Objectives
Severe forms of COVID‐19 affect predominantly subjects over 70y‐old and/or with comorbidities, but also a small proportion of young individuals without apparent predisposing factors. Prenatal factors may account for the susceptibility to adult disease. We postulated that low birthweight and prematurity are associated with severity of COVID‐19 in adults.
Methods
A prospective cohort including 397 consecutive patients 20 to 70y‐old with confirmed SARS‐CoV2 infection attended in a tertiary hospital in Barcelona. Current (age, gender, tobacco, comorbidities and drugs) and perinatal (birthweight and gestational age at birth) predictive variables were obtained from all patients by face‐to‐face or telephone interview and hospital records. Being born small for gestational age (SGA) was defined by birthweight below the 10th centile. Being born preterm was defined as born before 37 weeks of gestation. Logistic regression‐based predictive models were developed for predicting admission to intensive care unit (ICU) due to COVID‐19 complications.
Results
15% of cases (60/397) required admission to ICU. Age (adjusted OR 1.03 [1‐1.06], P = 0.061), gender (aOR 3.09 [1.58‐6.04], p < 0.001), body mass index (aOR 1.05 [0.99‐1.11], P = 0.139), chronic hypertension (aOR 3.71 [1.83‐7.5], p < 0.001) and being born SGA (aOR 2.97 [1.41‐6.24], p < 0.001) independently predicted admission to ICU. A model that includes all of them shows an area under the receiver‐operating characteristics (AUC) curve was 0.79 (95% CI, 0.73‐0.84). Other comorbidities, prematurity, smoking habit and chronic drug intake were not significantly associated to ICU admission.
Conclusions
Being born SGA significantly contributes to the likehood of critical illness in COVID‐19 in adults under 70y. Including this information in clinical algorithms could help in the prognostic stratification of COVID‐19.