COVID-19 risk factors identified in patients with chronic respiratory disease

Male sex, elevated baseline body temperature and increased respiratory rate were COVID-19 risk factors among ambulatory patients with chronic respiratory disease and acute respiratory symptoms, researchers reported in Respiratory Medicine.

“COPD and asthma were presumed to be associated with severe COVID-19 amongst the hospitalized, resulting in high health care utilization and morbidity/mortality. However, others found that asthmatics actually may have lower likelihood of COVID-19 severity,” Vamsi P. Guntur, MD, MSc, pulmonologist in the division of pulmonary, critical care and sleep medicine and the Cohen Family Asthma Institute at National Jewish Health, Denver, and colleagues wrote. “These discrepancies underscored our unawareness of associations between chronic respiratory disease and COVID-19.”

This single-center retrospective cohort analysis evaluated electronic medical record data from 907 adults with presumed COVID-19 (mean age, 55.8 years; 69.2% women) assessed from March 2020 to January 2021. Researchers analyzed all patient data on demographics, comorbidities, medications, vital signs, laboratory tests, pulmonary function tests, patient disposition and coinfections.

Overall, 154 patients tested positive for COVID-19 infection and 753 tested negative or were not tested for COVID-19. Patients with COVID-19 had higher median body temperature (P = .0023), lower oxygen saturation (P = .03), higher heart rate (P < .0001), higher respiratory rate (P = .015) and lower systolic blood pressure (P = .0031) compared with those who tested negative.

Male sex, elevated temperature at baseline and higher respiratory rate were risk factors predictive of COVID-19 infection. In addition, eosinopenia (OR = 0.74; 95% CI, 0.63-0.87; P < .0001), neutrophilia (OR = 0.88; 95% CI, 0.81-0.95; P = .0006) and lymphocytosis (OR = 0.88; 95% CI, 0.81-0.96; P = .0015) were also factors associated with a positive COVID-19 diagnosis in the multivariate analysis.

In addition, male sex (P = .05), lower oxygen saturation (P = .0096) and lower FEV₁ (P = .035) were all associated with higher hospital referral.

COPD, interstitial lung disease and asthma diagnoses were not associated with patients testing positive for COVID-19.

“Our results may help rapid clinical risk stratification of patients with chronic respiratory disease evaluated in ambulatory settings for COVID-19, particularly amongst the unvaccinated,” the researchers wrote. “This is especially important in areas with limited timely access to testing and the demonstrated benefits of early monoclonal antibody administration.”