Early Prognostic Indicators of Subsequent Hospitalization in Patients with Mild COVID-19

• Main Authors: Alyssa Ylescupidez, Aaron Rips, Henry T. Bahnson, Cate Speake, Punam Verma, Anne M. Hocking, Jane H. Buckner, Uma Malhotra
• Format: Article
• Language: English
• Published: MDPI AG 2021-04-01
• Series: Journal of Clinical Medicine
• Subjects: COVID-19; SARS CoV-2; pathophysiology; prognostic indicators; pandemic; comorbidities
• Online Access: https://www.mdpi.com/2077-0383/10/8/1562

Comprehensive data on early prognostic indicators in patients with mild COVID-19 remains sparse. In this single center case series, we characterized the initial clinical presentation in 180 patients with mild COVID-19 and defined the earliest predictors of subsequent deterioration and need for hospitalization. Three broad patient phenotypes and four symptom clusters were characterized, differentiated by varying risk for adverse outcomes. Among 14 symptoms assessed, subjective shortness of breath (SOB) most strongly associated with adverse outcomes (odds ratio (OR) 21.3, 95% confidence interval (CI): 2.7–166.4; <i>p</i> < 0.0001). In combination, SOB and number of comorbidities were highly predictive of subsequent hospitalization (area under the curve (AUC) 92%). Additionally, initial lymphopenia (OR 21.0, 95% CI: 2.1–210.1; <i>p</i> = 0.002) and male sex (OR 3.5, 95% CI: 0.9–13.0; <i>p</i> = 0.05) were associated with increased risk of poor outcomes. Patients with known comorbidities, especially multiple, and those presenting with subjective SOB or lymphopenia should receive close monitoring and consideration for preemptive treatment, even when presenting with mild symptoms.