Cause-specific death in hospitalized individuals infected with SARS-CoV-2: more than just acute respiratory failure or thromboembolic events

Cobos-Siles, Marta; Cubero-Morais, Pablo; Arroyo-Jiménez, Irene; Rey-Hernández, María; Hernández-Gómez, Laura; Vargas-Parra, Derly Judith; González-Fernández, María; Cazorla-González, Marina; Gabella-Martín, Miriam; Ruíz-Albi, Tomás; Berezo-García, José Angel; García-Cruces-Méndez, Jesús Fernando; Miramontes-González, José Pablo; Corral‐Gudino, Luis

doi:10.1007/s11739-020-02485-y

Cited by 26 publications

(34 citation statements)

References 24 publications

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“…The study design in seven studies was prospective cohort studies [8,12,[17][18][19][20]22], while the others were all retrospective cohort studies [11,13,15,16,21,[23][24][25]. There were a variety of countries, ranging from the U.S. to European countries, with 2 in the USA [11,24], five in the UK [8,13,15,19,22], 1 in Turkey [18],1 in France [16], 1 in Switzerland [23], 2 in Spain [21,25], 2 in Sweden [12,20], and 1 in the UK and Italy [17]. Of these, 13 study settings were in the hospital [8, 11-13, 15-20, 22, 23, 25] and two were in a nursing home [21,24].…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…The largest sample size was in Turkey [18], with 18,234 patients, and the smallest was in France [16], with 94 patients. Among all of the included studies, 11 studies used the clinical frailty scale (CFS) as an assessment tool for frailty [8,12,13,15,17,[19][20][21][22][23]25], one used the hospital frailty risk score [18], one used the frailty index [24], one used the palliative performance scale [11] and one used the frail nondisabled questionnaire [16]. Detailed information of adjustment variables for each study was shown in Supplemental Table 1.…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…Frailty was confirmed to be a predictor of risk with worse outcomes, such as falls, mortality and lower quality of life in different populations [7]. Several studies have presented the association between frailty and morality in patients with COVID-19, the majority of which have shown a clear association between increasing frailty and worse outcomes [8][9][10][11][12][13]. Three small and underpowered studies showed no association [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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Frailty as a predictor of mortality among patients with COVID-19: a systematic review and meta-analysis

et al. 2021

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Background A large number of studies have explored the association between frailty and mortality among COVID-19 patients, with inconsistent results. The aim of this meta-analysis was to synthesize the evidence on this issue. Methods Three databases, PubMed, Embase, and Cochrane Library, from inception to 20th January 2021 were searched for relevant literature. The Newcastle–Ottawa Scale (NOS) was used to assess quality bias, and STATA was employed to pool the effect size by a random effects model. Additionally, potential publication bias and sensitivity analyses were performed. Results Fifteen studies were included, with a total of 23,944 COVID-19 patients, for quantitative analysis. Overall, the pooled prevalence of frailty was 51% (95% CI: 44–59%). Patients with frailty who were infected with COVID-19 had an increased risk of mortality compared to those without frailty, and the pooled hazard ratio (HR) and odds ratio (OR) were 1.99 (95% CI: 1.66–2.38) and 2.48 (95% CI: 1.78–3.46), respectively. In addition, subgroup analysis based on population showed that the pooled ORs for hospitalized patients in eight studies and nursing home residents in two studies were 2.62 (95% CI: 1.68–4.07) and 2.09 (95% CI: 1.40–3.11), respectively. Subgroup analysis using the frailty assessment tool indicated that this association still existed when using the clinical frailty scale (CFS) (assessed in 6 studies, pooled OR = 2.88, 95% CI: 1.52–5.45; assessed in 5 studies, pooled HR = 1.99, 95% CI: 1.66–2.38) and other frailty tools (assessed in 4 studies, pooled OR = 1.98, 95% CI: 1.81–2.16). In addition, these significant positive associations still existed in the subgroup analysis based on study design and geographic region. Conclusion Our study indicates that frailty is an independent predictor of mortality among patients with COVID-19. Thus, frailty could be a prognostic factor for clinicians to stratify high-risk groups and remind doctors and nurses to perform early screening and corresponding interventions urgently needed to reduce mortality rates in patients infected by SARS-CoV-2.

