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Risk factors for progressing to critical illness in patients with hospital-acquired COVID-19
Kyung-Eui Lee1, Jinwoo Lee2, Sang-Min Lee1,2
1Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea.
Insights
Hospital-acquired COVID-19 patients with respiratory or cardiovascular disease, immunocompromised status, or frailty are at higher risk for critical illness. Early identification and isolation are crucial for better outcomes.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- Risk factors for progression to critical illness in hospital-acquired coronavirus disease 2019 (COVID-19) were previously unknown.
- This study aimed to identify these risk factors and their impact on clinical outcomes.
Purpose of the Study:
- To assess the incidence and risk factors for progression to critical illness in hospital-acquired COVID-19.
- To determine the effects of these risk factors on clinical outcomes.
Main Methods:
- A retrospective cohort study of 204 patients with hospital-acquired COVID-19 admitted between January 2020 and June 2022.
- Patients were stratified into risk groups based on identified risk factors.
- Multivariable logistic regression was used to analyze risk factors for progression to critical illness.
Main Results:
- 18.1% of patients (37 out of 204) progressed to critical illness.
- Preexisting respiratory disease, cardiovascular disease, immunocompromised status, higher Sequential Organ Failure Assessment (SOFA) score, and higher Clinical Frailty Scale were significant risk factors.
- Increased risk group stratification correlated with higher progression to critical illness and 28-day mortality.
Conclusions:
- Preexisting respiratory disease, cardiovascular disease, immunocompromised status, and higher SOFA and Clinical Frailty Scale scores are key risk factors for critical illness in hospital-acquired COVID-19.
- Prioritizing and isolating patients with these risk factors is essential for timely treatment and improved outcomes, particularly during pandemics.
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.
Conclusion:
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.
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