Fulminant onset COVID-19: predictors and outcome

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Epidemiology

Background:

• COVID-19 often causes organ dysfunction in the second week of illness.
• A subset of patients experiences rapid onset of organ dysfunction early in the disease course.
• Fulminant onset COVID-19, defined as organ dysfunction within 4 days of symptom onset, has not been systematically studied.

Purpose of the Study:

• To identify predictors of fulminant onset COVID-19.
• To investigate the prognosis of fulminant onset COVID-19.
• To establish fulminant onset COVID-19 as a distinct clinical phenotype.

Main Methods:

• Retrospective study of 2016 COVID-19 patients in South India (June 2020-January 2022).
• Patients categorized into fulminant and non-fulminant onset groups.
• Logistic regression used to analyze predictors; 30-day outcomes assessed.

Main Results:

• 32.4% of patients (653/2016) had fulminant onset COVID-19.
• Predictors included age >60 years, hypertension, and immune-suppressed state.
• Complete vaccination was associated with lower odds of fulminant onset (aOR 0.61).
• Fulminant onset COVID-19 patients had higher 30-day mortality and organ support needs.

Conclusions:

• Fulminant onset COVID-19 is a significant and not uncommon clinical presentation.
• It is associated with a poor prognosis and increased mortality.
• Recognition as a distinct phenotype is warranted for targeted management.