key: cord-0758205-4k81plj2
authors: Ghanei, Mostafa; Keyvani, Hossein; Haghdoost, Aliakbar; Abolghasemi, Hassan; Janbabaei, Ghasem; Reza Jamshidi, Hamdi; Hosein Ghazale, Amir; Hassan Saadat, Seyed; Gholami Fesharaki, Mohammad; Raei, Mehdi
title: The Risk Factors and Related Hospitalizations for Cases with Positive and Negative COVID-19 Tests: A Case-Control Study
date: 2021-06-15
journal: Int Immunopharmacol
DOI: 10.1016/j.intimp.2021.107894
sha: 78b5ef154a55a83b03e0a81b2f777cd2f0feffac
doc_id: 758205
cord_uid: 4k81plj2

BACKGROUND: The aim of this study was to evaluate the risk factors for hospitalizations of cases with positive and negative COVID-19 tests. METHODS: In this case-control study, the case and control groups consisted of 292 COVID-19 patients and 296 non-COVID-19 patients. Patients who referred to a reference laboratory in Tehran (Iran) in March 2020 were selected and interviewed. The patients were contacted by telephone and data were recorded through a questionnaire. RESULTS: The sample of this study consisted of 588 patients (349 [59%] females, 239 [41%] males) with a mean age of 42±15. The results of this study showed that comorbidities like diabetes (OR=7.42), hypertension (OR=4.85), asthma and respiratory diseases (OR=5.64) in addition to symptoms including fever (OR=6.67), chills (OR=11.2), anorexia (OR=11.3), dyspnea (OR=4.8), weakness and lethargy (OR=5.7) were the most predictive variables for hospitalization of non-COVID-19 cases. Furthermore, demographical variables like male gender (OR=3.71), high age (>50; OR=3.12), BMI (>25; OR=2.37), travel (OR=2.79), comorbidities including diabetes (OR=5.26), hypertension (OR=3.7) and underlying immunosuppressant patients receiving corticosteroid therapy (OR=3.62) in addition to symptoms like anorexia [OR=2.55] and dyspnea (OR=6.99) tend to increase the risk of hospital admission in COVID-19 patients, suggesting their predictive values for hospitalization of COVID-19 patients. CONCLUSION: Our results indicated that different factors tend to increase the odds of hospital admission in patients with positive and negative COVID-19 tests, suggesting their predictive values for hospitalization.

infections around the world (2). In Iran, since the first two cases of COVID-19 were reported on February 19, 2020 (3) ; until May 12, 2021 (2), more than 2.5 million have been infected and more than 75 thousand people have died of COVID-19 disease.

The clinical features of COVID-19 are varied, ranging from asymptomatic states or mild upper respiratory tract infections to severe pneumonia with respiratory failure (acute respiratory distress syndrome [ARDS] ) in the early stages or even death (4, 5) .

Major symptoms like fever, cough, dyspnea (4) and minor symptoms such as loss of taste and smell, gastrointestinal symptoms and cutaneous manifestations (6) (7) (8) (9) are common clinical features of this disease. Booth et al. (10) in a meta-analysis study comprising of 76 studies across 14 countries demonstrated that commonly reported variables including age >75, male sex, severe obesity, active cancer, crucial measure (e.g., respiratory rate and SpO2) as patient characteristics contributing to an increased risk of severe COVID-19 infection .

In a national cohort study of 88,747 cases tested for SARS-CoV-2, Loannou found that older age, high regional coronavirus disease 2019 burden, higher Charlson Comorbidity Index score (11), fever, dyspnea, and abnormal results in many routine laboratory tests are significant risk factors for mortality, while other factors such as chronic obstructive pulmonary diseases, obesity, smoking and hypertension were not found to be linked to mortality (12) . A nationwide study reported that age, sex, and comorbidity are generally associated with severe COVID-19 (13) .

As far as patient management is concerned, there is substantial interest in examining risk factors associated with hospitalization, severe illness, and mortality in case series. Exploration of the epidemiology, details of the clinical characteristics (e.g., respiratory symptoms, etc.), laboratory and CT scan results, comorbidities, and clinical outcomes of patients are essential in this regard (14) (15) (16) . Some cases are discharged earlier, whereas others needed longer hospitalization; therefore, risk factor estimation and definitive outcomes need to be clarified. Since its outbreak, there have existed myriad uncertainties about COVID-19 especially in different communities as well. Given most COVID-19 studies have been performed on hospitalized patients rather than those receiving pre-hospital care, this study was aimed at evaluating the risk factors for hospitalizations among individuals with positive and negative COVID-19 tests.

The front-line data of the present retrospective case-control study were obtained from Keyvan Virology Specialty Laboratory (KVSL) in Tehran, Iran. The KVSL was one of the main referral laboratories for screening suspected COVID-19 cases in Tehran.

The inclusion criteria in this study were: 18≤ age ≤90, willingness to participate, reference to Study participants responded to a 40-item telephone-based interview checklist including demographic information, current diseases, clinical outcomes, signs and symptoms, designed by a team of specialists (i.e., epidemiologists, statisticians, pulmonologists and infectious disease specialists) who were treating or studying COVID-19 disease. The content and face validity of this checklist were approved with Content Validity Ratio (CVR) > 0.7. The time interval between the referrals of and phone calls to patients was minimum 10 days (Min=10, Max=16).

In this study, the principle of information confidentiality was observed and participants would have willingly participated in this study. The research procedure was entirely consistent with the Human Ethics Committee of the Baqiyatallah University of Medical Sciences, and was implemented with an ethical number (IR.BMSU.REC.1399.044).

Categorical variables were compared by Chi-square (χ2) tests or Fisher's Exact Test and presented as n (%), whereas continuous variables were compared using the Mann-Whitney U test and were reported as median (Inter Quartile Range). In this study, logistic regression (OR with 95% confidence interval) was used to explore the risk factors related to COVID-19 and hospital admission. The SPSS software (version 18) and P-value less than 5% were used for statistical inferences and statistical significances, respectively. 

Comparing OR in COVID-19 (+) and COVID-19(-)

The data were obtained from 292 laboratory-confirmed COVID-19 patients and 296 non-COVID- ARD: Asthma and respiratory disease, COT: Corticosteroid Therapy, **: P-value<0.01, *: P-value<0.05

Numerous COVID-19 studies in Iran and other countries have been performed based on patients admitted to the hospital with moderate-to-severe coronavirus diseases, but the present study aimed to evaluate the risk factors affecting positive and negative COVID-19 test results. The aim of this retrospective case control study was to provide preliminary data on the risk of hospitalization among COVID-19 patients.

In the current study, the main clinical symptoms of COVID-19 patients were fever (56%), cough Our results also showed that signs and symptoms such as chills This result can be justified by more risky behaviors in males and stronger immune responses of females (29) .

It has been also reported that older age along with co-morbidities may be an important predictor of mortality resulting from COVID-19, SARS and MERS (30) (31) (32) . Therefore, in the initial screening; older patients who are immunocompromised should be considered as having a higher risk for developing moderate to severe form of the disease.

The limitations of this study included the lack of some clinical and laboratory findings due to the design of study, access to KVSL information only in the period from 10 March to 23 March, 2020

and not using CT scan usage for increasing the accuracy of COVID-19 detection (33) . 

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All authors conceived the study, designed, supervised the data collection, analyzed the data and drafted the manuscript. All authors read and approved the final manuscript