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Section: Search Results and Study Characteristicsmentioning

confidence: 99%

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Frailty as a predictor of mortality among patients with COVID-19: a systematic review and meta-analysis

et al. 2021

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“…In this cohort the effect of RNAemia was not present when adjusting for age, a surrogate for pre COVID-19 risk of death. As the death in COVID-19 is often due to respiratory failure 21 , 25 and the burden of chronic diseases 20 , 26 , viremia mediated extra-pulmonary organ failure may not be the key mechanism of death.…”

Section: Discussionmentioning

confidence: 99%

The impact of viremia on organ failure, biomarkers and mortality in a Swedish cohort of critically ill COVID-19 patients

Järhult

Hultström

Bergqvist

et al. 2021

Sci Rep

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The spread of virus via the blood stream has been suggested to contribute to extra-pulmonary organ failure in Coronavirus disease 2019 (COVID-19). We assessed SARS-CoV-2 RNAemia (RNAemia) and the association between RNAemia and inflammation, organ failure and mortality in critically ill COVID-19 patients. We included all patients with PCR verified COVID-19 and consent admitted to ICU. SARS-CoV-2 RNA copies above 1000/ml measured by PCR in plasma was defined as RNAemia and used as surrogate for viremia. In this cohort of 92 patients 59 (64%) were invasively ventilated. RNAemia was found in 31 patients (34%). Hypertension and corticosteroid treatment was more common in patients with RNAemia. Extra-pulmonary organ failure biomarkers and the extent of organ failure were similar in patients with and without RNAemia, but the former group had more renal replacement therapy and higher mortality (26 vs 16%; 35 vs 16%, respectively, p = 0.04). RNAemia was not an independent predictor of death at 30 days after adjustment for age. SARS-CoV2 RNA copies in plasma is a common finding in ICU patients with COVID-19. Although viremia was not associated with extra pulmonary organ failure it was more common in patients who did not survive to 30 days after ICU admission.Trial registration: ClinicalTrials NCT04316884.

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“…In this cohort the effect of RNAemia was not present when adjusting for age, a surrogate for pre COVID-19 risk of death. As the death in COVID-19 is often due to respiratory failure [20,23] and the burden of chronic diseases [19,24], viremia mediated extra-pulmonary organ failure may not be the key mechanism of death.…”

Section: Relation To Other Studiesmentioning

confidence: 99%

The Impact of Viremia on Organ Failure, Biomarkers and Mortality in a Swedish Cohort of Critically ill COVID-19 Patients

Järhult

Hultström

Bergqvist

et al. 2020

Preprint

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BackgroundThe spread of virus via the blood stream has been suggested to contribute to extra pulmonary organ failure in Coronavirus disease 2019 (COVID-19). We assessed SARS-CoV-2 RNAemia (RNAemia) and the association between RNAemia and inflammation, organ failure and mortality in critically ill COVID-19 patients.MethodsIn a tertiary center we included all patients with PCR verified COVID-19 and consent admitted to ICU. SARS-CoV-2 RNA copies above 1000/ml measured by PCR in plasma was defined as RNAemia and used as surrogate for viremia.ResultsOf the 92 patients RNAemia was found in 31 (34%) and RNA in plasma was detected in 63 (58%). Hypertension and corticosteroid treatment was more common in patients with RNAemia . RNAemia levels were higher in patients with RAAS-inhibitor treatment or corticosteroid treatment than those without. Extra-pulmonary organ failure biomarkers and the extent of organ failure were similar in patients with and without RNAemia, but the former group had more renal replacement therapy and higher mortality (26 vs 16%; 35 vs 16%, respectively, p=0.04). RNAemia was not an independent predictor of death at 30 days after adjustment for age. ConclusionSARS-CoV2 RNA copies in plasma is a common finding in ICU patients with COVID-19. Although viremia was not associated with extra pulmonary organ failure it was more common in patients who did not survive to 30 days after ICU admission.Trial registrationClinicalTrials NCT04316884

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Cause-specific death in hospitalized individuals infected with SARS-CoV-2: more than just acute respiratory failure or thromboembolic events

Cited by 26 publications

References 24 publications

Frailty as a predictor of mortality among patients with COVID-19: a systematic review and meta-analysis

Frailty as a predictor of mortality among patients with COVID-19: a systematic review and meta-analysis

The impact of viremia on organ failure, biomarkers and mortality in a Swedish cohort of critically ill COVID-19 patients

The Impact of Viremia on Organ Failure, Biomarkers and Mortality in a Swedish Cohort of Critically ill COVID-19 Patients

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