Researchers Identify Severe COVID-19 Risk Factors in Young Adults

PLoS One study looks at demographic and clinical markers for severe disease in patients aged 18-29.

With the age of COVID-19 hospitalizations getting younger in this fourth wave, a newly published Houston Methodist study looked at data from the first three peaks in hospitals that revealed clues about the risk factors of COVID in young adults.

Lead author Edward A. Graviss, Ph.D., MPH, FIDSA, an associate professor of pathology and genomic medicine at the Houston Methodist Research Institute, and his team examined demographic and clinical risk factors for major disease in hospitalized young adult COVID-19 patients of 18 -29 years in the Houston Methodist system of seven hospitals. Their analysis took place from March 1 to December 7, during the first three COVID-19 peaks in 2020. They also looked at readmissions and associated diagnoses of serious illness within 30 days of these patients being discharged from hospital.

With patients well distributed among the eight Houston Methodist hospitals in the greater Houston area, the 1,853 young adult patients were 20% non-Hispanic white, 32% non-Hispanic black, and 43% Hispanic or Latino. Women made up 62% of the patients, of which 12% were pregnant. Although these patients were relatively healthy, 68% were overweight or obese. The most common co-morbidities in the patients were asthma, mental disorders, hypertension and diabetes. While all patients had COVID-19 positive PCR tests and were potentially contagious at some point during their diagnostic encounter, only 43% reported COVID-19 symptoms on admission.

Medical staff at Houston Methodist hospitals are very busy with COVID cases rising again. Credit: Khalil AbuSharekh, Houston Methodist

Hispanic men were more likely to develop serious disease outcomes, and increasing age, asthma history, congestive heart failure, cerebrovascular disease, and diabetes were predictive of severe disease diagnoses within 30 days of initial hospitalization. Hispanic ethnicity, non-Hispanic black race, obesity, history of asthma and myocardial infarction, and exposure in the household were predictive of hospital readmission at 30 days.

Relatively few young adult patients received respiratory interventions, such as ventilator support, during their first diagnostic encounter, with 11% receiving supplemental oxygen and 3% requiring intensive care. While 96% of patients were discharged home after their first hospitalization, 15% of them returned to the hospital within 30 days. Of the inpatient admissions, four patients (1%) died during their first hospitalization and four died after discharge to another facility.

Overall, within 30 days of their first meeting, 17% of patients were diagnosed with pneumonia and 8% had at least one additional critical diagnosis, such as sepsis, myocardial infarction, cerebrovascular event, cardiac arrest, pulmonary embolism, thrombosis, acute respiratory distress syndrome (ARDS) and the like, to be classified as severe COVID-19 disease.

The authors say the study shows a significant risk of serious illness and readmission in young adults, especially those in marginalized communities and those with co-morbidities. They emphasize the need for increased COVID-19 awareness and prevention among young adults and ongoing research into risk factors for serious illness, readmission and long-term consequences of COVID-19.

Reference: “Risk Factors for COVID-19 Severity in Hospitalized Patients, Ages 18-29” by Micaela Sandoval, Duc T. Nguyen, Farhaan S. Vahidy, and Edward A. Graviss, July 30, 2021, PLoS One.
DOI: 10.1371/journaal.pone.0255544

Houston Methodist Research Institute employees working with Dr. Graviss working on this study were Micaela Sandoval and Duc T. Nguyen of the Department of Pathology and Genomic Medicine and Farhaan S. Vahidy of the Center for Outcomes Research.

The findings of this peer-reviewed retrospective cohort study are described in a paper titled “Risk factors for severity of COVID-19 in hospital patients aged 18-29 years”, in PLoS One, a multidisciplinary journal published by the Public Library of Science. , which is a non-profit open-access publishing and advocacy organization dedicated to accelerating advances in science and medicine.