromised.html.
  19. ARDS Definition Task Force; Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012;307:2526-2533.
  20. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315:801-810. https://doi.org/10.1001/jama.2016.0287
  21. Chowdhury MZI, Turin TC. Variable selection strategies and its importance in clinical prediction modelling. Fam Med Community Health 2020;8:e000262.
  22. Liu Y, Du X, Chen J, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect 2020;81:e6-e12. https://doi.org/10.1016/j.jinf.2020.04.002
  23. Ji W, Huh K, Kang M, et al. Effect of underlying comorbidities on the infection and severity of COVID-19 in Korea: a nationwide case-control study. J Korean Med Sci 2020;35:e237.
  24. Na YS, Kim JH, Baek MS, et al. In-hospital mortality prediction using frailty scale and severity score in elderly patients with severe COVID-19. Acute Crit Care 2022;37:303-311. https://doi.org/10.4266/acc.2022.00017
  25. Dickson RP, Martinez FJ, Huffnagle GB. The role of the microbiome in exacerbations of chronic lung diseases. Lancet 2014;384:691-702. https://doi.org/10.1016/S0140-6736(14)61136-3
  26. Zhang S, Zhang J, Wang C, et al. COVID-19 and ischemic stroke: Mechanisms of hypercoagulability (Review). Int J Mol Med 2021;47:21.
  27. Lee HY, Lee J, Jung YS, et al. Preexisting clinical frailty is associated with worse clinical outcomes in patients with sepsis. Crit Care Med 2022;50:780-790. https://doi.org/10.1097/CCM.0000000000005360
  28. Pansarasa O, Pistono C, Davin A, et al. Altered immune system in frailty: genetics and diet may influence inflammation. Ageing Res Rev 2019;54:100935.
  29. Sablerolles RSG, Lafeber M, van Kempen JAL, et al. Association between Clinical Frailty Scale score and hospital mortality in adult patients with COVID-19 (COMET): an international, multicentre, retrospective, observational cohort study. Lancet Healthy Longev 2021;2:e163-e170. https://doi.org/10.1016/S2666-7568(21)00006-4
  30. Gottlieb RL, Vaca CE, Paredes R, et al. Early remdesivir to prevent progression to severe Covid-19 in outpatients. N Engl J Med 2022;386:305-315. https://doi.org/10.1056/NEJMoa2116846
  31. Hammond J, Leister-Tebbe H, Gardner A, et al. Oral nirmatrelvir for high-risk, nonhospitalized adults with Covid-19. N Engl J Med 2022;386:1397-1408. https://doi.org/10.1056/NEJMoa2118542
  32. Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the treatment of Covid-19 - final report. N Engl J Med 2020;383:1813-1826. https://doi.org/10.1056/NEJMoa2007764
  33. Geetha S, Narayanamoorthy S, Manirathinam T, Kang D. Fuzzy case-based reasoning approach for finding COVID-19 patients priority in hospitals at source shortage period. Expert Syst Appl 2021;178:114997.
  34. Cho SY, Kang JM, Ha YE, et al. MERS-CoV outbreak following a single patient exposure in an emergency room in South Korea: an epidemiological outbreak study. Lancet 2016;388:994-1001. https://doi.org/10.1016/S0140-6736(16)30623-7
  35. Gondi S, Beckman AL, Deveau N, et al. Personal protective equipment needs in the USA during the COVID-19 pandemic. Lancet 2020;395:e90-e91. https://doi.org/10.1016/S0140-6736(20)31038-2
  36. Adams K, Rhoads JP, Surie D, et al. Vaccine effectiveness of primary series and booster doses against covid-19 associated hospital admissions in the United States: living test negative design study. BMJ 2022;379:e072065.
  37. Esper FP, Adhikari TM, Tu ZJ, et al. Alpha to Omicron: disease severity and clinical outcomes of major SARS-CoV-2 variants. J Infect Dis 2023;227:344-352.
  38. Benowitz NL, Goniewicz ML, Halpern-Felsher B, et al. Tobacco product use and the risks of SARS-CoV-2 infection and COVID-19: current understanding and recommendations for future research. Lancet Respir Med 2022;10:900-915. https://doi.org/10.1016/S2213-2600(22)00182-5
  39. Hwang SD, Ha J, Yun YN, Jung S, Chun JH. The status of genomic surveillance of the Coronavirus disease 2019 virus variants in Chungcheong region in 2021-2022. Public Health Wkly Rep 2023;16:1257-1271.
  40. Korea Disease Control and Prevention Agency. COVID-19 domestic cases and vaccination status in the country: press release [Internet]. Cheongju: Korea Disease Control and Prevention Agency, c2022 [cited 2023 Oct 11]. Available from: https://ncov.kdca.go.kr/pot/bbs/BD_selectBbs.do?q_bbsSn=1008&q_bbsDocNo=20220101989739249&q_clsfNo=0.