Comorbidity and prognostic factors on admission in a COVID-19 cohort of a general hospital.

ANTECEDENTS AND OBJECTIVE: To describe clinical features, comorbidity, and prognostic factors associated with in-hospital mortality in a cohort of COVID-19 admitted to a general hospital. MATERIAL AND METHODS: Retrospective cohort study of patients with COVID-19 admitted from 26th February 2020, who had been discharged or died up to 29th April 2020. A descriptive study and an analysis of factors associated with intrahospital mortality were performed. RESULTS: Out of the 101 patients, 96 were analysed. Of these, 79 (82%) recovered and were discharged, and 17 (18%) died in the hospital. Diagnosis of COVID-19 was confirmed by polymerase chain reaction to SARS-CoV2 in 92 (92.5%). The mean age was 63 years, and 66% were male. The most frequent comorbidities were hypertension (40%), diabetes mellitus (16%) y cardiopathy (14%). Patients who died were older (mean 77 vs 60 years), had higher prevalence of hypertension (71% vs 33%), and cardiopathy (47% vs 6%), and higher levels of lactate dehydrogenase (LDH) and reactive C protein (mean 662 vs 335 UI/L, and 193 vs 121mg/L respectively) on admission. In a multivariant analysis the variables significantly associated to mortality were the presence of cardiopathy (CI 95% OR 2,58-67,07), levels of LDH≥345 IU/L (CI 95% OR 1,52-46,00), and age≥65 years (CI 95% OR 1,23-44,62). CONCLUSIONS: The presence of cardiopathy, levels of LDH≥345 IU/L and age≥65 years, are associated with a higher risk of death during hospital stay for COVID-19. This model should be validated in prospective cohorts.

Comorbilidad y factores pronósticos al ingreso en una cohorte COVID-19 de un hospital general / Comorbidity and prognostic factors on admission in a COVID-19 cohort of a general hospital

Antecedentes y objetivo Describir el perfil clínico, la comorbilidad y los factores pronósticos de mortalidad intrahospitalaria en una cohorte COVID-19 de un hospital general. Material y métodos Estudio de cohortes retrospectivo de pacientes con COVID-19 ingresados desde el 26 de febrero, y dados de alta o fallecidos hasta el 29 de abril de 2020; estudio descriptivo y análisis de factores asociados a la mortalidad intrahospitalaria. Resultados De los pacientes ingresados (N=101), se analizaron 96: 79 (82%) dados de alta por curación y 17 (18%) fallecidos. En 92 casos (92,5%) se confirmó COVID-19 por reacción en cadena de la polimerasa a SARS-CoV-2. La edad media fue de 63 años, y el 66% eran varones. La comorbilidad previa más frecuente fue hipertensión arterial (40%), diabetes mellitus (16%) y cardiopatía (14%). Los pacientes que fallecieron tenían significativamente más edad (media 77 vs. 60 años), hipertensión arterial (71% vs. 33%), cardiopatía previa (47% vs. 6%), y niveles más elevados de lactato deshidrogenasa (LDH) (662 vs. 335UI/L) y proteína C reactiva (PCR) (193 vs. 121mg/L) al ingreso. En el análisis multivariante, se asociaron significativamente a mayor riesgo de muerte la presencia de cardiopatía (IC 95% OR 2,58-67,07), los niveles de LDH≥345UI/L (IC 95% OR 1,52-46,00), y la edad≥65 años (IC 95% OR 1,23-44,62). Conclusiones El antecedente de cardiopatía, los niveles de LDH≥345UI/L al ingreso y una edad≥65 años se asocian a una mayor mortalidad durante el ingreso por COVID-19. Hay que validar este modelo pronóstico en cohortes prospectivas (AU)

Antecedents and objective To describe clinical features, comorbidity, and prognostic factors associated with in-hospital mortality in a cohort of COVID-19 admitted to a general hospital. Material and methods Retrospective cohort study of patients with COVID-19 admitted from 26th February, who had been discharged or died, up to 29th April, 2020. A descriptive study and an analysis of factors associated with intrahospital mortality were performed. Results Out of the 101 patients, 96 were analysed. Of these, 79 (82%) recovered and were discharged, and 17 (18%) died in the hospital. Diagnosis of COVID-19 was confirmed by polymerase chain reaction to SARS-CoV-2 in 92 (92.5%). The mean age was 63 years, and 66% were male. The most frequent comorbidities were hypertension (40%), diabetes mellitus (16%) and cardiopathy (14%). Patients who died were older (mean 77 vs 60 years), had higher prevalence of hypertension (71% vs 33%), and cardiopathy (47% vs 6%), and higher levels of lactate dehydrogenase (LDH) and reactive C protein (mean 662 vs 335UI/L, and 193 vs 121mg/L respectively) on admission. In a multivariant analysis the variables significantly associated to mortality were the presence of cardiopathy (CI 95% OR 2,58-67,07), levels of LDH≥345IU/L (CI 95% OR 1,52-46,00), and age≥65 years (CI 95% OR 1,23-44,62). Conclusions The presence of cardiopathy, levels of LDH≥345IU/L and age ≥65 years are associated with a higher risk of death during hospital stay for COVID-19. This model should be validated in prospective cohorts (AU)

Comorbidity and prognostic factors on admission in a COVID-19 cohort of a general hospital. / Comorbilidad y factores pronósticos al ingreso en una cohorte COVID-19 de un hospital general.

