Table 2.
Baseline Demographics of Coinfected vs Noncoinfected Patients Hospitalized Patients for COVID-19 Across 38 Michigan Hospitals
| Characteristic | Total, (N=2,205), No. (%) |
No Coinfection, (N=2,064), No. (%) |
Coinfection, (N=141), No. (%) |
P Valuea | Community-Onset Coinfection, (N=67), No. (%) |
P Valueb | Hospital-Acquired Coinfection, (N=74), No. (%) |
P Valuec |
|---|---|---|---|---|---|---|---|---|
| Demographics | ||||||||
| Age, median y (range) | 64.9 (53.2–76.7) | 64.6 (52.9–76.6) | 67.5 (57.7–78.3) | .02 | 72.6 (60.9–85.0) | <.001 | 65.2 (54.0–72.6) | .9 |
| Sex, female | 1,051 (47.7) | 989 (47.9) | 62 (44.0) | .36 | 35 (52.2) | .49 | 27 (36.5) | .053 |
| Race | .02 | .07 | .003 | |||||
| White | 953 (43.2) | 887 (43.0) | 66 (46.8) | 38 (56.7) | 28 (37.8) | |||
| Black | 1031 (46.8) | 978 (47.4) | 53 (37.6) | 23 (34.3) | 30 (40.5) | |||
| Other | 221 (10.0) | 199 (9.6) | 22 (15.6) | 6 (9.0) | 16 (21.6) | |||
| Ethnicity (non-Hispanic) | 1917 (86.9) | 1801 (87.3) | 116 (82.3) | .09 | 58 (86.6) | .87 | 58 (78.4) | .03 |
| Admission location: ICU | 287 (13.0) | 233 (11.3) | 54 (38.3) | <.001 | 25 (37.3) | <.001 | 29 (39.2) | <.001 |
| Admission from long-term care facility | 317 (14.4) | 282 (13.7) | 35 (24.8) | <.001 | 27 (40.3) | <.001 | 8 (10.8) | .48 |
| Comorbidities | ||||||||
| BMI, median (IQR) | 29.9 (25.5–36.1) | 30.0 (25.6–36.1) | 27.9 (24.8–35.2) | .12 | 26.6 (22.7–31.8) | <.001 | 31.5 (26.1–39.0) | .25 |
| Charlson comorbidity index, median (IQR) | 1 (0–3) | 1 (0–3) | 2 (1–4) | <.001 | 2 (1–5) | 0.002 | 2 (1–4) | .09 |
| Diabetes, uncomplicated | 550 (24.9) | 512 (24.8) | 38 (27.0) | .57 | 9 (13.4) | .03 | 19 (39.2) | .005 |
| Diabetes, complicated | 270 (12.2) | 244 (11.8) | 26 (18.4) | .02 | 17 (25.4) | .001 | 9 (12.2) | .93 |
| Cardiovascular diseased | 1,597 (72.4) | 1480 (71.7) | 117 (83.0) | .004 | 56 (83.6) | .03 | 61 (82.4) | .04 |
| Hypertension | 1478 (67.0) | 1372 (66.5) | 106 (75.2) | .03 | 48 (71.6) | .38 | 58 (78.4) | .03 |
| History of myocardial infarction | 125 (5.7) | 109 (5.3) | 16 (11.3) | .003 | 11 (16.4) | .001 | 5 (6.8) | .59 |
| Congestive heart failure | 335 (15.2) | 306 (14.8) | 29 (20.6) | .07 | 20 (29.9) | .001 | 9 (12.2) | .53 |
| Cerebrovascular disease | 264 (12.0) | 243 (11.8) | 21 (14.9) | .27 | 14 (20.9) | .02 | 7 (9.5) | .54 |
| Chronic pulmonary diseasee | 557 (25.3) | 513 (24.9) | 44 (31.2) | .09 | 17 (25.4) | .92 | 27 (36.5) | .02 |
| COPD | 274 (12.4) | 248 (12.0) | 26 (18.4) | .03 | 10 (14.9) | .47 | 16 (21.6) | .01 |
| Asthma | 276 (12.5) | 256 (12.4) | 20 (14.2) | .54 | 6 (9.0) | .40 | 14 (18.9) | .1 |
