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

Juan Berenguer, Pablo Ryan, Jesús Rodríguez-Baño, Inmaculada Jarrín, Jordi Carratalà, Jerónimo Pachón, María Yllescas, José Ramón Arriba, COVID-19@Spain Study Group, Fundación SEIMC-GESIDA, Hospital General Universitario Gregorio Marañón, Hospital Universitario La Paz, Hospital Infanta Leonor, Complejo Hospitalario Virgen de la Salud, Hospital Universitario Rafael Méndez, Hospital Universitario de Cruces, Hospital de Melilla, Hospital San Eloy de Barakaldo, Hospital Universitario Central de Asturias, Hospital General Universitario de Alicante, Hospital Virgen de la Victoria, Hospital Universitario Puerto Real, EOXI Pontevedra e Salnés, Hospital de Figueres, Hospital Sant Jaume de Calella, Hospital del Mar, Hospital Virgen de la Arrixaca, Hospital de Can Misses, Hospital de Sagunto, Hospital Clínico San Cecilio, Hospital Universitario Príncipe de Asturias, Parc Sanitari Sant Joan de Déu, Hospital Nuestra Señora de Gracia, HC Marbella Internacional Hospital, Hospital La Princesa, Hospital Josep Trueta, Hospital Dos de Maig, Hospital Arnau de Vilanova-Lliria, Hospital General Universitario de Elche, Hospital Clínico Universitario de Valencia, Complejo Asistencial de Ávila, Hospital Comarcal de Alcañiz, Hospital Universitario Marqués de Valdecilla, Hospital Quiron-Salud de Torrevieja, Hospital Universitario Miguel Servet, SCIAS, Hospital de Barcelona, Fundación Hospital Universitario Alcorcón, Hospital Álvaro Cunqueiro, Complejo Asistencial Universitario de Salamanca, Hospital Universitario Severo Ochoa, Hospital CIMA-Sanitas, Hospital HLA Inmaculada, Hospital Universitario Rio Hortega, Hospital de Guadalajara, Hospital Universitario Infanta Sofía, Hospital Comarcal de Blanes, Hospital Universitari de Tarragona Joan XXIII, Hospital Universitario Basurto, Hospital Universitario de Canarias, Hospital Universitario de Gran Canaria Dr Negrín, Hospital Son Espases, Hospital Universitario de Móstoles, Complejo Hospitalario Universitario A Coruña, Hospital Costa del Sol, Hospital Clínico Universitario Lozano Blesa, Hospital Mutua de Terrassa, Hospital de la Plana, Hospital Virgen de la Concha–Complejo Asistencial de Zamora, Complejo Hospitalario Universitario Insular Materno-Infantil, Hospital de la Marina Baixa, Hospital Universitario Virgen Macarena, Hospital Universitari de Bellvitge, Hospital Universitario y Politécnico la Fe, Hospital Universitario del Vinalopó, Hospital de Sabadell (Parc Tauli), Hospital Clinic de Barcelona, Hospital Universitario de la Ribera, Fundación Jiménez Díaz, Hospital Clínico Universitario de Valladolid, Hospital Clínico San Carlos, Hospital Santa Creu i Sant Pau, Clínica Universitaria de Navarra–Campus Madrid, Hospital Son Llatzer, Hospital General de la Defensa Gómez Ulla, Hospital Universitario de Álava, Hospital Santos Reyes, Hospital Dr José Molina Orosa, Hospital Vall d’Hebrón, Hospital Universitario Rey Juan Carlos, Complejo Hospitalario Universitario Santa Lucía, Hospital Santa Bárbara, Complejo Hospitalario Universitario de Ferrol, Hospital de l'Esperit Sant, Hospital Universitario los Arcos del Mar Menor, Hospital HLA Universitario Moncloa, Hospital Virgen del Puerto, Hospital Marina Salud de Dénia, Hospital Universitario de Jerez, Hospital Reina Sofía de Tudela, Hospital Clínico Universitario de Santiago de Compostela, Hospital Universitario del Henares, Hospital Universitario Lucus Augusti, Hospital de Donostia, Hospital de Urduliz Alfredo Espinosa, Hospital de Mendaro, Hospital Juan Ramón Jiménez, Hospital de Tortosa Virgen de la Cinta, Hospital Riotinto, Hospital Vega Baja, Hospital Puerta de Hierro, Hospital Universitario de Getafe, Hospital General de la Palma, Hospital El Bierzo, Fundación Hospital de Calahorra, Hospital Alto Deba, Hospital Universitario San Juan de Alicante, Hospital de Guadarrama, Hospital Universitario de Jaén, Hospital de Mataró, Hospital de Palamós, Hospital Universitario de Valme, Clínica Universitaria de Navarra–Campus Navarra, Hospital Clínica Benidorm, Hospital Doce de Octubre, Hospital Universitario Virgen del Rocío, Hospital Universitario Ramón y Cajal, Hospital Universitario San Pedro, Hospital Quirón A Coruña, HM Sanchinarro, Hospital Francesc de Borja, Complejo Hospitalario Universitario Nuestra Señora de La Candelaria, Hospital Universitario HM Montepríncipe, Hospital Universitario HM Puerta del Sur, Hospital Universitario HM Torrelodones, Hospital Universitario HM Madrid, Hospital Don Benito-Villanueva de la Serena, Hospital de Viladecans, Centro Nacional de Epidemiología

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.

Keywords: COVID-19; Coronavirus; Pneumonia; Respiratory distress syndrome; SARS-CoV-2.

Copyright © 2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Figures

Graphical abstract
Graphical abstract
Fig. 1
Fig. 1
(A) Distribution of hospitalized patients with coronavirus disease 2019 (COVID-19) stratified by age and sex. (B) Mortality of patients with COVID-19 stratified by age and sex.
Fig. 2
Fig. 2
Univariable (A) and multivariable (B) Cox proportional hazards model of variables associated with death. CRP, C-reactive protein; eGFR, estimated glomerular filtration rate; INR, international normalized ratio; N/L, neutrophil-to-lymphocyte ratio; WBC, white blood cell count.
Fig. 3
Fig. 3
Kaplan-Meier plots for death according to age (A) and sex (B).

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Source: PubMed

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