SESSION TITLE: Critical Care Posters
SESSION TYPE: Original Investigation Posters
PRESENTED ON: October 18-21, 2020
PURPOSE: As the novel coronavirus continues to affect over 200 countries, resulting in greater than 350,000 deaths to date, older age is known to confer increased risk for severe disease. However, younger patients may be affected by severe disease as well, and limited literature focuses on the characteristics of these patients. Within a cohort of the first 137 patients admitted to the intensive care unit (ICU) of a tertiary care public hospital in the first month of the outbreak in New York City, we found a higher proportion of younger patients than previously reported. This case series describes baseline demographics, ICU course, and outcomes of 29 consecutive, critically ill patients under age 50 with known COVID-19.
METHODS: This retrospective observational study includes adults 18 years or older with confirmed COVID-19 who were admitted to our ICU between March 10 and April 7, 2020. Data were manually abstracted from electronic health records.
RESULTS: The majority of our cohort was male (23/29, 79.5%) and had an elevated BMI >25 (23/29, 79.5%). We found a high prevalence of diabetes, hypertension, and chronic kidney disease, similar to rates reported in other cohorts of COVID-19 patients. However, 37.9% (11/29) of our cohort had no known medical conditions at presentation. This subset was entirely male, three quarters were Hispanic, 3 had obesity, 7 were overweight, and 1 had normal BMI. By the April 22 follow-up, 12/29 (41%) patients had died, 13/29 (45%) had been discharged from the ICU, and 4/29 (14%) were still in the ICU. 4/26 (15%) patients required initiation of renal replacement therapy. 25/29 (86%) patients required mechanical ventilation and 23/29 (79%) required pressors. One patient was supported on VV ECMO. 19/29 (66%) met criteria for ARDS.
CONCLUSIONS: Evidence thus far suggests that advanced age increases the risk of severe COVID-19 disease; however, we found that critical illness and death were not limited to higher-risk age groups. While smoking is a proposed risk factor for COVID-19 severity, we found that more than half of the patients with documented smoking status had no smoking history. Interestingly, 38% of patients under age 50 had no past medical history on presentation to the hospital, but more than half were overweight and an additional third had obesity. Obesity has been proposed as a risk factor for severe COVID-19 in younger patients, suggesting that, in populations with high prevalence of obesity such as the United States, COVID-19 may have a more severe effect on younger populations.
CLINICAL IMPLICATIONS: These initial findings support a need for additional research into the risk factors for younger COVID-19 patients to progress to critical illness and death.
DISCLOSURES: No relevant relationships by Hannah Karpel, source=Web Response
No relevant relationships by Elana Kreiger-Benson, source=Web Response
No relevant relationships by Kelsey Luoma, source=Web Response
No relevant relationships by Sarah Martell, source=Web Response
No relevant relationships by Vikramjit Mukherjee, source=Web Response, value=Consulting fee
Removed 04/27/2020 by Vikramjit Mukherjee, source=Web Response