Prevalence and 30-Day Mortality in Hospitalized Patients With Covid-19 and Prior Lung Diseases

Jaime Signes-Costa, Iván J Núñez-Gil, Joan B Soriano, Ramón Arroyo-Espliguero, Charbel Maroun Eid, Rodolfo Romero, Aitor Uribarri, Inmaculada Fernández-Rozas, Marcos García Aguado, Víctor Manuel Becerra-Muñoz, Jia Huang, Martino Pepe, Enrico Cerrato, Sergio Raposeiras, Adelina Gonzalez, Francisco Franco-Leon, Lin Wang, Emilio Alfonso, Fabrizio Ugo, Juan Fortunato García-Prieto, Gisela Feltes, Mohammad Abumayyaleh, Carolina Espejo-Paeres, Jorge Jativa, Alvaro López Masjuan, Carlos Macaya, Juan A Carbonell Asíns, Vicente Estrada, HOPE COVID-19 investigators, Jaime Signes-Costa, Iván J Núñez-Gil, Joan B Soriano, Ramón Arroyo-Espliguero, Charbel Maroun Eid, Rodolfo Romero, Aitor Uribarri, Inmaculada Fernández-Rozas, Marcos García Aguado, Víctor Manuel Becerra-Muñoz, Jia Huang, Martino Pepe, Enrico Cerrato, Sergio Raposeiras, Adelina Gonzalez, Francisco Franco-Leon, Lin Wang, Emilio Alfonso, Fabrizio Ugo, Juan Fortunato García-Prieto, Gisela Feltes, Mohammad Abumayyaleh, Carolina Espejo-Paeres, Jorge Jativa, Alvaro López Masjuan, Carlos Macaya, Juan A Carbonell Asíns, Vicente Estrada, HOPE COVID-19 investigators

Abstract

Introduction: Patients with pre-existing respiratory diseases in the setting of COVID-19 may have a greater risk of severe complications and even death.

Methods: A retrospective, multicenter, cohort study with 5847 COVID-19 patients admitted to hospitals. Patients were separated in two groups, with/without previous lung disease. Evaluation of factors associated with survival and secondary composite end-point such as ICU admission and respiratory support, were explored.

Results: 1,271 patients (22%) had a previous lung disease, mostly COPD. All-cause mortality occurred in 376 patients with lung disease (29.5%) and in 819 patients without (17.9%) (p < 0.001). Kaplan-Meier curves showed that patients with lung diseases had a worse 30-day survival (HR = 1.78; 95%C.I. 1.58-2.01; p < 0.001) and COPD had almost 40% mortality. Multivariable Cox regression showed that prior lung disease remained a risk factor for mortality (HR, 1.21; 95%C.I. 1.02-1.44; p = 0.02). Variables independently associated with all-cause mortality risk in patients with lung diseases were oxygen saturation less than 92% on admission (HR, 4.35; 95% CI 3.08-6.15) and elevated D-dimer (HR, 1.84; 95% CI 1.27-2.67). Age younger than 60 years (HR 0.37; 95% CI 0.21-0.65) was associated with decreased risk of death.

Conclusions: Previous lung disease is a risk factor for mortality in patients with COVID-19. Older age, male gender, home oxygen therapy, and respiratory failure on admission were associated with an increased mortality. Efforts must be done to identify respiratory patients to set measures to improve their clinical outcomes.

Keywords: 30-Day mortality; ACE2, angiotensin converting enzyme II; CI, confidence interval; COPD; COPD, chronic obstructive pulmonary disease; COVID-19; COVID-19, 2019 novel coronavirus; CQ/HCQ, chloroquine/hydroxychloroquine; FEV1, forced expiratory volume in one second; HFNC, high flow nasal cannula; HOPE-COVID-19, Health Outcome Predictive Evaluation for COVID-19; HR, hazard ratio; ICS, inhaled corticosteroids; ICU, intensive care unit; ILD, interstitial lung disease; IQR, interquartile range; MERS, middle east respiratory syndrome; Prognosis; RT-PCR, real time reverse transcriptase-polymerase chain reaction; Respiratory diseases; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; STROBE, strengthening the reporting of observational studies in epidemiology; WHO, World Health Organization.

© 2020 SEPAR. Published by Elsevier España, S.L.U. All rights reserved.

Figures

Fig. 1
Fig. 1
Study flow chart. Data are expressed as absolute numbers and percentage referred to the whole group. COPD: Chronic Obstructive Respiratory Disease. ILD: Interstitial Lung Disease. * 21 patients withdrew due to age less tan 18 years.
Fig. 2
Fig. 2
Kaplan–Meier survival curves for the whole group and patients with lung diseases (A) and patients with different lung diseases (B). Events were censored at 30 days.

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