COVID-19 Hospitalizations in Young Adults

It has been shown that age and comorbidity influence outcomes of those hospitalized with COVID-19.  Specifically, older patients are more likely to experience severe adverse effects of the disease and numerous studies have corroborated this.  This study, however, focused on young adults and it sought to identify factors that led to hospitalizations related to COVID-19.  The researchers examined the relationship between demographics, comorbidities, clinical course, and outcomes with hospitalizations.  The sample included 395 people between the ages of 18 and 35 (mean = 29.9) that were admitted to one of eleven hospitals in the New York City public system.  Below are the key findings of the study:

1. Hospitalizations were more common in males (66.8%) than females (32.9%).
2. Fifty seven percent of young adults had at least one major comorbidity.
3. Diabetes (n = 54 deceased/73 diagnosed, 74% tested POS;9 8.2% with diabetic history deceased; Wilcoxon p (Wp) = .044), hypertension (14/44, 32% POS, 25.5%; Wp = 0.030), renal (6/16, 37.5% POS, 11%; Wp = 0.000), and cardiac problems (6/21, 28.6% POS,11%; Wp = 0.015) were all associated with mortality.
4. Blood glucose levels > 215 or hemoglobin A1c > 9.5 was associated with an increased risk of mortality.
5. Of the 395 patients, 55 (13.1%) died. Mortality with no comorbidity was 3.8%.
6. Invasive mechanical ventilation was given to 21% of patients of which 13.7% died.

The major limitations of the study were that it was retrospective in nature and that the patients were mostly from a low socioeconomic status with a common race/ethnicity background thus limiting generalizability to other populations. The results from the study, however, are still very relevant and provide insight into the adverse effects of COVID-19 on the younger population.

Non-Respiratory COVID-19 Symptoms and Effects

This systematic review and meta-analysis examined the prevalence of gastrointestinal (GI) symptoms and liver injury in those diagnosed with COVID-19 and also provided patient comparisons.  Approximately 64 studies met the criteria and used in the meta-analysis.  The researchers found the following:

1. Pooled rate of GI symptoms and liver dysfunction was 31.8% (95% CI: 21.0–42.5%, I² = 97.6%) and 27.4% (95% CI: 16.9–37.9%, I² = 97.9%), respectively.
2. Cases with GI symptoms were more likely to present with fatigue (OR 2.28, 95% CI: 1.66–3.14, P < 0.00001, I²= 31%), myalgia (OR 1.96, 95% CI: 1.06–3.65, P = 0.03, I² = 69%), and acute respiratory disease syndrome (ARDS) (OR 2.94, 95% CI: 1.17–7.40, P = 0.02, I² = 0) and had a trend to present as severe/critical type (OR 1.87, 95% CI: 0.98–3.57, P = 0.06, I² = 58%).
3. Those with GI symptoms had a greater likelihood of developing more severe illness.

Cardiovascular manifestations (CV) have also been seen as a result of COVID-19 and that with a very poor prognosis.  Given the limited information available regarding CV, this systematic review was done to provide foundational information about CV and COVID-19.   Highlighted below are the key findings:

1. Patients with suspected cardiac injury from COVID-19 often presented with chest pain in addition to other symptoms such as fever, cough, and/or dyspnea.
2. Patients presenting with cardiac injury associated with COVID-19 and inflammation experienced significantly worsened complications and outcomes.
3. Patients with cardiac injury required noninvasive and invasive mechanical ventilation more often ([46.3% vs3.9%; P< .001) and [22.0% vs 4.2%; P < .001], respectively) as compared to patients without cardiac injury.
4. Higher rates of ARDS were seen in patients with CV than patients with no CV (58.5% vs 14.7%; P < .001) .
5. Acute kidney injury (8.5% vs 0.3%), electrolyte imbalance (15.9% vs 5.1%), and coagulation disorders (7.3% vs 1.8%), were significantly higher among patients with an additional cardiac injury with COVID-19 disease.
6. Two studies reported a significantly higher mortality rate of 51% versus 4.5% and 59.6% versus 8.9% among patients with cardiac injury as opposed to patients without cardiac injury, respectively.

The two systematic reviews illustrate the significance of non-respiratory COVID-19 symptoms and manifestations. Information such as this is needed in order to reduce COVID-19-related morbidity and mortality.