Risk factors associated with mortality in hospitalized patients with SARS-CoV-2 infection. A prospective, longitudinal, unicenter study in Reus, Spain

Iftimie, Simona; López‐Azcona, Ana F.; Vicente-Miralles, Manuel; Descarrega-Reina, Ramon; Hernández-Aguilera, Anna; Riu, Francesc; Simó, Josep M.; Garrido, Pedro; Joven, Jorge; Camps, Jordi; Castro, Antoni

doi:10.1371/journal.pone.0234452

Cited by 46 publications

(36 citation statements)

References 43 publications

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“…Indeed, the Spanish Ministry of Health has already highlighted, in a document updated on 2 nd October, the higher incidence of the latter in the second wave [ 27 ]. The present study did not find any differences between the frequency of concomitant diseases in the two waves, similar findings to those of our preliminary study [ 11 ]. In this respect, we differ from a previous study conducted in Japan that has reported a lower incidence of cardiovascular and cerebrovascular diseases [ 3 ], and also from a multicenter study in Italy [ 28 , 29 ] that identified impaired renal function, but not obesity, cardiovascular disease or cancer, as the major predictors of in-hospital death.…”

Section: Discussionsupporting

confidence: 93%

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First and second waves of coronavirus disease-19: A comparative study in hospitalized patients in Reus, Spain

et al. 2021

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Many countries have seen a two-wave pattern in reported cases of coronavirus disease-19 during the 2020 pandemic, with a first wave during spring followed by the current second wave in late summer and autumn. Empirical data show that the characteristics of the effects of the virus do vary between the two periods. Differences in age range and severity of the disease have been reported, although the comparative characteristics of the two waves still remain largely unknown. Those characteristics are compared in this study using data from two equal periods of 3 and a half months. The first period, between 15th March and 30th June, corresponding to the entire first wave, and the second, between 1st July and 15th October, corresponding to part of the second wave, still present at the time of writing this article. Two hundred and four patients were hospitalized during the first period, and 264 during the second period. Patients in the second wave were younger and the duration of hospitalization and case fatality rate were lower than those in the first wave. In the second wave, there were more children, and pregnant and post-partum women. The most frequent signs and symptoms in both waves were fever, dyspnea, pneumonia, and cough, and the most relevant comorbidities were cardiovascular diseases, type 2 diabetes mellitus, and chronic neurological diseases. Patients from the second wave more frequently presented renal and gastrointestinal symptoms, were more often treated with non-invasive mechanical ventilation and corticoids, and less often with invasive mechanical ventilation, conventional oxygen therapy and anticoagulants. Several differences in mortality risk factors were also observed. These results might help to understand the characteristics of the second wave and the behaviour and danger of SARS-CoV-2 in the Mediterranean area and in Western Europe. Further studies are needed to confirm our findings.

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Section: Discussionsupporting

confidence: 93%

“…We have previously reported the main epidemiological and clinical characteristics and the mortality risk factors of the first wave patients during a month and a half between March and April [ 11 ]. In the present investigation we extended the study to mid-October to cover two equal periods of three and a half months.…”

Section: Discussionmentioning

confidence: 99%

First and second waves of coronavirus disease-19: A comparative study in hospitalized patients in Reus, Spain

et al. 2021

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“…All Mortality rate in hospitalized COVID19 patients has been described with a wide range, from 13.6% [5] to 28.0% [3]. Our rate (17.5%) is intermediate and similar to other reports from Spain [6], others countries [7] and an international meta-analysis that included 58 studies with 122,191 patients [8]. Indeed, the mortality rate from those that were admitted to ICU was also very similar to international reports [9].…”

Section: General Featuressupporting

confidence: 85%

Clinical characteristics and outcomes of 1,331 patients with COVID-19: HM Spanish Cohort

