VHA Covid-19 patients at higher risk for 17 respiratory/non-respiratory complications

Patients hospitalized with Covid-19 in the Veterans Health Administration (VHA) were more than five times more likely to die in the hospital and were at increased risk for 17 respiratory and non-respiratory complications compared to patients hospitalized with influenza, according to findings from the CDC’s Morbidity and Mortality Weekly Report (MMWR).

Over the course of the Covid-19 pandemic, the coronavirus has sometimes been erroneously compared to influenza infection — for example, President Donald J. Trump, who was himself hospitalized with Covid-19 earlier this month, has touted the idea that influenza is far more deadly than Covid, though experts have stated that this is not the case. This report from MMWR offers more proof that, while Covid-19 infection and influenza may share a number of symptoms, the two diseases are simply not the same.

“Findings from a large, national cohort of patients hospitalized within the VHA illustrate the increased risk for complications involving multiple organ systems among patients with Covid-19 compared with those with influenza, as well as racial/ethnic disparities in Covid-19–associated complications,” wrote Jordan Cates, PhD, of the Covid-19 Emergency Response Team and the Epidemic Intelligence Service at the CDC, Atlanta, and colleagues. “Compared with patients with influenza, those with Covid-19 had a more than five times higher risk for in-hospital death and approximately double the ICU admission risk and hospital length of stay, and were at higher risk for 17 acute respiratory, cardiovascular, hematologic, neurologic, renal and other complications. Racial and ethnic disparities in the percentage of complications among patients with Covid-19 was found for respiratory, neurologic, and renal complications, as well as for sepsis.”

For their report, Cates and colleagues pulled data from electronic health records in the VHA Praedico Surveillance System to form two study cohorts of hospitalized adult VHA patients — the first group was comprised of patients with nasopharyngeal (90%) or other specimens that tested positive for SARS-CoV-2 by real-time reverse transcription-polymerase chain reaction (RT-PCR) from March 1-May 31, while the second was comprised of patients with laboratory-confirmed influenza A or B by rapid antigen assay, real-time RT-PCR, direct or indirect fluorescent staining, or viral culture from Oct. 1, 2018-Feb. 1, 2020.

“Patients who received an influenza diagnosis after Feb. 1, 2020 were excluded to minimize the possible inclusion of patients co-infected with SARS-CoV-2,” the report authors explained. “Patients were restricted to those with a Covid-19 or influenza test during hospitalization or in the 30 days preceding hospitalization (including inpatient care at a nursing home). Patients who were still hospitalized as of July 31, 2020, or who were admitted >14 days before receiving testing were excluded from the analysis.”

The final analysis included 5,453 patients hospitalized with flu and 3,948 hospitalized with Covid-19. Among these, Black patients accounted for 48.3% of Covid-19 patients and 24.7% of flu patients, while the proportion of Hispanic patients was similar in both groups (9.0% versus 8.5%, respectively).

“The percentage of Covid-19 patients admitted to an ICU (36.5%) was more than twice that of influenza patients (17.6%); the percentage of Covid-19 patients who died while hospitalized (21.0%) was more than five times that of influenza patients (3.8%); and the duration of hospitalization was almost three times longer for Covid-19 patients (median 8.6 days; IQR = 3.9–18.6 days) than that for influenza patients (3.0 days; 1.8–6.5 days) (P<0.001 for all),” Cates and colleagues reported.

They also found that, among patients with Covid-19:

  • 76.8% had respiratory complications (pneumonia, 70.1%; respiratory failure, 46.5%; acute respiratory distress syndrome, 9.3%).
  • Non-respiratory complications were frequent (renal, 39.6%; cardiovascular, 13.1%; hematologic, 6.2%; neurologic, 4.1%; sepsis, 24.9%; bacteremia, 4.7%).
  • 24.1% had complications involving three or more organ systems.
  • Racial and ethnic minority patients were at higher risk than white patients for nine complications: pneumonia, respiratory failure, ARDS, hypertensive crisis, cerebral ischemia/infarction, intracranial hemorrhage, acute kidney failure, dialysis initiation, and sepsis.

Compared with flu patients, hospitalized Covid-19 patients had “two times the risk for pneumonia; 1.7 times the risk for respiratory failure; 19 times the risk for ARDS; 3.5 times the risk for pneumothorax; and statistically significantly increased risks for cardiogenic shock, myocarditis, deep vein thrombosis, pulmonary embolism, disseminated intravascular coagulation, cerebral ischemia or infarction, intracranial hemorrhage, acute kidney failure, dialysis initiation, acute hepatitis or liver failure, sepsis, bacteremia, and pressure ulcers,” they wrote—patients with Covid-19 were at lower risk for asthma exacerbation, COPD exacerbation, acute myocardial infarction or unstable angina, acute congestive heart failure, and hypertensive crisis than flu patients, “although acute MI or unstable angina, acute CHF, and hypertensive crisis were not statistically significant when restricting to patients diagnosed during the same seasonal months,” they added.

Cates and colleagues argued that these findings “highlight the higher risk for most complications associated with Covid-19 compared with influenza and might aid clinicians and researchers in recognizing, monitoring, and managing the spectrum of Covid-19 manifestations,” and that racial and ethnic minority groups are subject to Covid-19 disparities that are not solely accounted for by age and underlying medical conditions.

John McKenna, Associate Editor, BreakingMED™

Cat ID: 30

Topic ID: 79,30,791,932,730,933,30,926,192,653,927,151,928,925,934