COVID-19 Clinical Phenotypes: Presentation and Temporal Progression of Disease in a Cohort of Hospitalized Adults in Georgia, United States

Juliana F. da Silva; Alfonso C. Hernandez-Romieu; Sean D. Browning; Beau B. Bruce; Pavithra Natarajan; Sapna B. Morris; Jeremy A. W. Gold; Robyn Neblett Fanfair; Jessica Rogers-Brown; John Rossow; Christine M. Szablewski; Nadine Oosmanally; Melissa Tobin D'Angelo; Cherie Drenzek; David J. Murphy; Julie Hollberg; James M. Blum; Robert Jansen; David W. Wright; William Sewell; Jack Owens; Benjamin Lefkove; Frank W. Brown; Deron C. Burton; Timothy M. Uyeki; Priti R. Patel; Brendan R. Jackson; Karen K. Wong

doi:10.1093/ofid/ofaa596

Back

COVID-19 Clinical Phenotypes: Presentation and Temporal Progression of Disease in a Cohort of Hospitalized Adults in Georgia, United States

Journal article

Open access

Peer reviewed

COVID-19 Clinical Phenotypes: Presentation and Temporal Progression of Disease in a Cohort of Hospitalized Adults in Georgia, United States

Juliana F. da Silva, Alfonso C. Hernandez-Romieu, Sean D. Browning, Beau B. Bruce, Pavithra Natarajan, Sapna B. Morris, Jeremy A. W. Gold, Robyn Neblett Fanfair, Jessica Rogers-Brown, John Rossow, …

Open forum infectious diseases, Vol.8(1), pp.ofaa596-ofaa596

01/01/2021

DOI: 10.1093/ofid/ofaa596

PMCID: PMC7798484

PMID: 33537363

Files and links (1)

url

https://doi.org/10.1093/ofid/ofaa596View

Published (Version of record) Open Access

Abstract

Background. The epidemiological features and outcomes of hospitalized adults with coronavirus disease 2019 (COVID-19) have been described; however, the temporal progression and medical complications of disease among hospitalized patients require further study. Detailed descriptions of the natural history of COVID-19 among hospitalized patients are paramount to optimize health care resource utilization, and the detection of different clinical phenotypes may allow tailored clinical management strategies. Methods. This was a retrospective cohort study of 305 adult patients hospitalized with COVID-19 in 8 academic and com- munity hospitals. Patient characteristics included demographics, comorbidities, medication use, medical complications, intensive care utilization, and longitudinal vital sign and laboratory test values. We examined laboratory and vital sign trends by mortality status and length of stay. To identify clinical phenotypes, we calculated Gower's dissimilarity matrix between each patient's clinical characteristics and clustered similar patients using the partitioning around medoids algorithm. Results. One phenotype of 6 identified was characterized by high mortality (49%), older age, male sex, elevated inflammatory markers, high prevalence of cardiovascular disease, and shock. Patients with this severe phenotype had significantly elevated peak C-reactive protein creatinine, D-dimer, and white blood cell count and lower minimum lymphocyte count compared with other phenotypes (P < .01, all comparisons). Conclusions. Among a cohort of hospitalized adults, we identified a severe phenotype of COVID-19 based on the characteristics of its clinical course and poor prognosis. These findings need to be validated in other cohorts, as improved understanding of clinical phenotypes and risk factors for their development could help inform prognosis and tailored clinical management for COVID-19.

Immunology

Infectious Diseases

Microbiology

Life Sciences & Biomedicine

Science & Technology

Details

Title: Subtitle: COVID-19 Clinical Phenotypes: Presentation and Temporal Progression of Disease in a Cohort of Hospitalized Adults in Georgia, United States
Creators: Juliana F. da Silva - Centers for Disease Control and Prevention
Alfonso C. Hernandez-Romieu - United States Public Health Service
Sean D. Browning - Centers for Disease Control and Prevention
Beau B. Bruce - Centers for Disease Control and Prevention
Pavithra Natarajan - Centers for Disease Control and Prevention
Sapna B. Morris - United States Public Health Service
Jeremy A. W. Gold - Epidemic Intelligence Service
Robyn Neblett Fanfair - United States Public Health Service
Jessica Rogers-Brown - Centers for Disease Control and Prevention
John Rossow - United States Public Health Service
Christine M. Szablewski - Epidemic Intelligence Service
Nadine Oosmanally - Georgia Department of Public Health
Melissa Tobin D'Angelo - Georgia Department of Public Health
Cherie Drenzek - Georgia Department of Public Health
David J. Murphy - Emory University
Julie Hollberg - Emory University
James M. Blum - Emory University
Robert Jansen - Grady Health System
David W. Wright - Grady Memorial Hospital
William Sewell - Phoebe Putney Memorial Hospital
Jack Owens - Phoebe Putney Memorial Hospital
Benjamin Lefkove - Emory and Henry College
Frank W. Brown - Emory and Henry College
Deron C. Burton - United States Public Health Service
Timothy M. Uyeki - United States Public Health Service
Priti R. Patel - United States Public Health Service
Brendan R. Jackson - United States Public Health Service
Karen K. Wong - United States Public Health Service
Resource Type: Journal article
Publication Details: Open forum infectious diseases, Vol.8(1), pp.ofaa596-ofaa596
DOI: 10.1093/ofid/ofaa596
PMID: 33537363
PMCID: PMC7798484
NLM abbreviation: Open Forum Infect Dis
ISSN: 2328-8957
eISSN: 2328-8957
Publisher: Oxford University Press
Number of pages: 8
Grant note: Centers for Disease Control and Prevention; United States Department of Health & Human Services; Centers for Disease Control & Prevention - USA
Language: English
Date published: 01/01/2021
Academic Unit: Anesthesia
Record Identifier: 9984296151002771

Metrics

8 Record Views

7 Times Cited - Web of Science

See more details