Abstract: medRxiv preprint doi: https://doi.org/10.1101/2020.10.16.20214130; this version posted October 20, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license . CLINICAL COURSE AND OUTCOME OF COVID-19 ACUTE RESPIRATORY DISTRESS SYNDROME: DATA FROM A NATIONAL REPOSITORY Ali A. El-Solh, MD, MPH ; Umberto G. Meduri, MD ; Yolanda Lawson, MS ; Michael Carter, 1-3 4 1 PharmD , Kari A. Mergenhagen, PharmD 1 1 1 VA Western New York Healthcare System, Buffalo, NY.; Division of Pulmonary, Critical Care, and 2 Sleep Medicine, Department of Medicine; Department of Epidemiology and Environmental Health, 3 State University of New York at Buffalo School of Medicine and Biomedical Sciences and School of Public Health and Health Professions; Buffalo, NY; and Memphis VA Medical Center, Memphis, 4 Tennessee Please address any correspondence and reprint request to: Ali El Solh, MD, MPH VA Western New York Healthcare System 3495 Bailey Avenue Buffalo, NY 14215 Tel (716) 862-7392 Fax (716) 862-6526 Email: solh@buffalo.edu Summary conflict of interest statements: AES has received grant support from the Department of Veterans Affairs. UGM has received grant support from the Department of Veterans Affairs. YL declares no conflict to report. MC declares no conflict to report. KM declares no conflict to report. Funding information: None Acknowledgments: The views expressed in this manuscript do not communicate an official position of the Department of Veterans Affairs. 1 NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. medRxiv preprint doi: https://doi.org/10.1101/2020.10.16.20214130; this version posted October 20, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license . ABSTRACT Background: Mortality attributable to coronavirus disease-19 (COVID-19) 2 infection occurs mainly through the development of viral pneumonia-induced acute respiratory distress syndrome (ARDS). Research Question: The objective of the study is to delineate the clinical profile, predictors of disease progression, and 30-day mortality from ARDS using the Veterans Affairs Corporate Data Warehouse. Study Design and Methods: Analysis of a historical cohort of 7,816 hospitalized patients with confirmed COVID-19 infection between January 1, 2020, and August 1, 2020. Main outcomes were progression to ARDS and 30-day mortality from ARDS, respectively. Results: The cohort was comprised predominantly of men (94.5%) with a median age of 69 years (interquartile range [IQR] 60-74 years). 2,184 (28%) were admitted to the intensive care unit and 643 (29.4%) were diagnosed with ARDS. The median Charlson Index was 3 (IQR 1-5). Independent predictors of progression to ARDS were body mass index (BMI)≥ 40 kg/m , diabetes, lymphocyte 2 counts<700x109/L, LDH>450 U/L, ferritin >862 ng/ml, C-reactive protein >11 mg/dL, and Ddimer >1.5 ug/ml. In contrast, the use of an anticoagulant lowered the risk of developing ARDS (OR 0.66 [95% CI 0.49-0.89]. Crude 30-day mortality rate from ARDS was 41% (95% CI 38%-45%). Risk of death from ARDS was..