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Vol. 57. Issue S2.
COVID-19
Pages 34-41 (April 2021)
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Vol. 57. Issue S2.
COVID-19
Pages 34-41 (April 2021)
Original Article
DOI: 10.1016/j.arbres.2021.02.021
Characteristics and Risk Factors Associated With Mortality in a Multicenter Spanish Cohort of Patients With COVID-19 Pneumonia
Características y factores de riesgo asociados a mortalidad en una cohorte multicéntrica española de pacientes con neumonía por COVID-19
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José Ramón Muñoz-Rodrígueza,b,1, Francisco Javier Gómez-Romeroa,b,1, José Manuel Pérez-Ortiza,b, Pilar López-Juáreza, Juan Luis Santiagoa,c, Leticia Serrano-Oviedoa,
Corresponding author
lserranoo@sescam.jccm.es

Corresponding author.
, Francisco Javier Redondo-Calvoa,b,d,e, the COVID-19 SESCAM Network
a Translational Research Unit, University General Hospital of Ciudad Real, Servicio de Salud de Castilla-La Mancha (SESCAM), Spain
b School of Medicine at Ciudad Real, University of Castilla La Mancha, Spain
c Department of Dermatology, University General Hospital of Ciudad Real, Spain
d Department of Anaesthesiology and Critical Care Medicine, University General Hospital of Ciudad Real, Spain
e Head of Research, University General Hospital of Ciudad Real, Spain
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Table 1. Patient characteristics at baseline.
Table 2. Bivariable and multivariable-adjusted risk model for exitus (non-survivors).
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Abstract
Introduction

Spain is one of the countries with the highest number of COVID-19 patients. Unfortunately, few data for regions are available.

Objectives

This study aimed to describe the characteristics and independent risk factors associated with COVID-19 mortality in Castilla-La Mancha, Spain.

Methods

Cohort and multicenter study in all 14 public hospitals of the Castilla-La Mancha Health Service. Baseline characteristics, preexisting comorbidities, symptoms, clinical features and treatments were included. Multivariable logistic regression was used to evaluate factors associated with death and Kaplan–Meier test to examine survival probability. Statistical significance was considered with p<0.05 (95% CI). SPSS (version 24.0 for Windows) and R 4.0.2 (R Statistics) software were used.

Results

The cohort comprised 12,126 patients sequentially attended between February 11 and May 11, 2020. The mean age of patients was 66.4 years; 5667 (46.7%) were women. Six protective factors against exitus were defined: female sex, anosmia, cough, chloroquine and azithromycin. The risk factors were: age over 50, obesity, cardiac pathology, fever, dyspnea, lung infiltrates, lymphopenia, D-dimer above 1000ng/mL, and mechanical ventilation requirement. Survival analysis showed higher survival rate in women (75.7%) than men (72.1%). Cumulative survival was 87.5% for non-hospitalized patients, 70.2% for patients admitted to hospital and 61.2% in ICU patients. Additionally, survival probability decreased with increasing age range.

Conclusion

Determination of protective or death-promoting factors could be useful to stratify patients by severity criteria and to improve COVID-19 care management.

Keywords:
Covid-19
Pneumonia
Mortality
Pandemic
Risk factors
Resumen
Introducción

España es uno de los países con mayor número de pacientes con COVID-19. Desafortunadamente, se dispone de pocos datos por regiones.

Objetivos

Describir las características y los factores de riesgo independientes asociados a mortalidad por COVID-19 en Castilla-La Mancha, España.

Métodos

Estudio de cohorte, multicéntrico de los 14 hospitales públicos de Castilla-La Mancha. Se evaluaron las características clínicas, comorbilidades preexistentes, síntomas y tratamientos. Se utilizó una regresión logística multivariable para evaluar los factores asociados a muerte y Kaplan-Meier para medir supervivencia. Se consideró significación estadística con p < 0,05 (IC 95%). Se utilizaron los programas SPSS (versión 24.0 para Windows) y R 4.0.2 (R Statistics).

Resultados

Se estudiaron 12.126 pacientes atendidos secuencialmente entre el 11 de febrero y el 11 de mayo de 2020. La edad media fue de 66,4 años; 5.667 (46,7%) fueron mujeres. Se definieron seis factores protectores contra el exitus: sexo femenino, anosmia, tos, cloroquina y azitromicina. Los factores de riesgo fueron: edad superior a 50, obesidad, patología cardíaca, fiebre, disnea, infiltrados pulmonares, linfopenia, dímero-D > 1.000 ng/mL y necesidad de ventilación mecánica. Se observó mayor tasa de supervivencia en mujeres (75,7%) que en hombres (72,1%). La supervivencia acumulada fue del 87,5% para pacientes no hospitalizados, 70,2% para admitidos en planta hospitalaria y 61,2% en la Unidad de Cuidados Intensivos (UCI). Además, la probabilidad de supervivencia disminuyó con el aumento del rango de edad.

Conclusión

La determinación de los factores protectores o favorecedores de muerte podría ser útil para estratificar pacientes por criterios de gravedad y mejorar la atención frente a la COVID-19.

Palabras clave:
COVID-19
Neumonía
Mortalidad
Pandemia
Factores de riesgo

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