A Nationwide Analysis of the Impact of Vasculopathies on COVID-19 Hospitalization Outcomes

Abstract Background and Aims: The study investigated the short-term outcomes of COVID-19 in conjunction with vasculopathies, including vasculitides, for inpatient hospitalization encounters. Methods: The 2020 National Inpatient Sample was used to identify hospitalizations presenting with a primary admitting diagnosis of COVID-19 with and without a secondary diagnosis of vasculopathy, including vasculitides. The primary outcomes of interest were mortality and mechanical ventilation use in COVID-19 hospitalizations with and without vasculopathies. Secondary outcomes were in-hospital length of stay and hospital charges. Results: A total of 1,050,040 weighted hospitalizations were included in this study with a principal diagnosis of COVID-19. Among this population, 1,440 weighted hospitalizations had a concurrent diagnosis of vasculopathy, and 1,048,600 weighted hospitalizations had COVID-19 without a concurrent diagnosis of vasculopathy. Positive associations regarding mortality were found in Kawasaki disease (aOR 7.9115, 95% CI [1.4612 - 42.8362]; p = 0.0164), microscopic polyangiitis (aOR 3.5589, 95% CI [1.1356 - 11.1529]; p = 0.0295), thrombotic microangiopathy (aOR 3.9213, 95% CI [2.1959 - 7.0027]; p = 4.00E-06), other specified necrotizing vasculitis (aOR 20.9423, 95% CI [4.5566 - 96.2510]; p = 9.44E-05), unspecified necrotizing vasculopathy (aOR 16.6108 , 95% CI [2.0106 - 137.2299]; p = 0.0091), and cryoglobulinemia (aOR 8.5863 , 95% CI [2.2848 - 32.2669]; p = 0.0015). Positive associations regarding mechanical ventilation were found in microscopic polyangiitis (aOR 7.4010, 95% CI [2.9088 - 18.8311]; p = 2.72E-05), thrombotic microangiopathy (aOR 3.5112, 95% CI [2.1457 - 5.7459]; p = 6.06E-07), other specified necrotizing vasculitis (aOR 34.9851, 95% CI [6.5912 - 185.6968]; p = 3.06E-05), and unspecified necrotizing vasculopathy (aOR 18.3357, 95% CI [2.2010 - 152.7467]; p = 0.0072). Additionally, the relative difference in length of stay was 53% higher in COVID-19 hospitalizations with vasculopathies than those without (RD 1.53, 95% CI [1.35 - 1.74]; p = 6.18E-11); similarly, the relative difference in total hospital charges was 97% higher (RD 1.97, 95% CI [1.58 - 2.46]; p = 2.18E-09). Conclusion: This study demonstrates significantly higher odds of morbidity and mortality among COVID-19 hospitalizations with vasculopathies substantiating previous claims in the literature.