To identify predictors of poor prognosis in previously healthy young individuals admitted with COVID-19.
We studied a cohort of patients hospitalized with COVID-19 disease. All patients without comorbidities, no usual treatments and ≤65 years old were selected from an international registry (HOPE-COVID-19, NCT04334291). We focused on baseline variables-symptoms and signs at admission-to analyze risk factors for poor prognosis. The primary endpoint was a composite of major adverse clinical events during hospitalization including mortality, mechanical ventilation, high flow nasal oxygen therapy, prone, sepsis, SIRS, and embolic events.
Overall, 773 healthy young patients were included. The primary composite endpoint was observed in 29% (225/773) and the overall mortality rate was 3.6% (28/773). In the combined event group, 75% (168/225) of patients were men and the mean age was 49 (±11) years, whereas in the non-combined event group, the prevalence of male gender was 43% (238/548) and the mean age was 42 (±13) years; p<0.001 for both. On admission, respiratory insufficiency and cough were described in 51.4% (114/222), and 76% (170/223) of patients, respectively, in the combined event group, vs. 7.9% (42/533) and 56% (302/543) of patients in the other group; p<0.001 for both. The strongest independent predictor for the combined endpoint was desaturation (SpO2<92%) (OR: 5.40; CI95% 3.34-8.75; p<0.001), followed by tachypnea (OR: 3.17; CI95% 1.93-5.21; p<0.001), male gender (OR: 3.01; CI95% 1.96-4.61; p<0.001), and pulmonary infiltrates on chest X ray at admission (OR: 2.21; CI95% 1.18-4.16; p: 0.014).
Major adverse clinical events were unexpectedly high considering the baseline characteristics of the cohort. Signs of respiratory compromise at admission, and male gender, were predictive for poor prognosis among young healthy patients hospitalized with COVID-19.

Copyright © 2021. Published by Elsevier Ltd.