Risk for In-Hospital Complications Associated with COVID-19 and Influenza - Veterans Health Administration, United States, October 1, 2018-May 31, 2020 - PubMed (original) (raw)

Risk for In-Hospital Complications Associated with COVID-19 and Influenza - Veterans Health Administration, United States, October 1, 2018-May 31, 2020

Jordan Cates et al. MMWR Morb Mortal Wkly Rep. 2020.

Abstract

Coronavirus disease 2019 (COVID-19) is primarily a respiratory illness, although increasing evidence indicates that infection with SARS-CoV-2, the virus that causes COVID-19, can affect multiple organ systems (1). Data that examine all in-hospital complications of COVID-19 and that compare these complications with those associated with other viral respiratory pathogens, such as influenza, are lacking. To assess complications of COVID-19 and influenza, electronic health records (EHRs) from 3,948 hospitalized patients with COVID-19 (March 1-May 31, 2020) and 5,453 hospitalized patients with influenza (October 1, 2018-February 1, 2020) from the national Veterans Health Administration (VHA), the largest integrated health care system in the United States,* were analyzed. Using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes, complications in patients with laboratory-confirmed COVID-19 were compared with those in patients with influenza. Risk ratios were calculated and adjusted for age, sex, race/ethnicity, and underlying medical conditions; proportions of complications were stratified among patients with COVID-19 by race/ethnicity. Patients with COVID-19 had almost 19 times the risk for acute respiratory distress syndrome (ARDS) than did patients with influenza, (adjusted risk ratio [aRR] = 18.60; 95% confidence interval [CI] = 12.40-28.00), and more than twice the risk for myocarditis (2.56; 1.17-5.59), deep vein thrombosis (2.81; 2.04-3.87), pulmonary embolism (2.10; 1.53-2.89), intracranial hemorrhage (2.85; 1.35-6.03), acute hepatitis/liver failure (3.13; 1.92-5.10), bacteremia (2.46; 1.91-3.18), and pressure ulcers (2.65; 2.14-3.27). The risks for exacerbations of asthma (0.27; 0.16-0.44) and chronic obstructive pulmonary disease (COPD) (0.37; 0.32-0.42) were lower among patients with COVID-19 than among those with influenza. 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. Among patients with COVID-19, the risk for respiratory, neurologic, and renal complications, and sepsis was higher among non-Hispanic Black or African American (Black) patients, patients of other races, and Hispanic or Latino (Hispanic) patients compared with those in non-Hispanic White (White) patients, even after adjusting for age and underlying medical conditions. 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. The higher risk for certain complications among racial and ethnic minority patients provides further evidence that certain racial and ethnic minority groups are disproportionally affected by COVID-19 and that this disparity is not solely accounted for by age and underlying medical conditions.

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Conflict of interest statement

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Figures

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Adjusted relative risk for selected acute respiratory and nonrespiratory complications in hospitalized patients with COVID-19 (March 1– May 31, 2020), compared with historically hospitalized patients with influenza (October 1, 2018–February 1, 2020) — Veterans Health Administration, United States,, Abbreviations: ARDS = acute respiratory distress syndrome; CHF = congestive heart failure; COPD = chronic obstructive pulmonary disease; DIC = disseminated intravascular coagulation; MI = myocardial infarction. * 95% confidence intervals (CIs) indicated with error bars. † When restricted to patients with influenza during the same seasonal months (March–May), aRRs and 95% CIs for acute MI or unstable angina, acute CHF, and hypertensive crisis were 0.90 (0.74–1.11), 1.03 (0.82–1.28), and 0.75 (0.44–1.29), respectively. § Dialysis during hospitalization was identified using International Classification of Diseases, Tenth Revision, Clinical Modification and current procedural terminology codes, and new initiation of dialysis was determined by excluding patients with indication of dialysis within the past year. ¶ Separate crude and adjusted log-binomial models were run for each complication (which were not mutually exclusive). All adjusted models adjusted for age, sex, race/ethnicity, and outcome-specific underlying conditions. Specifically, respiratory complication models controlled for COPD, asthma, and other lung diseases; neurologic complication models controlled for underlying cerebrovascular diseases, neurological/musculoskeletal conditions, heart disease, and heart failure; cardiovascular and hematologic condition models controlled for heart disease, heart failure, renal conditions, diabetes mellitus, and extreme obesity; the acute kidney failure model controlled for underlying renal disease, diabetes mellitus, and hypertension. Complications related to the worsening of a chronic medical condition were restricted to those patients with that underlying medical condition.

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