Mortality risk assessment in Spain and Italy, insights of the HOPE COVID-19 registry

Iván J Núñez-Gil, Cristina Fernández-Pérez, Vicente Estrada, Víctor M Becerra-Muñoz, Ibrahim El-Battrawy, Aitor Uribarri, Inmaculada Fernández-Rozas, Gisela Feltes, María C Viana-Llamas, Daniela Trabattoni, Javier López-País, Martino Pepe, Rodolfo Romero, Alex F Castro-Mejía, Enrico Cerrato, Thamar Capel Astrua, Fabrizio D'Ascenzo, Oscar Fabregat-Andres, José Moreu, Federico Guerra, Jaime Signes-Costa, Francisco Marín, Danilo Buosenso, Alfredo Bardají, Sergio Raposeiras-Roubín, Javier Elola, Ángel Molino, Juan J Gómez-Doblas, Mohammad Abumayyaleh, Álvaro Aparisi, María Molina, Asunción Guerri, Ramón Arroyo-Espliguero, Emilio Assanelli, Massimo Mapelli, José M García-Acuña, Gaetano Brindicci, Edoardo Manzone, María E Ortega-Armas, Matteo Bianco, Chinh Pham Trung, María José Núñez, Carmen Castellanos-Lluch, Elisa García-Vázquez, Noemí Cabello-Clotet, Karim Jamhour-Chelh, María J Tellez, Antonio Fernández-Ortiz, Carlos Macaya, HOPE COVID-19 Investigators, Iván J Núñez-Gil, Cristina Fernández-Pérez, Vicente Estrada, Víctor M Becerra-Muñoz, Ibrahim El-Battrawy, Aitor Uribarri, Inmaculada Fernández-Rozas, Gisela Feltes, María C Viana-Llamas, Daniela Trabattoni, Javier López-País, Martino Pepe, Rodolfo Romero, Alex F Castro-Mejía, Enrico Cerrato, Thamar Capel Astrua, Fabrizio D'Ascenzo, Oscar Fabregat-Andres, José Moreu, Federico Guerra, Jaime Signes-Costa, Francisco Marín, Danilo Buosenso, Alfredo Bardají, Sergio Raposeiras-Roubín, Javier Elola, Ángel Molino, Juan J Gómez-Doblas, Mohammad Abumayyaleh, Álvaro Aparisi, María Molina, Asunción Guerri, Ramón Arroyo-Espliguero, Emilio Assanelli, Massimo Mapelli, José M García-Acuña, Gaetano Brindicci, Edoardo Manzone, María E Ortega-Armas, Matteo Bianco, Chinh Pham Trung, María José Núñez, Carmen Castellanos-Lluch, Elisa García-Vázquez, Noemí Cabello-Clotet, Karim Jamhour-Chelh, María J Tellez, Antonio Fernández-Ortiz, Carlos Macaya, HOPE COVID-19 Investigators

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-ORhydroxychloroquine 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.

Keywords: COVID-19; Mortality; Prognosis; Registry; Score.

Conflict of interest statement

The author(s) declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Study patient flow diagram
Fig. 2
Fig. 2
Percentages (y axis) of death (blue bar) and invasive mechanical ventilation (orange bar) stratified by in-hospital events. In brackets, the raw numbers of patients with that complication, in the descriptive cohort (color figure online)

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Source: PubMed

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