Song Rebecca J, Ho Yuk-Lam, Schubert Petra, Park Yojin, Posner Daniel, Lord Emily M, Costa Lauren, Gerlovin Hanna, Kurgansky Katherine E, Anglin-Foote Tori, DuVall Scott, Huffman Jennifer E, Pyarajan Saiju, Beckham Jean C, Chang Kyong-Mi, Liao Katherine P, Djousse Luc, Gagnon David R, Whitbourne Stacey B, Ramoni Rachel, Muralidhar Sumitra, Tsao Philip S, O'Donnell Christopher J, Gaziano John Michael, Casas Juan P, Cho Kelly
Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, United States of America.
Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America.
PLoS One. 2021 May 13;16(5):e0251651. doi: 10.1371/journal.pone.0251651. eCollection 2021.
The risk factors associated with the stages of Coronavirus Disease-2019 (COVID-19) disease progression are not well known. We aim to identify risk factors specific to each state of COVID-19 progression from SARS-CoV-2 infection through death.
We included 648,202 participants from the Veteran Affairs Million Veteran Program (2011-). We identified characteristics and 1,809 ICD code-based phenotypes from the electronic health record. We used logistic regression to examine the association of age, sex, body mass index (BMI), race, and prevalent phenotypes to the stages of COVID-19 disease progression: infection, hospitalization, intensive care unit (ICU) admission, and 30-day mortality (separate models for each). Models were adjusted for age, sex, race, ethnicity, number of visit months and ICD codes, state infection rate and controlled for multiple testing using false discovery rate (≤0.1). As of August 10, 2020, 5,929 individuals were SARS-CoV-2 positive and among those, 1,463 (25%) were hospitalized, 579 (10%) were in ICU, and 398 (7%) died. We observed a lower risk in women vs. men for ICU and mortality (Odds Ratio (95% CI): 0.48 (0.30-0.76) and 0.59 (0.31-1.15), respectively) and a higher risk in Black vs. Other race patients for hospitalization and ICU (OR (95%CI): 1.53 (1.32-1.77) and 1.63 (1.32-2.02), respectively). We observed an increased risk of all COVID-19 disease states with older age and BMI ≥35 vs. 20-24 kg/m2. Renal failure, respiratory failure, morbid obesity, acid-base balance disorder, white blood cell diseases, hydronephrosis and bacterial infections were associated with an increased risk of ICU admissions; sepsis, chronic skin ulcers, acid-base balance disorder and acidosis were associated with mortality.
Older age, higher BMI, males and patients with a history of respiratory, kidney, bacterial or metabolic comorbidities experienced greater COVID-19 severity. Future studies to investigate the underlying mechanisms associated with these phenotype clusters and COVID-19 are warranted.
与2019冠状病毒病（COVID-19）疾病进展阶段相关的风险因素尚不清楚。我们旨在确定从严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染到死亡的COVID-19进展各阶段的特定风险因素。
我们纳入了退伍军人事务部百万退伍军人计划（2011年起）的648,202名参与者。我们从电子健康记录中确定了特征和1809种基于国际疾病分类（ICD）编码的表型。我们使用逻辑回归来检验年龄、性别、体重指数（BMI）、种族和常见表型与COVID-19疾病进展阶段的关联：感染、住院、重症监护病房（ICU）入院和30天死亡率（每个阶段分别建立模型）。模型针对年龄、性别、种族、民族、就诊月数和ICD编码、州感染率进行了调整，并使用错误发现率（≤0.1）控制多重检验。截至2020年8月10日，5929人SARS-CoV-2呈阳性，其中1463人（25%）住院，579人（10%）入住ICU，398人（7%）死亡。我们观察到，与男性相比，女性入住ICU和死亡的风险较低（优势比（95%置信区间）：分别为0.48（0.30 - 0.76）和0.59（0.31 - 1.15）），与其他种族患者相比，黑人患者住院和入住ICU的风险较高（优势比（95%置信区间）：分别为1.53（1.32 - 1.77）和1.63（1.32 - 2.02））。我们观察到，年龄较大且BMI≥35与20 - 24kg/m²相比，所有COVID-19疾病状态的风险均增加。肾衰竭、呼吸衰竭、病态肥胖、酸碱平衡紊乱、白细胞疾病、肾积水和细菌感染与入住ICU的风险增加相关；败血症、慢性皮肤溃疡、酸碱平衡紊乱和酸中毒与死亡率相关。
年龄较大、BMI较高、男性以及有呼吸、肾脏、细菌或代谢合并症病史的患者，COVID-19病情更严重。有必要开展进一步研究以探究与这些表型簇和COVID-19相关的潜在机制。