ANTECEDENTS AND OBJECTIVE: To describe clinical features, comorbidity, and prognostic factors associated with in-hospital mortality in a cohort of COVID-19 admitted to a general hospital. MATERIAL AND METHODS: Retrospective cohort study of patients with COVID-19 admitted from 26th February, who had been discharged or died, up to 29th April, 2020. A descriptive study and an analysis of factors associated with intrahospital mortality were performed. RESULTS: Out of the 101 patients, 96 were analysed. Of these, 79 (82%) recovered and were discharged, and 17 (18%) died in the hospital. Diagnosis of COVID-19 was confirmed by polymerase chain reaction to SARS-CoV-2 in 92 (92.5%). The mean age was 63 years, and 66% were male. The most frequent comorbidities were hypertension (40%), diabetes mellitus (16%) and cardiopathy (14%). Patients who died were older (mean 77 vs 60 years), had higher prevalence of hypertension (71% vs 33%), and cardiopathy (47% vs 6%), and higher levels of lactate dehydrogenase (LDH) and reactive C protein (mean 662 vs 335UI/L, and 193 vs 121mg/L respectively) on admission. In a multivariant analysis the variables significantly associated to mortality were the presence of cardiopathy (CI 95% OR 2,58-67,07), levels of LDH≥345IU/L (CI 95% OR 1,52-46,00), and age≥65 years (CI 95% OR 1,23-44,62). CONCLUSIONS: The presence of cardiopathy, levels of LDH≥345IU/L and age ≥65 years are associated with a higher risk of death during hospital stay for COVID-19. This model should be validated in prospective cohorts.

[Analysis of admissions for chronic obstructive pulmonary disease in Andalusia in 2000]. / Análisis de los ingresos por enfermedad pulmonar obstructiva crónica en Andalucía, año 2000.

OBJECTIVE: To analyze the impact of admissions for chronic obstructive pulmonary disease (COPD) in Andalusia during 2000. METHODS: All patients with DRG codes 088 and 541, which would receive ICD-9 codes 491, 492, 493.2, 494 and 496 in the cause of admission field, were extracted from the Minimum Basic Data Set for Andalusia. We compiled descriptive statistics from these data, calculated the cost per day of hospitalization for our own hospital, and then extrapolated to estimate the cost for Andalusia. RESULTS: COPD exacerbations generated 10,386 admissions in 2000, leading to 117,011 days of hospitalization. Eighty-three percent of the patients were men and the mean age was 70 12 years. The average hospital stay was 11 10 days. Huelva was the province with the shortest hospital stay (9 days). Mortality was 6.7%. The minimum expenditure generated was E 27 million, not counting the cost of intensive care unit admissions. CONCLUSIONS: Admissions due to COPD have great impact on the Andalusian health care system. Further studies are needed to evaluate alternatives to hospitalization.

Análisis de los ingresos por enfermedad pulmonar obstructiva crónica en Andalucía, año 2000 / Analysis of admissions for chronic obstructive pulmonary disease in Andalusia in 2000

OBJETIVO: Analizar el impacto que han tenido los ingresos por enfermedad pulmonar obstructiva crónica (EPOC) en Andalucía durante el año 2000. MÉTODOS: Se seleccionaron del Conjunto Mínimo Básico de Datos de Andalucía 2000 todos los pacientes con el código GRD 088 y aquellos con GRD 541 que tuvieran como causa de ingreso algunos de estos códigos CIE-9: 491, 492, 493.2, 494 y 496. Con estos datos se realizó un estudio descriptivo. Posteriormente, se realizó el cálculo del coste de una estancia en nuestro centro y se extrapoló al resto de Andalucía, calculando el coste mínimo generado. RESULTADOS: Durante el año 2000 hubo 10.386 ingresos por reagudización de EPOC, lo que generó 117.011 estancias. El 83 per cent de los ingresos fueron varones. La edad media fue de 70 ñ 12 años. La estancia media fue de 11 ñ 10 días. La provincia con la estancia menor fue Huelva con 9 días. La mortalidad fue del 6,7 per cent. El gasto sanitario mínimo generado fue de 27 millones de euros (4.500 millones de pesetas), sin contar con las estancias de UCI. CONCLUSIONES: Los ingresos por EPOC generan un gran impacto asistencial y económico en la sanidad andaluza. Son necesarios estudios que valoren otras alternativas al ingreso (AU)

Clinical aspects and prognostic factors in elderly patients hospitalised for community-acquired pneumonia.

The aims of this study were to determine the clinical and epidemiological characteristics of community-acquired pneumonia (CAP) in the elderly, to identify prognostic factors, and to establish a predictive model for mortality of CAP. Elderly patients with CAP admitted to "Carlos Haya" Hospital in Malaga, Spain, over a 36-month period were included. Multivariate analysis was used to identify prognostic factors from variables present on admission, from which a discrimination rule was constructed to predict mortality. A total of 343 patients were included, with the annual incidence ranging from 16.3 to 28.1 per 1,000 admissions. Most (82.5%) had some kind of accompanying or underlying disease. Clinical presentation was atypical in 87 (25.4%). Microbiological diagnosis was made in 24.5%. There were 49 (14.3%) deaths. The prognostic factors in multivariate analysis on admission were bilateral radiographic infiltrate, a blood urea nitrogen level of more than 7 mmol/l, absence of fever, a respiratory rate of 30/min or more, confusion, and shock. The discriminating rule to predict mortality comprising three or more of these factors was 91.2% specific, with a negative predictive value of 93.4% and an overall accuracy of 86.9%. CAP in the elderly is associated with a high degree of mortality. The discriminating rule incorporating the prognostic factors identified is a powerful predictor of mortality.