Characteristics and predictors of death among 4,035 consecutively hospitalized patients with COVID-19 in Spain

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Objectives

We aimed to analyse the characteristics and predictors of death in hospitalized patients with COVID-19 in Spain.

Methods

Retrospective observational study of the first consecutive patients hospitalized with COVID-19 confirmed by real-time polymerase chain reaction (RT-PCR) assay in 127 Spanish centres until March 17, 2020. The follow-up censoring date was April 17, 2020. We collected demographic, clinical, laboratory, treatment, and complications data. The primary endpoint was all-cause mortality. Univariable and multivariable Cox regression analyses were performed to identify factors associated with death.

Results

Of the 4,035 patients, males accounted for 2,433/3,987 (61.0%), the median age was 70 years, and 2,539/3,439 (73.8%) had >1 comorbidity. The most common symptoms were a history of fever, cough, malaise, and dyspnoea. During hospitalization 1,255/3,979 (31.5%) patients developed acute respiratory distress syndrome, 736/3,988 (18.5%) were admitted to intensive care units, and 619/3,992 (15.5%) underwent mechanical ventilation. Viral or host-targeted medications included lopinavir/ritonavir 2,820/4,005 (70.4%), hydroxychloroquine 2,618/3,995 (65.5%), interferon-beta 1,153/3,950 (29.2%), corticosteroids 1,109/3,965 (28.0%), and tocilizumab 373/3,951 (9.4%). Overall 1,131/4,035 (28%) patients died. Mortality increased with age (85.6% occurring in older than 65 years). Seventeen factors were independently associated with an increased hazard of death, the strongest among them included advanced age, liver cirrhosis, low age-adjusted oxygen saturation, higher concentrations of C-reactive protein, and lower estimated glomerular filtration rate.

Conclusions

Our findings provide comprehensive information about characteristics and complications of severe COVID-19 and may help to identify patients at a higher risk of death.

Graphical abstract

Related collections

Most cited references 24

Record: found
Abstract: found
Article: not found

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Chaolin Huang, Yeming Wang, Xingwang Li … (2020)

Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.

0 comments Cited 22346 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

0 comments Cited 13843 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Fei Zhou, Ting Yu, Ronghui Du … (2020)

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

0 comments Cited 13789 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Juan Berenguer

Journal

Journal ID (nlm-ta): Clin Microbiol Infect

Journal ID (iso-abbrev): Clin. Microbiol. Infect

Title: Clinical Microbiology and Infection

Publisher: European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd.

ISSN (Print): 1198-743X

ISSN (Electronic): 1469-0691

Publication date PMC-release: 4 August 2020

Publication date (Electronic): 4 August 2020

Affiliations

[1 ]Hospital General Universitario Gregorio Marañón, Madrid, Spain

[2 ]Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain

[3 ]Hospital Universitario Infanta Leonor, Madrid, Spain

[4 ]Hospital Universitario Virgen Macarena, Seville, Spain

[5 ]Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain

[6 ]Department of Medicine, Universidad de Sevilla, Seville, Spain

[7 ]Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain

[8 ]Hospital Universitario de Bellvitge, Barcelona, Spain

[9 ]Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, Spain

[10 ]Universitat de Barcelona, Barcelona, Spain

[11 ]Hospital Universitario Virgen del Rocío, Seville, Spain

[12 ]Fundación SEIMC/GeSIDA, Madrid, Spain

[13 ]Hospital Universitario La Paz, IdiPAZ, Madrid, Spain

[14 ]Instituto de Investigación Hospital Universitario La Paz

Author notes

[∗ ]Corresponding author. Unidad de Enfermedades Infecciosas/VIH (4100) Hospital Gregorio Marañón, Doctor Esquerdo 46 28007 Madrid Tel.: +34 91 586 8592; fax: +34 91 426 5177 jbb4@ 123456me.com

[#]

Contributed equaly to this work.

Article

Publisher ID: S1198-743X(20)30431-6

DOI: 10.1016/j.cmi.2020.07.024

PMC ID: 7399713

PubMed ID: 32758659

SO-VID: 9c6b820e-8bc0-4c67-b221-e3c97de9270b

License:

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

History

Date received : 9 June 2020

Date revision received : 6 July 2020

Date accepted : 16 July 2020

Comments

Comment on this article

scite_

Cited by 151

See all cited by

- Version 1
- Version 1

Characteristics and predictors of death among 4,035 consecutively hospitalized patients with COVID-19 in Spain

Read this article at

Abstract

Objectives

Methods

Results

Conclusions

Graphical abstract

Related collections

Novel Coronavirus Disease COVID-19

Most cited references 24

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Clinical Characteristics of Coronavirus Disease 2019 in China

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Author and article information

Contributors

Journal

Affiliations

Author notes

Article

History

Categories

Comments

Comment on this article

Similar content 403

Cited by 151