Acute respiratory distress syndrome may increase death risk among young COVID-19 patients

A team of international scientists have recently estimated the risk and prevalence of acute respiratory distress syndrome (ARDS) in hospitalized young adults with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Study: Acute respiratory distress syndrome after SARS-CoV-2 infection on young adult population: international observational federated study based on electronic health records through the 4CE consortium ARDS after SARS-CoV-2 infection on young adult. Image Credit: Design_Cells/Shutterstock
Study: Acute respiratory distress syndrome after SARS-CoV-2 infection on young adult population: international observational federated study based on electronic health records through the 4CE consortium ARDS after SARS-CoV-2 infection on young adult. Image Credit: Design_Cells/Shutterstock

The findings reveal a high mortality rate among young adults who have developed ARDS after SARS-CoV-2 infection. The study is currently available on the medRxiv* preprint server.

Background

Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, is associated with mild to severe respiratory complications, including ARDS. The prevalence of ARDS is estimated to be about 31% and 92% among hospitalized and intensive care unit (ICU)-admitted patients with SARS-CoV-2 infection, respectively. In the general population, its prevalence is about 3.4% after SARS-CoV-2 infection.

The presence of ARDS in COVID-19 patients is associated with poor prognosis, with a mortality rate as high as 39%. According to the available literature, older adults are more likely to develop ARDS after SARS-CoV-2 infection. However, studies have shown that in the US, more than 20% of ICU-admitted COVID-19 patients with ARDS are young adults.

In the current study, the scientists have assessed the risk of ARDS in hospitalized young adults with COVID-19. They also compared the risk factors of ARDS and outcomes between the young study population and an older population.

Study design

The study analysis was conducted on patient-level electronic healthcare records collected from the International Consortium for Clinical Characterization of COVID-19. The consortium dataset includes patient information from 241 United States hospitals and 43 European hospitals.

The ARDS-related risk factors were identified by comparing young adult patients with and without ARDS. In addition, the mortality rate at 90 days after the hospital admission was estimated.

Risk factors for ARDS

A total of 75,377 hospitalized patients with laboratory-confirmed COVID-19 were included in the analysis. ARDS was detected in about 7.8% of hospitalized young adults (age group: 18 – 49 years) with COVID-19. Among hospitalized older adults (Age group: above 49 years) with COVID-19, about 10% were diagnosed with ARDS. Among all COVID-19 patients with ARDS, about 13% were young adults.

Regarding age-related risks, young patients aged 26 – 49 years showed a higher risk of developing ARDS compared to those aged 18 – 25 years. An increased risk was also observed among male patients than female patients.

Regarding comorbidities, the analysis revealed that the presence of peptic ulcer disease, paralysis, obesity, congestive heart failure, valvular disease, diabetes, chronic pulmonary disease, and liver disease significantly increases the risk of developing ARDS. A high prevalence of obesity, diabetes, and hypertension was observed among young COVID-19 patients with ARDS.

No significant association between hypertension and risk of ARDS was observed in the study population. Similarly, human immunodeficiency virus (HIV) infection, cancer, hypothyroidism, psychosis, alcohol and illicit drug consumption, and smoking were not found to increase the risk of ARDS.

Clinical outcomes of patients with ARDS

The clinical outcomes and mortality rate were compared between young adult and older adult patients with ARDS.   

Regarding clinical outcomes, a lower risk of developing acute kidney failure, cardiac conduction disorder, fluid, electrolyte and acid-base balance disorders, and stroke was observed among young patients with ARDS compared to older patients with ARDS. However, the young patients showed a comparatively higher risk of developing pneumonia and sepsis due to streptococcal infection. More than 50% of young ARDS patients showed the presence of bacterial superinfection during their hospital stay.

Regarding mortality rate, the analysis revealed that about 16% of young ARDS patients and 41% of older ARDS patients died 90 days after hospital admission.

Study significance

The study estimates the prevalence of ARDS in hospitalized COVID-19 patients representing an international young adult population. A moderate prevalence of ARDS (7.8%) but a high rate of mortality (16%) has been observed in the large international study cohort of young adults with COVID-19. A high prevalence of obesity, diabetes, and hypertension has been observed in young ARDS patients.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
Dr. Sanchari Sinha Dutta

Written by

Dr. Sanchari Sinha Dutta

Dr. Sanchari Sinha Dutta is a science communicator who believes in spreading the power of science in every corner of the world. She has a Bachelor of Science (B.Sc.) degree and a Master's of Science (M.Sc.) in biology and human physiology. Following her Master's degree, Sanchari went on to study a Ph.D. in human physiology. She has authored more than 10 original research articles, all of which have been published in world renowned international journals.

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