Fulminant onset COVID-19: predictors and outcome

Abstract

PurposeDuring COVID-19 infection, organ dysfunction such as respiratory failure tends to occur towards the second week of illness; however, in a subset, there may be rapid onset of organ dysfunction as early as symptom onset. We define fulminant onset COVID-19 as rapid onset of organ dysfunction such as acute respiratory failure, acute kidney injury, acute encephalopathy or shock within 4 days of symptom onset. Fulminant onset COVID-19 has not yet been systematically studied. We aimed to identify predictors and prognosis of fulminant onset COVID-19.MethodsThis retrospective study was carried out on patients admitted to a single referral hospital in South India between June 2020 and January 2022. Patients were categorised into fulminant and non-fulminant onset COVID-19. Candidate predictors for fulminant onset were chosen by an intuitive approach and analysed using logistic regression. Then, the outcome of fulminant onset COVID-19 at 30 days was studied.ResultsOut of 2016 patients with confirmed COVID-19, 653 (32.4%) had fulminant onset COVID-19. Age>60 years (a-OR 1.57, 95% CI 1.30 to 1.90, p<0.001), hypertension (a-OR 1.29, 95% CI 1.03 to 1.61, p=0.03) and immune-suppressed state (a-OR 5.62, 95% CI 1.7 to 18.7, p=0.005) were significant predictors of fulminant onset COVID-19. Complete vaccination lowered the odds of fulminant onset COVID-19 significantly (a-OR 0.61, 95% CI 0.43 to 0.85, p=0.004). At 30 days, the fulminant onset COVID-19 group had higher odds of mortality and need for organ support.ConclusionFulminant onset COVID-19 is not uncommon and it carries poor prognosis and deserves recognition as a distinct phenotype of COVID-19.

The Time-Varying Impact of COVID-19 on the Acute Kidney Disorders: A Historical Matched Cohort Study and Mendelian Randomization Analysis

“…We observed that the risk of acute kidney disorder reached its highest level in the second week after the initiation of COVID-19 and then gradually decreased with no significance in the fourth week. Consistent with a previous study reporting that organ dysfunction tends to occur in the second week after SARS-CoV-2 infection [ 36 ], the median time to AKI occurrence was approximately 8 to 9 d after infection, corresponding to the second week [ 37 , 38 ]. Although comparable results of the time-varying hazard effects of COVID-19 on the risk of subsequently kidney outcomes are lacking, one previous study reported similar temporal trends of COVID-19 on subsequent life-threatening secondary infections [ 18 ].…”

Clinical and Epidemiological Profiles of Primary Healthcare Professionals with COVID-19 Infection and Long COVID: An Observational Study

“…These results are consistent with other studies that suggest that people who are overweight or obese are more likely to have prolonged symptoms following COVID infection [ 57 , 58 , 59 ]. However, other studies claim that factors such as hypertension, chronic kidney disease, and immunocompromised states are related [ 60 ].…”