Comorbilidades asociadas a mortalidad o enfermedad severa en pacientes hospitalizados con COVID-19 / Comorbidities associated with mortality or severe disease in hospitalized patients with COVID-19

Objetivo: Conocer las comorbilidades de los pacientes hospitalizados con COVID-19 e identificar cuales se asocian a mayor severidad y/o mortalidad intrahospitalaria. Métodos: Estudio de cohortes retrospectivo en el que se incluyeron todos los pacientes ingresados con COVID-19 desde 1 de marzo del 2020 hasta el 31 mayo de 2020. Se realizó un análisis descriptivo de las comorbilidades y se vio cuales se asocian a una mayor mortalidad intrahospitalaria y/o severidad de la enfermedad mediante un modelo de regresión logística binaria. Resultados: Un total de 336 pacientes fueron incluidos en el estudio de los cuales 52 (15,5%) fallecieron durante el ingreso. Un 58% eran varones, la edad media fue 66 años y el índice Charlson fue de 1. En el análisis multivariante se identificaron como comorbilidades asociadas a mortalidad la edad > 65 años (OR 2,65; p 0,021), el sexo masculino (OR 3,26; p 0,004), la enfermedad cardiovascular ateroesclerótica (OR 2,11; p<0,040) y no ateroesclerótica (OR 6,40; p<0,001) y la neoplasia (OR 5,09; p<0,001). Se asociaron a mayor severidad de la COVID-19 la edad> 65 años (OR 1,87; p 0,033), el sexo masculino (OR 2,86; p <0,001), la obesidad (OR 1,82; p 0,034) y SAOS (OR 5,26; p 0,006). Conclusiones: La enfermedad cardiovascular previa y la neoplasia se asocian a mortalidad intrahospitalaria mientras que la obesidad y el SAOS se asocian a severidad de la enfermedad en pacientes hospitalizados con COVID-19. La edad >65 años y el sexo masculino se asocian a una mayor severidad y mortalidad intrahospitalaria. (AU)

Objective: To evaluate the comorbidities in hospitalized patients with COVID-19 and identify which ones are associated with severe COVID-19 disease and/or in-hospital mortality. Methods: A retrospective cohort study was performed. All patients admitted with confirmed COVID-19 from March 1, 2020 to May 31, 2020 were included. A descriptive analysis of comorbidities was made. We evaluated what comorbidities are associated with in-hospital mortality and/or severe COVID-19 disease using a binary logistic regression model. Results: A total of 336 patients were included in the study: 52 (15,5%) died during hospitalization. Mean age was 66 + 14 years, 58% were men and the Charlson Comorbidity Index was 1. In multivariate analysis, age >65 years (HR 2,65; p 0,021), male sex (HR 3,26; p 0,004), atherosclerotic cardiovascular disease (HR 2,11; p 0,040), non-atherosclerotic cardiovascular disease (HR 6,40; p<0,001) and malignancy (HR 5,09; p< 0,001), were identified as comorbidities associated with in hospital-mortality. Age >65 years (HR 1,87; p 0,033), male sex (HR 2,86; p<0,001), obesity (HR 1,82; p 0,034) and obstructive sleep apnea (HR 5,26; p 0,006) were associated with severe COVID-19 disease. Conclusions: Previous cardiovascular disease and malignancy are risk factors of in-hospital mortality while obesity and obstructive sleep apnea are associated with severe COVID-19 disease in hospitalized patients. Age >65 years and male sex are associated with both. (AU)

Development and validation of a clinical score to estimate progression to severe or critical state in COVID-19 pneumonia hospitalized patients.

The prognosis of a patient with COVID-19 pneumonia is uncertain. Our objective was to establish a predictive model of disease progression to facilitate early decision-making. A retrospective study was performed of patients admitted with COVID-19 pneumonia, classified as severe (admission to the intensive care unit, mechanic invasive ventilation, or death) or non-severe. A predictive model based on clinical, laboratory, and radiological parameters was built. The probability of progression to severe disease was estimated by logistic regression analysis. Calibration and discrimination (receiver operating characteristics curves and AUC) were assessed to determine model performance. During the study period 1152 patients presented with SARS-CoV-2 infection, of whom 229 (19.9%) were admitted for pneumonia. During hospitalization, 51 (22.3%) progressed to severe disease, of whom 26 required ICU care (11.4); 17 (7.4%) underwent invasive mechanical ventilation, and 32 (14%) died of any cause. Five predictors determined within 24 h of admission were identified: Diabetes, Age, Lymphocyte count, SaO2, and pH (DALSH score). The prediction model showed a good clinical performance, including discrimination (AUC 0.87 CI 0.81, 0.92) and calibration (Brier score = 0.11). In total, 0%, 12%, and 50% of patients with severity risk scores ≤ 5%, 6-25%, and > 25% exhibited disease progression, respectively. A risk score based on five factors predicts disease progression and facilitates early decision-making according to prognosis.