• Brendan R Jackson, Jeremy A W Gold, Pavithra Natarajan, John Rossow, Robyn Neblett Fanfair, Juliana da Silva, Karen K Wong, Sean D Browning, Bamrah MorrisSapnaSCDC COVID-19 Emergency Response.U.S. Public Health Service., Jessica Rogers-Brown, Alfonso C Hernandez-Romieu, Christine M Szablewski, Nadine Oosmanally, Melissa Tobin-D'Angelo, Cherie Drenzek, David J Murphy, Julie Hollberg, James M Blum, Robert Jansen, David W Wright, William M SeweSll, Jack D Owens, Benjamin Lefkove, Frank W Brown, Deron C Burton, Timothy M Uyeki, Stephanie R Bialek, Priti R Patel, and Beau B Bruce.
• CDC COVID-19 Emergency Response.
• Clin. Infect. Dis. 2020 Sep 24.

BackgroundCoronavirus disease (COVID-19) can cause severe illness and death. Predictors of poor outcome collected on hospital admission may inform clinical and public health decisions.MethodsWe conducted a retrospective observational cohort investigation of 297 adults admitted to eight academic and community hospitals in Georgia, United States, during March 2020. Using standardized medical record abstraction, we collected data on predictors including admission demographics, underlying medical conditions, outpatient antihypertensive medications, recorded symptoms, vital signs, radiographic findings, and laboratory values. We used random forest models to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CI) for predictors of invasive mechanical ventilation (IMV) and death.ResultsCompared with age <45 years, ages 65-74 years and ≥75 years were predictors of IMV (aOR 3.12, CI 1.47-6.60; aOR 2.79, CI 1.23-6.33) and the strongest predictors for death (aOR 12.92, CI 3.26-51.25; aOR 18.06, CI 4.43-73.63). Comorbidities associated with death (aORs from 2.4 to 3.8, p <0.05) included end-stage renal disease, coronary artery disease, and neurologic disorders, but not pulmonary disease, immunocompromise, or hypertension. Pre-hospital use vs. non-use of angiotensin receptor blockers (aOR 2.02, CI 1.03-3.96) and dihydropyridine calcium channel blockers (aOR 1.91, CI 1.03-3.55) were associated with death.ConclusionsAfter adjustment for patient and clinical characteristics, older age was the strongest predictor of death, exceeding comorbidities, abnormal vital signs, and laboratory test abnormalities. That coronary artery disease, but not chronic lung disease, was associated with death among hospitalized patients warrants further investigation, as do associations between certain antihypertensive medications and death.Published by Oxford University Press for the Infectious Diseases Society of America 2020. This work is written by (a) US Government employee(s) and is in the public domain in the US.

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