• Raquel Díaz-Simón, Antonio Lalueza, Jaime Lora-Tamayo, Manuel Rubio-Rivas, Cristina Llamazares Mendo, María Luisa Taboada Martínez, Cristina Asencio Méndez, Paula M Pesqueira Fontán, CruzAna FernándezAFInternal Medicine Department, Puerta de Hierro University Hospital, (Madrid), Majadahonda, Spain., Juan Luis Romero Cabrera, Begoña Cortés Rodríguez, Aurora Espinar Rubio, de ÁvilaVicente Serrano RomeroVSRInternal Medicine Department, Virgen de la Salud Hospital, Toledo, Spain., Gema Maria García García, Luis Cabeza Osorio, María González-Fernández, NoyaAmara GonzálezAGInternal Medicine Department, Ourense University Hospital Complex, Ourense, Spain., Máximo Bernabeu Wittel, Francisco Arnalich Fernandez, Verónica Martínez Sempere, Arturo Artero, Jose Loureiro-Amigo, HuelgasRicardo GómezRGInternal Medicine Department, Málaga Regional University Hospital, Malaga, Spain., SantosJuan Miguel AntónJMAInternal Medicine Department, Infanta Cristina University Hospital, (Madrid), Parla, Spain., Carlos Lumbreras, and SEMI-COVID-19 Network.
• Internal Medicine Department, 12 de Octubre University Hospital, Madrid, Spain. rdiazs@salud.madrid.org.
• J Gen Intern Med. 2021 Oct 1; 36 (10): 308030873080-3087.

BackgroundAge is a risk factor for COVID severity. Most studies performed in hospitalized patients with SARS-CoV2 infection have shown an over-representation of older patients and consequently few have properly defined COVID-19 in younger patients who require hospital admission. The aim of the present study was to analyze the clinical characteristics and risk factors for the development of respiratory failure among young (18 to 50 years) hospitalized patients with COVID-19.MethodsThis retrospective nationwide cohort study included hospitalized patients from 18 to 50 years old with confirmed COVID-19 between March 1, 2020, and July 2, 2020. All patient data were obtained from the SEMI-COVID Registry. Respiratory failure was defined as the ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2 ratio) ≤200 mmHg or the need for mechanical ventilation and/or high-flow nasal cannula or the presence of acute respiratory distress syndrome.ResultsDuring the recruitment period, 15,034 patients were included in the SEMI-COVID-19 Registry, of whom 2327 (15.4%) were younger than 50 years. Respiratory failure developed in 343 (14.7%), while mortality occurred in 2.3%. Patients with respiratory failure showed a higher incidence of major adverse cardiac events (44 (13%) vs 14 (0.8%), p<0.001), venous thrombosis (23 (6.7%) vs 14 (0.8%), p<0.001), mortality (43 (12.5%) vs 7 (0.4%), p<0.001), and longer hospital stay (15 (9-24) vs 6 (4-9), p<0.001), than the remaining patients. In multivariate analysis, variables associated with the development of respiratory failure were obesity (odds ratio (OR), 2.42; 95% confidence interval (95% CI), 1.71 to 3.43; p<0.0001), alcohol abuse (OR, 2.40; 95% CI, 1.26 to 4.58; p=0.0076), sleep apnea syndrome (SAHS) (OR, 2.22; 95% CI, 1.07 to 3.43; p=0.032), Charlson index ≥1 (OR, 1.77; 95% CI, 1.25 to 2.52; p=0.0013), fever (OR, 1.58; 95% CI, 1.13 to 2.22; p=0.0075), lymphocytes ≤1100 cells/μL (OR, 1.67; 95% CI, 1.18 to 2.37; p=0.0033), LDH >320 U/I (OR, 1.69; 95% CI, 1.18 to 2.42; p=0.0039), AST >35 mg/dL (OR, 1.74; 95% CI, 1.2 to 2.52; p=0.003), sodium <135 mmol/L (OR, 2.32; 95% CI, 1.24 to 4.33; p=0.0079), and C-reactive protein >8 mg/dL (OR, 2.42; 95% CI, 1.72 to 3.41; p<0.0001).ConclusionsYoung patients with COVID-19 requiring hospital admission showed a notable incidence of respiratory failure. Obesity, SAHS, alcohol abuse, and certain laboratory parameters were independently associated with the development of this complication. Patients who suffered respiratory failure had a higher mortality and a higher incidence of major cardiac events, venous thrombosis, and hospital stay.© 2021. Society of General Internal Medicine.

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