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Risk of COVID-19-related morbidity and mortality in young and middle-aged adults

Presented by
Dr Eva Tabernero Huguet, Hospital Universitario Cruces, Spain
ERS 2021
Contrary to the current believe that only the elderly are at high risk for COVID-19, significant morbidity was seen in younger patients. While heart disease could be considered as a baseline risk factor, hypoxemia, LDH, and lymphocyte count were predictors of poor evolution. In contrast, anosmia and chest pain were associated with a better prognosis.

At the start of the COVID-19 pandemic it was generally thought that the disease was mostly affecting older adults, and that young people were more likely to have milder cases. However, at the moment, young and middle-aged adults are the largest group of COVID-19 patients. Dr Eva Tabernero Huguet (Hospital Universitario Cruces, Spain) explained that it is possible for the young to develop severe disease [1,2]. Therefore, Dr Tabernero Huguet and colleagues investigated clinical aspects in adults hospitalised for COVID-19, and identified risk factors for poor evolution.

In a multicentre, prospective study, 513 hospitalised COVID-19 patients with pneumonia aged 18–65 years were included from March 2020 to May 2020. The primary outcome was a composite of poor evolution: admission to intensive care unit (ICU) and/or use of non-invasive ventilation, new use of continuous positive airway pressure (CPAP), high flow nasal cannula oxygen, and death.

Of the included patients, 102 (19.8%) had poor evolution. The mortality rate was 3.9% (n=20), indicating that COVID-19 has significant morbidity in young and middle-aged adults. In addition, heart disease showed to be a risk factor (OR 5.41, 95% CI 1.72–16.60, P=0.003), while anosmia and chest pain had protective effects (OR 0.34, 95% CI 0.13–0.76, P=0.014; OR 0.19, 95% CI 0.03–0.74, P=0.033, respectively). Hypoxemia, LDH, and lymphocyte count were predictors of poor evolution (OR 0.72, 95% CI 0.65–0.80, P<0.001; OR 1.04, 95% CI 1.01–1.07, P=0.006; OR 0.46, 95% CI 0.24–0.87, P=0.017, respectively).

In conclusion, COVID-19 has a significant morbidity in younger and middle-aged patients with heart disease as the most important risk factor. Anosmia and chest pain showed to be protective.

  1. Taberno Huguet E, et al. COVID-19 in young and middle aged adults. Predictors of poor evolution and clinical difference. Abstract 88. ERS 2021, 5–8 September.
  2. Taberno Huguet E, et al. Infection 2021:1–11.


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