Low birth weight as a potential risk factor for severe COVID-19 in adults

  1. Fàtima Crispi
  2. Francesca Crovetto
  3. Marta Larroya
  4. Marta Camacho
  5. Marta Tortajada
  6. Oriol Sibila
  7. Joan Ramon Badia
  8. Marta López
  9. Kilian Vellvé
  10. Ferran Garcia
  11. Antoni Trilla
  12. Rosa Faner
  13. Isabel Blanco
  14. Roger Borràs
  15. Alvar Agustí
  16. Eduard Gratacós

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Abstract

The identification of factors predisposing to severe COVID-19 in young adults remains partially characterized. Low birth weight (LBW) alters cardiovascular and lung development and predisposes to adult disease. We hypothesized that LBW is a risk factor for severe COVID-19 in non-elderly subjects. We analyzed a prospective cohort of 397 patients (18–70 years) with laboratory-confirmed SARS-CoV-2 infection attended in a tertiary hospital, where 15% required admission to Intensive Care Unit (ICU). Perinatal and current potentially predictive variables were obtained from all patients and LBW was defined as birth weight ≤ 2.500 g. Age (adjusted OR (aOR) 1.04 [1–1.07], P = 0.012), male sex (aOR 3.39 [1.72–6.67], P < 0.001), hypertension (aOR 3.37 [1.69–6.72], P = 0.001), and LBW (aOR 3.61 [1.55–8.43], P = 0.003) independently predicted admission to ICU. The area under the receiver-operating characteristics curve (AUC) of this model was 0.79 [95% CI, 0.74–0.85], with positive and negative predictive values of 29.1% and 97.6% respectively. Results were reproduced in an independent cohort, from a web-based survey in 1822 subjects who self-reported laboratory-positive SARS-CoV-2 infection, where 46 patients (2.5%) needed ICU admission (AUC 0.74 [95% CI 0.68–0.81]). LBW seems to be an independent risk factor for severe COVID-19 in non-elderly adults and might improve the performance of risk stratification algorithms.

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  1. Version published to 10.1038/s41598-021-82389-9
  3. Rapid Reviews Infectious Diseases

    Anders Hviid

    Review 2: "LOW BIRTH WEIGHT AS A RISK FACTOR FOR SEVERE COVID-19 IN ADULTS"

    This study suggests that low birth weight (LBW) could be a risk factor for severe COVID-19. Reviewers found that the methods employed were not rigorous to support this conclusion, and there remains a more complex relationship between LBW and adverse pulmonary outcomes.

  4. Rapid Reviews Infectious Diseases

    Stephanie Eick, Naida Gaber

    Review 1: "LOW BIRTH WEIGHT AS A RISK FACTOR FOR SEVERE COVID-19 IN ADULTS"

    This study suggests that low birth weight (LBW) could be a risk factor for severe COVID-19. Reviewers found that the methods employed were not rigorous to support this conclusion, and there remains a more complex relationship between LBW and adverse pulmonary outcomes.

  5. ScreenIT

    SciScore for 10.1101/2020.09.14.20193920: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data were analysed with SPSS v26 and R software version 3.6.2 (R project for statistical computing, Vienna, Austria).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)
    R project for statistical
    suggested: (R Project for Statistical Computing, RRID:SCR_001905)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: This study has some strengths and limitations that merit comment. Among the strengths, we prospectively collected information spanning the full COVID-19 clinical spectrum, from mild to hospitalized and ICU patients. Likewise, we validated our observations in an independent dataset. Finally, we included only non-elderly subjects (<70 years) to avoid the potential confounding effect of age-related comorbidities. The study sample size was too small to assess the predictive value of LBW across age ranges. We acknowledge that the evidence here presented should be validated in another prospective hospital cohort. We opted for an online survey to shorten validation time. We acknowledge also a potential selection bias since there were virtually no deaths in our study population. Firstly, mortality rate for COVID-19 was very low in our hospital (8%, 194/2,425) with most cases occurring in subjects >70 years-old. Secondly, we tried to contact all COVID-19 patients identified in the EMRs, but a few very severe cases were directly intubated and died preventing the interview for the study. Finally, we acknowledge the potential inaccuracy of the perinatal data obtained by interview or online survey. However, self-reported birth weight has demonstrated to be a good surrogate of adverse in utero environment, particularly in non-elderly subjects.41 Conclusions: Low birth weight increases the risk of severe COVID-19 in non-elderly adults. This new information further...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  6. Version published to 10.1101/2020.09.14.20193920v1 on medRxiv