| Dementia | 285 (12.9) | 267 (12.9) | 18 (12.8) | .95 | 13 (19.4) | .12 | 5 (6.8) | .12 |
| Liver disease, moderate to severe | 16 (0.7) | 15 (0.7) | 1 (0.7) | .99 | 0 (0) | .99 | 1 (1.4) | .43 |
| Kidney disease, moderate to severe | 587 (26.6) | 535 (25.9) | 52 (36.9) | .004 | 27 (40.3) | .009 | 25 (33.8) | .13 |
| Cancerf | 55 (2.5) | 49 (2.4) | 6 (4.3) | .16 | 3 (4.5) | .22 | 3 (4.1) | .42 |
| Solid organ transplant | 20 (0.9) | 16 (0.8) | 4 (2.8) | .03 | 2 (3.0) | .11 | 2 (2.7) | .13 |
| Immunosuppressive drugs prior to hospitalization | 251 (11.4) | 234 (11.3) | 17 (12.1) | .79 | 8 (11.9) | .88 | 9 (12.2) | .83 |
| At hospital presentation, symptoms/severity | ||||||||
| Duration of symptoms prior to hospital admission, median (IQR) | 5 (2–8) | 5 (2–8) | 5 (1–7) | .5 | 3 (0–7) | .048 | 6 (3–8) | .35 |
| Severity of illness on presentation to the hospitalg | <.001 | <.001 | <.001 | |||||
| Ambient air | 1,227 (55.6) | 1,171 (56.7) | 56 (39.7) | 27 (40.3) | 29 (39.2) | |||
| Low flow oxygen | 846 (38.4) | 786 (38.1) | 60 (42.6) | 29 (43.3) | 31 (41.9) | |||
| High flow/noninvasive | 39 (1.8) | 33 (1.6) | 6 (4.3) | 3 (4.5) | 3 (4.1) | |||
| Mechanical ventilation | 93 (4.2) | 74 (3.6) | 19 (20.4) | 8 (11.9) | 11 (14.9) | |||
| Highest level of respiratory supporth | <.001 | .003 | <.001 | |||||
| Ambient air | 602 (27.3) | 582 (28.2) | 20 (14.2) | 18 (26.9) | 2 (2.7) | |||
| Low flow oxygen | 1,073 (48.7) | 1,031 (50.0) | 42 (29.8) | 32 (47.8) | 10 (13.5) | |||
| High flow oxygen | 143 (6.5) | 138 (6.7) | 5 (3.5) | 2 (3.0) | 3 (4.1) | |||
| Noninvasive mechanical vent | 42 (1.9) | 40 (1.9) | 2 (1.4) | 1 (1.5) | 1 (1.4) | |||
| Mechanical ventilation | 345 (15.6) | 273 (13.2) | 72 (51.1) | 14 (20.9) | 58 (78.4) | |||
| Symptom prior to culture i | ||||||||
| New or escalating oxygen requirementj | 91 (64.5) | 35 (52.2) | 45 (60.8) | |||||
| Fever on day 1 or 2 | 1031 (48.4) | 991 (48.0) | 40 (59.7) | .06 | ||||
| Fever at any point in hospitalization | 1265 (57.4) | 1150 (55.7) | 115 (81.6) | <.001 | 47 (70.1) | 65 (87.8) | <.001 | |
| Laboratory result k | ||||||||
| White blood cell count, median K/µL (IQR) | 8.9 (6.3–13.2) | 8.7 (6.3–12.9) | 11.7 (7.7–17.0) | <.001 | 9.9 (6.1–14.9) | <.001 | 13.0 (9.3–18.4) | <.001 |
| Ferritin | 692.5 (317.9–1,472.7) |
686.3 (314.0–1,464.0) |
797.0 (372.2–1,511.1) |
.38 | 515.0 (278.0–1,285.1) |
.74 | 999.3 (471.0–1,750.7) |
.05 |
| C-reactive protein, mg/dL | 19.7 (8.0–87.6) | 19.4 (7.9–87.2) | 25.2 (11.9–96.1) | .24 | 24.2 (13.6–93.5) | .02 | 26.1 (8.5–96.1) | .57 |
| Lactate dehydrogenase | 368 (260–526) | 367 (258–522) | 403 (293–577.5) | .08 | 337 (285–547) | .21 | 435 (328–596) | .03 |
