Dissecting clinical features of COVID-19 in a cohort of 21,312 acute care patients
Cole Maguire, Elie Soloveichik, Netta Blinchevsky, Jaimie Miller, Robert Morrison, Johanna Busch, W Michael Brode, Dennis Wylie, Justin Rousseau, Esther Melamed
Communications Medicine, doi:10.1038/s43856-025-00844-4
Background Although, COVID-19 has resulted in over 7 million deaths globally, many questions still remain about the risk factors for disease severity and the effects of variants and vaccinations over the course of the pandemic. To address this gap, we conducted a retrospective analysis of electronic health records from COVID-19 patients over 2.5 years of the COVID-19 pandemic to identify associated clinical features. Methods We analyze a retrospective cohort of 21,312 acute-care patients over a 2.5 year period and define six clinical trajectory groups (TGs) associated with demographics, diagnoses, vitals, labs, imaging, consultations, and medications. Results We show that the proportion of mild patients increased over time, particularly during Omicron waves. Additionally, while mild and fatal patients had differences in age, age did not distinguish patients with severe versus critical disease. Furthermore, we find that both male sex and Hispanic/Latino ethnicity are associated with more severe/critical TGs. More severe patients also have a higher rate of neuropsychiatric diagnoses and consultations, along with an immunological signature of high neutrophils and immature granulocytes, and low lymphocytes and monocytes. Interestingly, low albumin is one of the best lab predictors of COVID-19 severity in association with higher malnutrition in severe/critical patients, raising concern of nutritional insufficiency influencing COVID-19 outcomes. Despite this, only a small fraction of severe/critical patients had nutritional labs checked (e.g. Vitamin D, thiamine, B vitamins) or received vitamin supplementation. Conclusions Our findings expand on clinical risk factors in COVID-19, and highlight the interaction between severity, nutritional status, and neuropsychiatric complications in acute care patients to enable identification of patients at risk for severe disease. The coronavirus disease 2019 (COVID-19) pandemic has caused an estimated 645 million hospitalizations and over 7 million deaths globally 1 . Although COVID-19 mainly affects the respiratory system, it can also cause multi-system damage 2 . While multiple studies have identified risk factors for COVID-19 respiratory severity 3-5 , the rates of non-respiratory complications remain unclear. Furthermore, most COVID-19 studies have focused on hospitalized patients 3, [6] [7] [8] , leaving a knowledge gap in the clinical features of non-hospitalized patients evaluated in acute care facilities, such as the emergency department (ED). Additionally, critical questions remain regarding patient outcomes in association with different circulating SARS-CoV-2 strains between 2019 and 2022 9 . Notably, Omicron strains have been linked to less severe disease compared to earlier strains, attributed to either lower virulence and/or immunity from vaccinations and prior infections 10 . However, it remains undetermined how specific clinical features have differed in patients with Omicron compared to earlier..
Author contributions C.M. and E.M. conceived this work. C.M., E.S., and N.B. conceived the methodology and software. C.M., E.S., and N.B. undertook the formal analysis. C.M., E.S., N.B., and J.M. obtained resources and data curation. C.M. and E.S. was responsible for visualization. E.M. obtained funding. E.M., J.R., and C.M. conducted the project administration. E.M., J.R., D.W. were responsible for supervision. C.M. and E.M. wrote the original draft. C.M., E.S., N.B., J.M., R.M., D.W., J.B., W.M.B, and E.M. reviewed and edited the final manuscript.
Competing interests
Additional information Supplementary information The online version contains supplementary material available at https://doi.org/10.1038/s43856-025-00844-4 . Correspondence and requests for materials should be addressed to Esther Melamed. Peer review information Communications Medicine thanks Violeta Diana Oprea and Chavit Tunvirachaisakul for their contribution to the peer review of this work. A peer review file is available. Reprints and permissions information is available at http://www.nature.com/reprints Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate..
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"subtitle": [],
"title": "Dissecting clinical features of COVID-19 in a cohort of 21,312 acute care patients",
"type": "journal-article",
"update-policy": "https://doi.org/10.1007/springer_crossmark_policy",
"volume": "5"
}