key: cord-0861216-n5qv0ny9 authors: El‐Hayek, Elissar; Kahwagi, Georges‐Junior; Issy, Nour; Tawil, Christina; Younis, Nabil; Abou‐Khalil, Rony; Matar, Madonna; Hallit, Souheil title: ‎Factors associated with coronavirus disease 2019 infection severity among a sample of Lebanese adults: Data from a cross‐sectional study date: 2022-05-23 journal: Health Sci Rep DOI: 10.1002/hsr2.654 sha: af08b66b73c91cd5713efabccc282f5fb5c249ef doc_id: 861216 cord_uid: n5qv0ny9 BACKGROUND AND AIMS: Identification of factors responsible for severe illness related to coronavirus disease 2019 (COVID‐19) could help in the early management of patients with high risk, especially in developing countries with poor medical care systems. To date, no data have been published concerning the factors associated with COVID‐19 severity in Lebanon. In this study, we aimed at investigating the relation between sociodemographic variables, health status, and the clinical outcomes of COVID‐19 in a sample of Lebanese adults. METHODS: In our cross‐sectional study, 1052 patients (563 male and 489 female, with the median age of 42.83 ± 17.88 years), tested positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) between January and March 2021, were recruited from a hospital in Byblos, Lebanon. Basic demographic data, medical history, clinical data, and selfreported symptoms related to COVID‐19 were collected. Clinical classification of COVID‐19 severity was carried out according to the WHO interim guidance on May 27, 2020. Multi and bivariate regression analysis were performed. RESULTS: When comparing patients with moderate symptoms versus mild, the results showed that older age (aOR = 1.05; 95% CI: 1.03–1.06) and having dyslipidemia (aOR = 1.89; 95% CI: 1.01–3.49) were significantly associated with higher odds of having moderate symptoms. When comparing patients with severe symptoms versus mild, older age (aOR = 1.08; 95% CI: 1.06–1.10), higher body mass index (aOR = 1.09; 95% CI: 1.04–1.15) and having respiratory diseases (aOR = 2.57; 95% CI: 1.03–6.36) were significantly associated with higher odds of having severe symptoms, whereas female gender (aOR = 0.56; 95% CI: 0.32–0.98) was significantly associated with lower odds of having severe symptoms compared to males. Finally, when comparing patients with severe symptoms versus moderate, older age (aOR = 1.03; 95% CI: 1.01–1.05) was found to be significantly associated with higher odds of having severe symptoms. CONCLUSION: Identification of risk factors may contribute to a better understanding of the COVID‐19 pathogenesis and provide clinical reference for early prognosis and management of patients. The COVID-19 pandemic has spread quickly, as of February 2021, more than 5 million confirmed deaths attributed to COVID- 19 Besides being one of the deadliest in history, the COVID-19 pandemic has produced an exceptional global socioeconomic crisis. Early management of symptomatic subjects at high risk of developing severe forms of COVID-19 has shown to reduce efficiently the numbers of hospitalizations and intensive care admission, decreasing thereby the related costs sustained by public health systems. 9 Numerous studies have revealed that the clinical outcomes of SARS-CoV-2 infection in term of disease severity and related death are influenced by multiple comorbidities such as hypertension, 10 dyslipidemia, 11 diabetes, 12 obesity, 13 chronic kidney diseases, 14 respiratory diseases, 15 and cardiovascular diseases. 16 Demographics such as age and gender are also known to be associated with COVID-19 severity. 10, 17, 18 Additional studies are needed indeed to better identify risk factors responsible for severe and critical illness or even death Basic demographic data (including age and gender), medical history (including body mass index (BMI), tobacco use, alcohol consumption and pre-existing comorbidities), clinical data, and selfreported symptoms related to COVID-19 were collected for all patients identified to have a positive SARS-CoV-2 test. These data were taken either from health records for inpatients or by conducting telephone surveys for outpatients. The most common symptoms experienced by the patients after COVID-19 infection were respiratory symptoms including cough, sore throat, nasal congestion, runny nose and pneumonia (59.7%), myalgia (57.0%), loss of smell and/or taste (50.2%), headache (49.3%), and fever (37.2%). The full description of all symptoms are summarized in Table 5 . Those with mild disease experienced myalgia the most (68.8%), followed by respiratory disease (60%), headache (59.2%), loss of smell infections. 25, 26 In our study, diabetes was significantly associated with higher odds of having severe disease compared to mild, in agreement with a meta-analysis showing that diabetes is associated with a twofold increase in severity of COVID-19, as compared to nondiabetics. 27 Similarly, numerous evidence suggest that diabetes is associated with physiological and structural abnormalities in lung tissues that could exacerbate the lung injury during infections. 28 In addition to diabetes, we have found that higher BMI was also significantly associated with higher odds of having more severe forms of COVID-19. These results suggest an association of metabolic comorbidities with adverse outcomes of COVID-19. Obesity is actually a major health problem that could trigger a series of other disorders, including hypertension, cardiovascular disease, diabetes mellitus, and chronic kidney disease. 31 A meta-analysis done by Popkin et al. reveals that the odds of hospitalization and mortality is significantly higher in obese people infected with COVID-19 when compared to nonobese patients. 32 This increased risk of severe illness is related to higher rates of metabolic and cardiovascular complications. 33 Furthermore, obesity is characterized by a chronic systemic inflammation that could contribute to the pathogenesis of COVID-19. 34, 35 According to bivariate analysis ( 38, 39 The mechanism underlying these gender differences in term of COVID-19 outcomes is not yet clearly understood. It can be partly explained by the higher expression of proinflammatory cytokines and chemokines in males. 40 response. 41 In addition, it has been shown that IL-6 receptor, the main actor in the cytokine storm, is expressed at higher levels in lung epithelial cells in males compared to females. These findings suggest that males are more disposed to cytokine storm that can lead to the worsening of COVID-19 outcomes 40, 42, 43 The major limitation of our study is the absence of laboratory and radiologic data, which may also be important prognostic factors. Unfortunately, no other national data are available to compare our results with. A selection bias is also possible since the data was collected from one hospital only, hindering the generalization of the findings. Accurate information could not be disposed for some treatments, especially for the outpatients that were We acknowledge all the patients that have participated in this study. 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Elissar El-Hayek http://orcid.org/0000-0002-5336-3636Madonna Matar http://orcid.org/0000-0003-4870-8879