- 2022-09
- EBioMedicine 83
- Al Ozonoff
- Joanna Schaenman
- Naresh Doni Jayavelu
- Carly E Milliren
- Carolyn S Calfee
- Charles B Cairns
- Monica Kraft
- Lindsey R Baden
- Albert C Shaw
- Florian Krammer
- Harm van Bakel
- Denise A Esserman
- Shanshan Liu
- Ana Fernandez Sesma
- Viviana Simon
- David A Hafler
- Ruth R Montgomery
- Steven H Kleinstein
- Ofer Levy
- Christian Bime
- Elias K Haddad
- David J Erle
- Bali Pulendran
- Kari C Nadeau
- Mark M Davis
- Catherine L Hough
- William B Messer
- Nelson I Agudelo Higuita
- Jordan P Metcalf
- Mark A Atkinson
- Scott C Brakenridge
- David Corry
- Farrah Kheradmand
- Lauren I R Ehrlich
- Esther Melamed
- Grace A McComsey
- Rafick Sekaly
- Joann Diray-Arce
- Bjoern Peters
- Alison D Augustine
- Elaine F Reed
- Matthew C Altman
- Patrice M Becker
- Nadine Rouphael
Study Design
- Type
- Observational
- Sample size
- n = 1,164
- Population
- 1164 patients from 20 hospitals across the United States
- Methods
- Prospective, observational study; immunophenotyping; disease severity assessed using a 7-point ordinal scale; multivariable logistic regression
- Duration
- 1 year after discharge
- Funding
- Independent
Background
Better understanding of the association between characteristics of patients hospitalized with coronavirus disease 2019 (COVID-19) and outcome is needed to further improve upon patient management.Methods
Immunophenotyping Assessment in a COVID-19 Cohort (IMPACC) is a prospective, observational study of 1164 patients from 20 hospitals across the United States. Disease severity was assessed using a 7-point ordinal scale based on degree of respiratory illness. Patients were prospectively surveyed for 1 year after discharge for post-acute sequalae of COVID-19 (PASC) through quarterly surveys. Demographics, comorbidities, radiographic findings, clinical laboratory values, SARS-CoV-2 PCR and serology were captured over a 28-day period. Multivariable logistic regression was performed.Findings
The median age was 59 years (interquartile range [IQR] 20); 711 (61%) were men; overall mortality was 14%, and 228 (20%) required invasive mechanical ventilation. Unsupervised clustering of ordinal score over time revealed distinct disease course trajectories. Risk factors associated with prolonged hospitalization or death by day 28 included age ≥ 65 years (odds ratio [OR], 2.01; 95% CI 1.28-3.17), Hispanic ethnicity (OR, 1.71; 95% CI 1.13-2.57), elevated baseline creatinine (OR 2.80; 95% CI 1.63- 4.80) or troponin (OR 1.89; 95% 1.03-3.47), baseline lymphopenia (OR 2.19; 95% CI 1.61-2.97), presence of infiltrate by chest imaging (OR 3.16; 95% CI 1.96-5.10), and high SARS-CoV2 viral load (OR 1.53; 95% CI 1.17-2.00). Fatal cases had the lowest ratio of SARS-CoV-2 antibody to viral load levels compared to other trajectories over time (p=0.001). 589 survivors (51%) completed at least one survey at follow-up with 305 (52%) having at least one symptom consistent with PASC, most commonly dyspnea (56% among symptomatic patients). Female sex was the only associated risk factor for PASC.Interpretation
Integration of PCR cycle threshold, and antibody values with demographics, comorbidities, and laboratory/radiographic findings identified risk factors for 28-day outcome severity, though only female sex was associated with PASC. Longitudinal clinical phenotyping offers important insights, and provides a framework for immunophenotyping for acute and long COVID-19.Funding
NIH.