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ORIGINAL RESEARCH article

Front. Med.

Sec. Intensive Care Medicine and Anesthesiology

Volume 12 - 2025 | doi: 10.3389/fmed.2025.1602129

This article is part of the Research TopicOutcome of Sepsis and Prediction of Mortality Risk - Volume IIView all 4 articles

The association between Vital Signs at Hospital Admission and Adverse Outcomes in Patients with COVID-19: A Retrospective Cohort Study.

Provisionally accepted
Niklas  LidströmerNiklas Lidströmer1,2,3Marat  MurzabekovMarat Murzabekov1,2,3Niklas  BorgNiklas Borg1,2,3Michael  RunoldMichael Runold4Eric  HerleniusEric Herlenius1,2,3*Susanne  RautiainenSusanne Rautiainen2,3,4,5
  • 1Department of Women's and Children's Health, CMM, Karolinska Institutet (KI), Solna, Stockholm, Sweden
  • 2Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Stockholm, Sweden
  • 3Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Stockholm, Sweden
  • 4Department of Medicine, Karolinska Institutet (KI), Solna, Stockholm, Sweden
  • 5Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden

The final, formatted version of the article will be published soon.

Background: Vital sign measurements at hospital admission are used to identify patients at risk for adverse events. However, how vital signs at admission are related to adverse outcomes among COVID-19 patients is not fully characterized.Objectives: To characterize vital signs at admission and their associations with intensive care unit/intermediate care unit (ICU/IMCU) admission and in-hospital mortality in adult patients with COVID-19.Methods: This retrospective cohort study included 2,826 adults admitted with COVID-19 to Karolinska University Hospitals, Stockholm, Sweden, between 2 March 2020 and 1 June 2021. The Cox proportional hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between vital signs at admission and ICU/IMCU admission and in-hospital mortality.Results: The median age was 62.2 years, and 62.1% were men. Each unit increase in respiratory rate (HR 1.03, 95% CI 1.02–1.05), heart rate (HR 1.01, 95% CI 1.00–1.02), temperature (HR 1.21, 95% CI 1.11–1.32), and each unit decrease in saturation (HR 1.05, 95% CI 1.04–1.06) were associated with ICU/IMCU admission. Respiratory rate (HR 1.04, 95% CI 1.02–1.07) and saturation (HR 1.04, 95% CI 1.02–1.06) were also associated with in-hospital mortality. These associations persisted across pandemic waves and subgroups of age, gender, medication use, and oxygen support.Conclusion: Respiratory rate and lower saturation at admission were associated with increased ICU/IMCU admission and in-hospital mortality. Our findings suggest that greater emphasis on respiratory rate and oxygen saturation in early warning scores - such as the revised Sequential Organ Failure Assessment (SOFA) score and other sepsis prediction models, to improve risk stratification of viral sepsis, especially in patients with COVID-19.

Keywords: COVID-19, Vital Signs, Respiratory Rate, Saturation, Temperature can predict Deleted: understood Deleted: e Deleted: s Deleted: support incorporating

Received: 28 Mar 2025; Accepted: 03 Jun 2025.

Copyright: © 2025 Lidströmer, Murzabekov, Borg, Runold, Herlenius and Rautiainen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Eric Herlenius, Department of Women's and Children's Health, CMM, Karolinska Institutet (KI), Solna, 171 77, Stockholm, Sweden

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