Observational study: prospective longitudinal cohort (Green)
The objective of this longitudinal cohort study recently published in JAMA Network Open, was to identify excess risk and risk factors associated with hospitalisation, mechanical ventilation, and mortality in patients with SARS-CoV-2 infection. The study included 88747 patients tested for SARS-CoV-2 nucleic acid by polymerase chain reaction between February 28 and May 14, 2020, and followed up through June 22, 2020, in the Department of Veterans Affairs (VA) national health care system, including 10 131 patients (11.4%) who tested positive. Risks of hospitalisation, mechanical ventilation, and death were estimated in time-to-event analyses using Cox proportional hazards models. The authors found that hospitalisation, mechanical ventilation, and mortality were significantly higher in patients with positive SARS-CoV-2 test results than among those with negative test results. Significant risk factors for mortality included older age, high regional coronavirus disease 2019 burden, higher Charlson Comorbidity Index score, fever, dyspnoea, and abnormal results in many routine laboratory tests; however, obesity, Black and Hispanic ethnicity, chronic obstructive pulmonary disease, hypertension, and smoking were not associated with increased mortality. The authors concluded that, in their study, most SARS-CoV-2 deaths were associated with older age, male sex, and comorbidity burden. Many factors previously reported to be associated with mortality in smaller studies were not confirmed, such as obesity, Black and Hispanic ethnicity, chronic obstructive pulmonary disease, hypertension, and smoking.