Medical Student Icahn School of Medicine at Mount Sinai New York City, New York, United States
Introduction: Thoracic vertebral column deformities can reduce compliance of the chest wall leading to respiratory complications. The first strain of SARS-CoV-2 (L-variant) caused critical respiratory illness in a number of vulnerable patients. This study investigates the association between scoliosis and severity of disease course from SARS-CoV-2 (COVID).
Methods: This single-center, retrospective study analyzed clinical data of 137 subjects admitted to the hospital for COVID between March 2020 to June 2021 with a positive COVID PCR result and an ICD-10 code for scoliosis (M41.0–M41.9). Subjects with COVID vaccination or CPT codes for surgical correction of scoliosis (22842–22847) were excluded. Degree of coronal plane scoliosis on CT and X-ray was confirmed by two independent measurers and grouped into no scoliosis (Cobb angle < 10), mild (10-24), moderate (25-39), and severe scoliosis (>40) cohorts. Baseline characteristics were compared between cohorts and a multivariable logistic regression controlling for age, gender, and BMI examined the significance of scoliosis as an independent risk factor for ARDS, ICU admission, mechanical ventilation, and mortality.
Results: The no scoliosis (n=58), mild (n=12), moderate (n=38), and severe scoliosis (n=29) cohorts only differed significantly in BMI (p=0.02), with the no scoliosis group having the highest average BMI (28.8 kg/m2). The cohorts did not differ in age, gender, smoking status, diabetes, hypertension, or other cardiopulmonary and autoimmune diseases. None of the subjects developed ARDS. The percentage of patients who had ICU admissions (no scoliosis=13.8%, mild=16.7%, moderate=13.6%, severe=13.8%; p=0.99), mechanical ventilation (no scoliosis=5.2%, mild=8.3%, moderate=7.9%, severe=6.9%, p=0.95), or expired (no scoliosis=18.3%, mild=8.3%, moderate=13.2%, severe=10.3%; p=0.53) did not significantly differ between the cohorts. The mild, moderate, and severe scoliosis cohorts did not have a significantly higher likelihood of ICU admissions (1.2 [0.9-1.6] p=0.06, 0.9 [0.5-1.7] p=0.68, 0.9 [0.7-1.2] p=0.41), mechanical ventilation (2.1 [0.2-2.5] p=0.57, 1.3 [0.2-8.2] p=0.79, 1.8 (0.2-1.5) p=0.57), or death (0.4 [0.03-3.2] p=0.39, 0.4 [0.1-1.6] p=0.21, 0.5 (0.1-2.1) p=0.31) than the no scoliosis cohort.
Conclusion : Scoliosis is not an independent risk factor for critical illness in COVID patients. There were no trends to indicate a consistent effect of the degree of scoliosis on the likelihood of an adverse outcome.
