1. Mortality risk assessment in Spain and Italy, insights of the HOPE COVID-19 registry.
- Author
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Núñez-Gil IJ, Fernández-Pérez C, Estrada V, Becerra-Muñoz VM, El-Battrawy I, Uribarri A, Fernández-Rozas I, Feltes G, Viana-Llamas MC, Trabattoni D, López-País J, Pepe M, Romero R, Castro-Mejía AF, Cerrato E, Astrua TC, D'Ascenzo F, Fabregat-Andres O, Moreu J, Guerra F, Signes-Costa J, Marín F, Buosenso D, Bardají A, Raposeiras-Roubín S, Elola J, Molino Á, Gómez-Doblas JJ, Abumayyaleh M, Aparisi Á, Molina M, Guerri A, Arroyo-Espliguero R, Assanelli E, Mapelli M, García-Acuña JM, Brindicci G, Manzone E, Ortega-Armas ME, Bianco M, Trung CP, Núñez MJ, Castellanos-Lluch C, García-Vázquez E, Cabello-Clotet N, Jamhour-Chelh K, Tellez MJ, Fernández-Ortiz A, and Macaya C
- Subjects
- Aged, COVID-19 complications, COVID-19 therapy, Female, Hospitalization, Humans, Italy, Male, Middle Aged, Propensity Score, Registries, Risk Assessment, Risk Factors, Spain, Survival Rate, COVID-19 mortality
- Abstract
Recently the coronavirus disease (COVID-19) outbreak has been declared a pandemic. Despite its aggressive extension and significant morbidity and mortality, risk factors are poorly characterized outside China. We designed a registry, HOPE COVID-19 (NCT04334291), assessing data of 1021 patients discharged (dead or alive) after COVID-19, from 23 hospitals in 4 countries, between 8 February and 1 April. The primary end-point was all-cause mortality aiming to produce a mortality risk score calculator. The median age was 68 years (IQR 52-79), and 59.5% were male. Most frequent comorbidities were hypertension (46.8%) and dyslipidemia (35.8%). A relevant heart or lung disease were depicted in 20%. And renal, neurological, or oncological disease, respectively, were detected in nearly 10%. Most common symptoms were fever, cough, and dyspnea at admission. 311 patients died and 710 were discharged alive. In the death-multivariate analysis, raised as most relevant: age, hypertension, obesity, renal insufficiency, any immunosuppressive disease, 02 saturation < 92% and an elevated C reactive protein (AUC = 0.87; Hosmer-Lemeshow test, p > 0.999; bootstrap-optimist: 0.0018). We provide a simple clinical score to estimate probability of death, dividing patients in four grades (I-IV) of increasing probability. Hydroxychloroquine (79.2%) and antivirals (67.6%) were the specific drugs most commonly used. After a propensity score adjustment, the results suggested a slight improvement in mortality rates (adjusted-OR
hydroxychloroquine 0.88; 95% CI 0.81-0.91, p = 0.005; adjusted-ORantiviral 0.94; 95% CI 0.87-1.01; p = 0.115). COVID-19 produces important mortality, mostly in patients with comorbidities with respiratory symptoms. Hydroxychloroquine could be associated with survival benefit, but this data need to be confirmed with further trials. Trial Registration: NCT04334291/EUPAS34399.- Published
- 2021
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