Risk factors for the progression of coronavirus 2019 (COVID-19) to severe disease or death are underexplored in U.S. cohorts.
Our study provides insight into the disease trajectories of hospitalized patients with COVID-19 in the United States and the risk factors associated with severe outcomes. Different combinations of risk factors predict severe disease or death with probabilities ranging from over 90% to as little as 5% (that is, 18-fold for patients at highest risk compared with those at lowest risk). It is difficult to know how end-of-life practices differed across doctors and hospitals and whether DNR/DNI orders reflected patient preference or rapid development of severe disease with perceived poor outcomes. The relationship between obesity and COVID-19 outcomes in older patients is complicated because excess body weight in frail older adults may be somewhat protective against additional stressors.
Although 60% of patients were non-White, we did not observe associations of race/ethnicity with severe disease or death after adjustment for clinical factors. Furthermore, the health system did not exceed its capacity of the hospital and intensive care unit beds.
The CIRC performed best at predicting progression to severe disease or death in the first two days of hospital admission and thus offers valuable information at the time of initial hospital evaluation. Within the 5 study hospitals, the model discriminated higher- from lower-risk patients equally well regardless of whether the patients were from the hospitals used to fit the model.
In conclusion, we identified significant factors easily ascertained at admission that are associated with severe COVID-19 outcomes.