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
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Abstract
In young adults (18 to 49 years old), investigation of the acute respiratory distress syndrome (ARDS) after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been limited. We evaluated the risk factors and outcomes of ARDS following infection with SARS-CoV-2 in a young adult population.
Methods
A retrospective cohort study was conducted between January 1st, 2020 and February 28th, 2021 using patient-level electronic health records (EHR), across 241 United States hospitals and 43 European hospitals participating in the Consortium for Clinical Characterization of COVID-19 by EHR (4CE). To identify the risk factors associated with ARDS, we compared young patients with and without ARDS through a federated analysis. We further compared the outcomes between young and old patients with ARDS.
Results
Among the 75,377 hospitalized patients with positive SARS-CoV-2 PCR, 1001 young adults presented with ARDS (7.8% of young hospitalized adults). Their mortality rate at 90 days was 16.2% and they presented with a similar complication rate for infection than older adults with ARDS. Peptic ulcer disease, paralysis, obesity, congestive heart failure, valvular disease, diabetes, chronic pulmonary disease and liver disease were associated with a higher risk of ARDS. We described a high prevalence of obesity (53%), hypertension (38%- although not significantly associated with ARDS), and diabetes (32%).
Conclusion
Trough an innovative method, a large international cohort study of young adults developing ARDS after SARS-CoV-2 infection has been gather. It demonstrated the poor outcomes of this population and associated risk factor.
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SciScore for 10.1101/2022.03.31.22273257: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: 2.1 Common 4CE Data collection by HS: As previously described[16], each participating HS were responsible for and obtained ethics approval, as needed, from the appropriate ethics committee at their institution. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Medications administered were collected at the class level (as per the ATC standard nomenclature[22], e-Appendix 1). ATCsuggested: NoneResults 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 L…SciScore for 10.1101/2022.03.31.22273257: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: 2.1 Common 4CE Data collection by HS: As previously described[16], each participating HS were responsible for and obtained ethics approval, as needed, from the appropriate ethics committee at their institution. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Medications administered were collected at the class level (as per the ATC standard nomenclature[22], e-Appendix 1). ATCsuggested: NoneResults 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:A limitation of relying on billing codes to identify comorbidities is the challenge of accurately distinguishing comorbidities from complications. In our analysis, comorbidities were considered as those diagnoses from billing codes assigned up to one year before and up to 90 days after the admission. This approach is more sensitive, but it can lead to considering complications as comorbidities. It is particularly true for peptic ulcer disease or paralysis which was identified as a comorbidity associated with ARDS but which is also known to be a common complication of mechanical ventilation[28,29] or prolonged ICU admission. We perform a complementary univariable analysis on the sub population who had previous hospital visits and considering only the ICD code related to those previous visits as comorbidities (one year and – 14 days before the admission). In this univariable analysis presented in e-Table 2, ARDS was associated with the presence of peptic ulcer disease or paralysis in a previous hospitalization, which explained our choice to keep both in the main multivariable analysis that means considering them as comorbidities. “Paralysis” regroups is related a large diversity of diagnoses. including encephalitis, myelitis and encephalomyelitis, hereditary ataxia, cerebral palsy, hemiplegia and hemiparesis, paraplegia (paraparesis) and quadriplegia (quadriparesis), and other paralytic syndromes (e-Appendix 2); but a common co-occurrence is reduced lung capacity which could co...
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.
Results from scite Reference Check: We found no unreliable references.
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