Acute Respiratory Distress Syndrome May Increase the Risk of Death in Young COVID-19 Patients

A team of international scientists recently estimated the risk and prevalence of acute respiratory distress syndrome (ARDS) in hospitalized young adults with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. did.

The findings reveal a high mortality rate in young adults who develop ARDS after SARS-CoV-2 infection. Research is currently medRxiv* Preprint server.

Background

Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 is associated with mild to severe respiratory complications, including ARDS. The prevalence of ARDS is estimated to be approximately 31% and 92% for inpatients with SARS-CoV-2 infection and those admitted to the intensive care unit (ICU), respectively. In the general population, the prevalence after SARS-CoV-2 infection is approximately 3.4%.

The presence of ARDS in patients with COVID-19 is associated with a poor prognosis, with mortality rates as high as 39%. According to the available literature, older people are more likely to develop ARDS after SARS-CoV-2 infection. However, in the United States, studies show that more than 20% of ARDS COVID-19 patients admitted to the ICU are young adults.

In the current study, scientists assessed the risk of ARDS in young adults hospitalized with COVID-19. They also compared the risk factors and outcomes of ARDS between the young and older populations.

Research design

Research analysis was performed on patient-level electronic medical records collected from an international consortium for clinical characterization of COVID-19. The consortium dataset contains patient information from 241 hospitals in the United States and 43 hospitals in Europe.

Risk factors associated with ARDS were identified by comparing young adult patients with and without ARDS. We also estimated the mortality rate 90 days after admission.

Risk factors for ARDS

A total of 75,377 inpatients with COVID-19 identified in the laboratory were included in the analysis. ARDS was detected in approximately 7.8% of young adults (age group: 18-49 years) hospitalized for COVID-19. Approximately 10% of the elderly (age group: 49 years and older) hospitalized for COVID-19 were diagnosed with ARDS. Of all COVID-19 patients with ARDS, about 13% were young adults.

In terms of age-related risk, young patients aged 26-49 years were shown to be at increased risk of developing ARDS compared to patients aged 18-25 years. An increased risk was also observed among male patients rather than female patients.

For comorbidities, analysis Stomach Ulcer disease, Paralysis, obesity, congestive heart failure, valvular disease, diabetes, chronic lung disease, and liver disease significantly increase the risk of developing ARDS. High prevalence of obesity, diabetes, and hypertension was observed among young COVID-19 patients with ARDS.

No significant association was observed between hypertension and risk of ARDS in the study population. Similarly, human immunodeficiency virus (HIV) infection, cancer, hypothyroidism, mental illness, alcohol and illicit drug consumption, and smoking did not increase the risk of ARDS.

Clinical outcomes of patients with ARDS

Clinical outcomes and mortality were compared between young and elderly adults with ARDS.

In terms of clinical outcomes, younger patients with ARDS were observed to have a lower risk of developing acute renal failure, cardiac conduction disorders, fluids, electrolytes, acid-base balance disorders, and stroke compared to older patients with ARDS. .. However, younger patients have shown a relatively high risk of developing pneumonia and sepsis due to streptococcal infection. Over 50% of young ARDS patients showed the presence of a bacterial superinfection during hospitalization.

In terms of mortality, analysis revealed that approximately 16% of young ARDS patients and 41% of older ARDS patients died 90 days after admission.

Significance of research

This study estimates the prevalence of ARDS in hospitalized COVID-19 patients representing the international youth population. The prevalence of ARDS is moderate (7.8%), but high mortality (16%) has been observed in a large cohort of international studies of young adults with COVID-19. High prevalence of obesity, diabetes and hypertension has been observed in young ARDS patients.

*Important Notices

medRxiv publishes unpeer-reviewed preliminary scientific reports and should not be considered definitive, guide clinical / health-related behaviors, or be treated as established information.