Early Outcomes of SARS-CoV-2 Infection in a Multisite Prospective Cohort of Inpatient Veterans

Jennifer M Ross; Jonathan D Sugimoto; Andrew Timmons; Jonathan Adams; Katrina Deardoff; Anna Korpak; Cindy Liu; Kathryn Moore; Deanna Wilson; Roger Bedimo; Kyong-Mi Chang; Kelly Cho; Kristina Crothers; Eric Garshick; J Michael Gaziano; Mark Holodniy; Christine M Hunt; Stuart N Isaacs; Elizabeth Le; Barbara E Jones; Javeed A Shah; Nicholas L Smith; Jennifer S Lee; EPIC Investigators

doi:10.1093/ofid/ofad330

Early Outcomes of SARS-CoV-2 Infection in a Multisite Prospective Cohort of Inpatient Veterans

Open Forum Infect Dis. 2023 Jun 27;10(7):ofad330. doi: 10.1093/ofid/ofad330. eCollection 2023 Jul.

Authors

Jennifer M Ross^{1

2}, Jonathan D Sugimoto¹, Andrew Timmons¹, Jonathan Adams¹, Katrina Deardoff¹, Anna Korpak¹, Cindy Liu¹, Kathryn Moore¹, Deanna Wilson³, Roger Bedimo^{4

5}, Kyong-Mi Chang^{6

7}, Kelly Cho^{8

9}, Kristina Crothers^{1

10}, Eric Garshick^{8

11}, J Michael Gaziano^{8

9}, Mark Holodniy^{3

12}, Christine M Hunt^{13

14}, Stuart N Isaacs^{6

7}, Elizabeth Le³, Barbara E Jones^{15

16}, Javeed A Shah^{1

2}, Nicholas L Smith^{1

17}, Jennifer S Lee^{3

18}; EPIC Investigators

Affiliations

¹ VA Puget Sound Health Care System, Seattle, Washington, USA.
² Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA.
³ VA Palo Alto Health Care System, Palo Alto, California, USA.
⁴ VA North Texas Health Care System, Dallas, Texas, USA.
⁵ Department of Medicine, University of Texas-Southwestern Medical Center, Dallas, Texas, USA.
⁶ Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.
⁷ Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁸ VA Boston Health Care System, Boston, Massachusetts, USA.
⁹ Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
¹⁰ Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington, USA.
¹¹ Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts, USA.
¹² Department of Medicine-Infectious Diseases, Stanford University, Palo Alto, California, USA.
¹³ VA Durham Health Care System, Durham, North Carolina, USA.
¹⁴ Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
¹⁵ VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.
¹⁶ University of Utah School of Medicine, Salt Lake City, Utah, USA.
¹⁷ Department of Epidemiology, University of Washington, Seattle, Washington, USA.
¹⁸ Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, and, by courtesy, Department of Epidemiology and Population Health, Stanford University, Palo Alto, California, USA.

PMID: 37484899
PMCID: PMC10358428 (available on 2024-06-27)
DOI: 10.1093/ofid/ofad330

Abstract

Background: Over 870 000 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections have occurred among Veterans Health Administration users, and 24 000 have resulted in death. We examined early outcomes of SARS-CoV-2 infection in hospitalized veterans.

Methods: In an ongoing, prospective cohort study, we enrolled veterans age ≥18 tested for SARS-CoV-2 and hospitalized at 15 Department of Veterans Affairs medical centers between February 2021 and June 2022. We estimated adjusted odds ratios (aORs), adjusted incidence rate ratios (aIRRs), and adjusted hazard ratios (aHRs) for maximum illness severity within 30 days of study entry (defined using the 4-category VA Severity Index for coronavirus disease 2019 [COVID-19]), as well as length of hospitalization and rehospitalization within 60 days, in relationship with demographic characteristics, Charlson comorbidity index (CCI), COVID-19 vaccination, and calendar period of enrollment.

Results: The 542 participants included 329 (61%) who completed a primary vaccine series (with or without booster; "vaccinated"), 292 (54%) enrolled as SARS-CoV-2-positive, and 503 (93%) men, with a mean age of 64.4 years. High CCI scores (≥5) occurred in 61 (44%) vaccinated and 29 (19%) unvaccinated SARS-CoV-2-positive participants. Severe illness or death occurred in 29 (21%; 6% died) vaccinated and 31 (20%; 2% died) unvaccinated SARS-CoV-2-positive participants. SARS-CoV-2-positive inpatients per unit increase in CCI had greater multivariable-adjusted odds of severe illness (aOR, 1.21; 95% CI, 1.01-1.45), more hospitalization days (aIRR, 1.06; 95% CI, 1.03-1.10), and rehospitalization (aHR, 1.07; 95% CI, 1.01-1.12).

Conclusions: In a cohort of hospitalized US veterans with SARS-CoV-2 infection, those with a higher CCI had more severe COVID-19 illness, more hospital days, and rehospitalization, after adjusting for vaccination status, age, sex, and calendar period.

Keywords: COVID-19; comorbidity; rehospitalization; severity; veteran.

Published by Oxford University Press on behalf of Infectious Diseases Society of America 2023.

Grants and funding

K08 CA228761/CA/NCI NIH HHS/United States