COVID-19 in young and middle-aged adults: predictors of poor outcome and clinical differences

Abstract

Introduction Young and middle-aged adults are the largest group of patients infected with SARS-CoV-2 and some of them develop severe disease. Objective To investigate clinical manifestations in adults aged 18–65 years hospitalized for COVID-19 and identify predictors of poor outcome. Secondary objectives: to explore differences compared to the disease in elderly patients and the suitability of the commonly used community-acquired pneumonia prognostic scales in younger populations. Methods Multicenter prospective registry of consecutive patients hospitalized for COVID-19 pneumonia aged 18–65 years between March and May 2020. We considered a composite outcome of “poor outcome” including intensive care unit admission and/or use of noninvasive ventilation, continuous positive airway pressure or high flow nasal cannula oxygen and/or death. Results We identified 513 patients < 65 years of age, from a cohort of 993 patients. 102 had poor outcomes (19.8%) and 3.9% died. 78% and 55% of patients with poor outcomes were classified as low risk based on CURB and PSI scores, respectively. A multivariate Cox regression model identified six independent factors associated with poor outcome: heart disease, absence of chest pain or anosmia, low oxygen saturation, high LDH and lymphocyte count < 800/mL. Conclusions COVID-19 in younger patients carries significant morbidity and differs in some respects from this disease in the elderly. Baseline heart disease is a relevant risk factor, while anosmia and pleuritic pain are associated to better prognosis. Hypoxemia, LDH and lymphocyte count are predictors of poor outcome. We consider that CURB and PSI scores are not suitable criteria for deciding admission in this population.

Practices, Knowledge, and Attitudes of Chinese University Students Toward Traditional Chinese Herbal Medicine for the Control of COVID-19

“…Especially, the number of COVID-19 cases is increasing rapidly worldwide among young adults, a healthier population group generally believed to be “invincible” to infectious disorders. 2 , 3 Recent evidence suggested that, during the COVID-19 second wave caused by highly virulent SARS-CoV-2 variants, young adults were more severely burdened than other age tiers, and the profile of deaths considerably changed with a shift to younger COVID-19 victims. 3 Most of the COVID-19 infected individuals are either asymptomatic carriers or accompanied with a mild influenza-like disorder.…”

Risk Factors, Characteristics, and Outcome in Non-Ventilated Patients with Spontaneous Pneumothorax or Pneumomediastinum Associated with SARS-CoV-2 Infection

“…Low SpO2 is acknowledged as a consequence of SARS-CoV-2 induced pulmonary infiltration. Tabernero et al 27 reported a multivariate Cox regression model developed based on data of 513 patients hospitalized for COVID-19 that identified six independent factors associated with poor outcome, among which the low oxygen saturation was the most significant. In a retrospective observational study, Liu et al 28 evaluated the risk prediction tools for patients with COVID-19 in Wuhan, China, and they showed that respiration rate score, oxygen saturations score, temperature score, and AVPU (Alert, Voice, Pain, Unresponsive) score were independent predictors of death.…”

Predictors of Poor Outcome among Critically Ill COVID-19 Patients: A Nationally Representative Sample of the Saudi Arabian Population

“…The findings of a high percentage of ARDS or respiratory failure in this study were consistent with those of another study that reported that the incidence of ARDS, which require oxygen supplementations, was the most concerning complication among critically ill patients with COVID-19 [ 34 ]. Although mechanical ventilation is considered a lifesaving intervention for patients with critical COVID-19 cases [ 26 ], several studies emphasize that the need for mechanical ventilation is an indicator of poor outcome [ 35 , 36 , 37 ]. Since most of our critically ill patients had ARDS (62%) and most of these patients needed mechanical oxygen therapy (57.5% received IMV) to sustain their life, we came to a different logical interpretation for the association between mechanical ventilation and the incidence of poor outcomes.…”