Characteristics and predictors of death among 4035 consecutively hospitalized patients with COVID-19 in Spain

Abstract

Objectives To analyse the characteristics and predictors of death in hospitalized patients with coronavirus disease 2019 (COVID-19) in Spain. Methods A retrospective observational study was performed of the first consecutive patients hospitalized with COVID-19 confirmed by real-time PCR assay in 127 Spanish centres until 17 March 2020. The follow-up censoring date was 17 April 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 4035 patients, male subjects accounted for 2433 (61.0%) of 3987, the median age was 70 years and 2539 (73.8%) of 3439 had one or more comorbidity. The most common symptoms were a history of fever, cough, malaise and dyspnoea. During hospitalization, 1255 (31.5%) of 3979 patients developed acute respiratory distress syndrome, 736 (18.5%) of 3988 were admitted to intensive care units and 619 (15.5%) of 3992 underwent mechanical ventilation. Virus- or host-targeted medications included lopinavir/ritonavir (2820/4005, 70.4%), hydroxychloroquine (2618/3995, 65.5%), interferon beta (1153/3950, 29.2%), corticosteroids (1109/3965, 28.0%) and tocilizumab (373/3951, 9.4%). Overall, 1131 (28%) of 4035 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 including 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 clinicians identify patients at a higher risk of death.

Targeting Inflammation and Immunosenescence to Improve Vaccine Responses in the Elderly

“…Epidemiological data reveals that individuals over 60 years of age are disproportionately affected by SARS-CoV-2 infection experiencing the most severe forms of disease and the highest hospitalization rates (178)(179)(180). Age is a strong predictor of death among patients hospitalized with COVID-19 (181,182) and a review of epidemiological data from different countries revealed an exponential increase in case fatality rates with age, regardless of the geographic region (183). Despite being the most affected risk group, older adults are the least likely to respond to a new vaccine.…”

Clinical and Demographic Characteristics of COVID-19 Patients Admitted in a Tertiary Care Hospital in the Dominican Republic

“…An interesting finding in this study was there were not remarkable alterations in laboratory counts among all patients. Leukopenia and thrombocytopenia were the most common alterations reported in many other series 9,11,12 , and regarding inflammatory markers, elevations in CRP, ferritin a DD, have been associated with severe COVID and a higher risk of ventilation or ICU admission. Indeed, we found those who were admitted to ICU, tended to have higher ferritin and CRP (median 508 and 7.2, respectively) than those who did not require ICU (median 358 and 3.5, respectively), but the values were not as high as other reports.…”

From Skirmishes to Protracted Battles: A Bibliometric Analysis About Human Beings and Coronaviruses From 1991 to 2020

“…Based on clinical and epidemiological analyses, older age, male and preexisting comorbidity were identi ed as important risk factors for the development of severe or lethal disease in COVID-19, which were similar to SARS and MERS [22][23][24]. The ve most common comorbidities were hypertension, diabetes, cardiovascular disease, chronic obstructive pulmonary disease and tumor, while higher D-dimer, higher neutrophil/lymphocyte ratio, higher level of Creactive protein, lymphopenia, thrombocytopenia and obesity were the independent risk factors of death in COVID-19 patients [25][26][27]. According to epidemiology and large scale data, diabetes has been identi ed as an important risk factor for mortality and rates of progression to acute respiratory distress syndrome (ARDS) in hospitalized patients with COVID-19 [28,29].…”