Cardinal-Fernández¹,

Cuesta²,

Barberán³

et al. 2021

Rev Esp Quimioter

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Background. Spain is one of the European countries most affected by the COVID-19 pandemic. Epidemiologic studies are warranted to improve the disease understanding, evaluate the care procedure and prepare for futures waves. The aim of the study was to describe epidemiologic characteristics associated with hospitalized patients with COVID-19. Methods. This real-world, observational, multicenter and retrospective study screened all consecutive patients admitted to 8 Spanish private hospitals. Inclusion criteria: hospitalized adults (age≥18 years old) with clinically and radiologically findings compatible with COVID-19 disease from March 1st to April 5th, 2020. Exclusion criteria: patients presenting negative PCR for SARS-CoV-2 during the first 7 days from hospital admission, transfer to a hospital not belonging to the HM consortium, lack of data and discharge against medical advice in emergency departments. Results. One thousand and three hundred thirty-one COVID-19 patients (medium age 66.9 years old; males n= 841, medium length of hospital stayed 8 days, non-survivors n=233) were analyzed. One hundred and fifteen were admitted to intensive care unit (medium length of stay 16 days, invasive mechanical ventilation n= 95, septic shock n= 37 and renal replacement therapy n= 17). Age, male gender, leukocytes, platelets, oxygen saturation, chronic therapy with steroids and treatment with hydroxychloroquine/azithromycin were independent factors associated with mortality. The proportion of patients that survive and received tocilizumab and steroids were lesser and higher respectively than those that die, but their association was not significant. Conclusions. Overall crude mortality rate was 17.5%, rising up to 36.5% in the subgroup of patients that were admitted to the intensive care unit. Seven factors impact in hospital mortality. No immunomodulatory intervention were associated with in-hospital mortality.

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“…Some studies reported DM as a potent risk factor for death from COVID-19. 19 The hypothesis beyond the role of comorbidities, especially hypertension and diabetes, is that these patients usually consume angiotensin-converting enzyme (ACE) inhibitors. The target of SARS-CoV-2 is the ACE enzyme that is more highly expressed in the presence of ACE inhibitors.…”

Section: Discussionmentioning

confidence: 99%

“…23 Contrary to the theoretical effects of nicotine on overexpression of ACE2 in respiratory airways, this low prevalence of smoking in the hospitalized COVID-19 patients has been previously reported by other investigators from China, US and Spain. 19,24,25 There are multiple explanations for such findings. Due to the immunomodulatory effects of nicotine, it may protect against coronavirus infection.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcomes of 905 COVID-19 Patients Admitted to Imam Khomeini Hospital Complex in the Capital City of Tehran, Iran

et al. 2020

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Background: We studied the clinical characteristics and outcomes of 905 hospitalized coronavirus disease 2019 (COVID-19) patients admitted to Imam Khomeini Hospital Complex (IKHC), Tehran, Iran. Methods: COVID-19 patients were recruited based on clinical symptoms and patterns of computed tomography (CT) imaging between February 20 and March 19. All patients were tested for the presence of COVID-19 RNA. The Poisson regression model estimated the incidence rate ratio (IRR) for different parameters. Results: The average age (± standard deviation) was 56.9 (±15.7) years and 61.77% were male. The most common symptoms were fever (93.59%), dry cough (79.78%), and dyspnea (75.69%). Only 43.76% of patients were positive for the RT-PCR COVID-19 test. Prevalence of lymphopenia was 42.9% and more than 90% had elevated lactate dehydrogenase (LDH) or C-reactive protein (CRP). About 11% were severe cases, and 13.7% died in the hospital. The median length of stay (LOS) was 3 days. We found higher risks of mortality in patients who were older than 70 years (IRR = 11.77, 95% CI 3.63–38.18), underwent mechanical ventilation (IRR = 7.36, 95% CI 5.06–10.7), were admitted to the intensive care unit (ICU) (IRR = 5.47, 95% CI 4.00–8.38), tested positive on the COVID-19 test (IRR = 2.80, 95% CI 1.64–3.55), and reported a history of comorbidity (IRR = 1.76, 95% CI 1.07–2.89) compared to their corresponding reference groups. Hydroxychloroquine therapy was not associated with mortality in our study. Conclusion: Older age, experiencing a severe form of the disease, and having a comorbidity were the most important prognostic factors for COVID-19 infection. Larger studies are needed to perform further subgroup analyses and verify high-risk groups.

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Risk factors associated with mortality in hospitalized patients with SARS-CoV-2 infection. A prospective, longitudinal, unicenter study in Reus, Spain

Cited by 46 publications

References 43 publications

First and second waves of coronavirus disease-19: A comparative study in hospitalized patients in Reus, Spain

First and second waves of coronavirus disease-19: A comparative study in hospitalized patients in Reus, Spain

Clinical characteristics and outcomes of 1,331 patients with COVID-19: HM Spanish Cohort

Clinical Characteristics and Outcomes of 905 COVID-19 Patients Admitted to Imam Khomeini Hospital Complex in the Capital City of Tehran, Iran

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