Development of a predictive prognostic rule for early assessment of COVID-19 patients in primary care settings

Abstract

OBJETIVO: Investigar posibles factores pronósticos y escalas predictivas simples en adultos mayores con COVID-19. DISEÑO: Cohorte retrospectiva de base comunitaria. EMPLAZAMIENTO: Atención Primaria Tarragona. PARTICIPANTES: 282 adultos ≥50 años no institucionalizados con COVID-19 confirmada (hospitalizada o ambulatoria) ocurrida durante marzo-junio 2020. MEDICIONES PRINCIPALES: la relación entre covariables basales (edad, sexo, condiciones/comorbilidades preexistentes y sintomatología inicial) y el riesgo de mala evolución (ingreso en UCI o muerte) se analizó mediante modelos de regresión logística. RESULTADOS: De los 282 COVID-19 casos (edad media 65.9 años; 49.6% varones), 154 (54.6%) fueron hospitalizados (30 ingresados en UCI) y 45 (16%) fallecieron. En total, 64 (22.7%) requirieron UCI o fallecieron. La mediana de tiempo de seguimiento durante el curso clínico fue 31 días (rango: 30-150) en los pacientes que sobrevivieron y 14 días (rango: 1-81) en fallecidos. En análisis crudos, la edad/años, sexo varón, algunas comorbilidades (enfermedad renal, respiratoria o cardiaca, diabetes e hipertensión) y síntomas (confusión/letargia, disnea) se asociaron con mayor riesgo de UCI/muerte, mientras que otros síntomas (rinorrea, mialgias, cefalea, ageusia/anosmia) se asociaron con menor riesgo. En análisis multivariable solo la edad/años (OR: 1.04; IC 95%: 1.01-1.07; p=0.004), confusión/letargia (OR: 5.33; IC 95%: 1.54-18.48; p=0.008), disnea (OR: 5.41; IC 95%: 2.74-10.69; p<0.001) y mialgias (OR: 0.30; IC 95%: 0.10-0.93; p=0.038) permanecieron significativamente asociadas con mayor/menor riesgo. Una posible escala pronóstica CD65-M (acrónimo de las 4 variables mencionadas) mostró buena correlación con el riesgo de UCI/muerte (área bajo curva ROC: 0.828; IC 95%: 0.774-0.882). CONCLUSIÓN: La evolución clínica en pacientes COVID-19 es inicialmente impredecible, pero la aplicación de escalas pronósticas simples como la propuesta CD65-M (pendiente validación externa) podría ser útil para una orientación/valoración pronóstica de estos pacientes en atención primaria.

Analysis of Risk Factors for In-Hospital Death Due to COVID-19 in Patients Hospitalised at the Temporary Hospital Located at the National Stadium in Warsaw: A Retrospective Analysis

“…A detailed analysis of the clinical characteristics of the patients identified several factors associated with the COVID-19 prognosis. We found an association between older age and increased mortality from COVID-19, which was consistent with the findings from studies by, for example, Yang et al (2020), Zhou et al (2020), Grasselli et al (2020), Baena-Díez et al (2020), Vila-Corcoles et al (2021), Wang and Wang (2021) and Alharthy et al (2021) [ 18 , 40 , 41 , 42 , 43 , 44 , 45 ].…”

“…As COVID-19 poses a global threat to public health, research investigating the characteristics of patients infected with the new pathogen as well as the risk factors for infection, severe disease and death from COVID-19 occupies an important place among studies concerning the SARS-CoV-2 pandemic. Such research provides necessary information used to develop strategies for the appropriate treatment of patients [ 37 , 38 , 39 , 40 , 41 ]. Therefore, the aim of this study was to identify the factors affecting the mortality of COVID-19 patients at a temporary hospital located at the National Stadium in Warsaw (Poland).…”

“…Research on COVID-19 places considerable focus on identifying and analysing the risk factors for death from COVID-19 related to comorbidities [ 41 , 42 , 50 , 51 , 52 , 53 ] and symptoms [ 41 , 52 , 54 ], which was also the subject of the present study. Fang et al found that chronic kidney disease significantly contributed to the death of COVID-19 patients [ 50 ].…”

A retrospective cohort study of 238,000 COVID-19 hospitalizations and deaths in Brazil

“…However, some factors are associated with a higher hospitalization rate, such as increased C-reactive protein level with high sensitivity, lymphocytopenia, and high myocardial rates 16 . Viral and genetic factors (comorbidities) should also be considered in the evolution of COVID-19 prognosis, without discarding the possibility that socioeconomic deprivation may be associated with worse outcomes 17 . In Barcelona, Spain, an ecological study found that the incidence of this disease is inversely proportional to the socioeconomic gradient 17 .…”

“…Viral and genetic factors (comorbidities) should also be considered in the evolution of COVID-19 prognosis, without discarding the possibility that socioeconomic deprivation may be associated with worse outcomes 17 . In Barcelona, Spain, an ecological study found that the incidence of this disease is inversely proportional to the socioeconomic gradient 17 .…”