| Erythrocyte sedimentation rate | 60 (36–85) | 60 (36–85) | 55.0 (36.0–84.0) | .61 | 40 (21–55) | .06 | 79 (56–96) | .14 |
| Procalcitonin, ng/mL | 0.21 (0.09–0.70) | 0.2 (0.08–0.64) | 0.89 (0.18–3.21) | <.001 | 0.75 (0.16–3.96) | <.001 | 1.1 (0.4–2.2) | <.001 |
| Treatment during hospitalization | ||||||||
| IL-6 agentsl | 34 (1.5) | 27 (1.3) | 7 (5.0) | .005 | 4 (6.0) | .04 | 15 (20.3) | <.001 |
| Steroidsn | 661 (30.0) | 607 (29.4) | 54 (38.3) | .03 | 15 (22.4) | .59 | 39 (52.7) | <.001 |
| Antibiotic during hospitalizationm | 1,386 (62.9) | 1,259 (61.0) | 127 (90.1) | <.001 | 58 (86.6) | <.001 | 69 (93.2) | <.001 |
| Days of therapy (DOT), median (IQR) | 4 (2–9) | 4 (2–8) | 12 (7–19) | <.001 | 10 (5–14) | <.001 | 16 (9–21.5) | <.001 |
| Days of antibiotic exposure, median (IQR)o | 3 (1–5) | 2 (1–5) | 8 (4–12) | <.001 | 6 (3–8) | <.001 | 10 (5–15.5) | <.001 |
| Days of antibiotic exposure prior to coinfection diagnosis, median (IQR)m | 1 (1–4) | 3 (1–7) | ||||||
| Days of hospitalization prior to infection | 8 (5–12) | <.001 | ||||||
| Any antibiotic during hospitalization or at discharge | 1,468 (66.6) | 1,340 (64.9) | 128 (90.8) | <.001 | 59 (88.1) | <.001 | 69 (93.2) | |
| Length of stay | 5 (3–9) | 5 (3–9) | 11 (7–19) | <.001 | 7 (4–11) | 0 | 16.5 (10–25) | <.001 |
| Days of mechanical ventilation | 0 (0–0) | 0 (0–0) | 7 (4–14) | <.001 | ||||
Note. SAR, subacute rehabilitation center; BMI, body mass index; COPD, chronic obstructive pulmonary disease;
IQR, interquartile range. Units are no. (%) unless otherwise specified.
Comparison of non-coinfected to all coinfection.
Comparison of non-coinfected to community-onset coinfection.
Comparion of non-coinfected to hospital-acquired coinfection.
Defined as combination of hypertension, congestive heart failure, atherosclerosis.
Defined as COPD or asthma or chronic pulmonary disease or structural lung disease.
Defined as leukemia, lymphoma, solid tumor.
Based on WHO criteria: (1) ambient air, (2) low-flow oxygen, (3) high flow oxygen or noninvasive mech ventilation, (4) mechanical ventilation
At any point during hospitalization up to day culture is sent: (1) no supplemental oxygen; (2) low-flow oxygen, (3) heated high-flow nasal cannula, (4) noninvasive mech ventilation, (5) mechanical ventilation.
1 day before or day of culture.
Either type of oxygen support or amount of oxygenation support.
Within 1 day of culture, day prior or day of culture for those infected.
Tocilizumab, sarilumab.
Any antibiotic, excluding azithromycin alone.
Solumedrol, hydrocortisone, prednisone, prednisolone, dexamethasone.
For hospital-acquired infections.
Any dose of antibiotic on any day counts as 1 day.