Predictors of mortality of COVID-19 in the general population and nursing homes

Pedro Pablo España, Amaia Bilbao, Susana García-Gutiérrez, Iratxe Lafuente, Ane Anton-Ladislao, Ane Villanueva, Ane Uranga, Maria Jose Legarreta, Urko Aguirre, Jose Maria Quintana, COVID-19-Osakidetza Working group, Susana García-Gutiérrez, Miren Orive, Nerea Gonzalez, Iratxe Lafuente, Ane Anton, Ane Villanueva, Josune Martin, Cristina Muñoz, Maria Jose Legarreta, Urko Aguirre, Jose María Quintana, Pedro Pablo España, Ane Uranga, Mikel Egurrola, Amaia Aramburu, Amaia Artaraz, Leire Chasco, Olaia Bronte, Patricia García, Ana Jodar, Virginia Fernandez, Cristobal Esteban, Naia Mas, Esther Pulido, Itxaso Bengoetxea, Antonio Escobar, Amaia Bilbao, Iñigo Gorostiza, Iñaki Arriaga, José Joaquín Portu, Naiara Parraza, Milagros Iriberri, Rafael Zalacain, Luis Alberto Ruiz, Leyre Serrano, Adriana Couto, Oier Ateka, Arantza Cano, Maria Olatz Ibarra, Eduardo Millan, Mayte Bacigalupe, Jon Letona, Andoni Arcelay, Iñaki Berraondo, Pedro Pablo España, Amaia Bilbao, Susana García-Gutiérrez, Iratxe Lafuente, Ane Anton-Ladislao, Ane Villanueva, Ane Uranga, Maria Jose Legarreta, Urko Aguirre, Jose Maria Quintana, COVID-19-Osakidetza Working group, Susana García-Gutiérrez, Miren Orive, Nerea Gonzalez, Iratxe Lafuente, Ane Anton, Ane Villanueva, Josune Martin, Cristina Muñoz, Maria Jose Legarreta, Urko Aguirre, Jose María Quintana, Pedro Pablo España, Ane Uranga, Mikel Egurrola, Amaia Aramburu, Amaia Artaraz, Leire Chasco, Olaia Bronte, Patricia García, Ana Jodar, Virginia Fernandez, Cristobal Esteban, Naia Mas, Esther Pulido, Itxaso Bengoetxea, Antonio Escobar, Amaia Bilbao, Iñigo Gorostiza, Iñaki Arriaga, José Joaquín Portu, Naiara Parraza, Milagros Iriberri, Rafael Zalacain, Luis Alberto Ruiz, Leyre Serrano, Adriana Couto, Oier Ateka, Arantza Cano, Maria Olatz Ibarra, Eduardo Millan, Mayte Bacigalupe, Jon Letona, Andoni Arcelay, Iñaki Berraondo

Abstract

The factors that predispose an individual to a higher risk of death from COVID-19 are poorly understood. The goal of the study was to identify factors associated with risk of death among patients with COVID-19. This is a retrospective cohort study of people with laboratory-confirmed SARS-CoV-2 infection from February to May 22, 2020. Data retrieved for this study included patient sociodemographic data, baseline comorbidities, baseline treatments, other background data on care provided in hospital or primary care settings, and vital status. Main outcome was deaths until June 29, 2020. In the multivariable model based on nursing home residents, predictors of mortality were being male, older than 80 years, admitted to a hospital for COVID-19, and having cardiovascular disease, kidney disease or dementia while taking anticoagulants or lipid-lowering drugs at baseline was protective. The AUC was 0.754 for the risk score based on this model and 0.717 in the validation subsample. Predictors of death among people from the general population were being male and/or older than 60 years, having been hospitalized in the month before admission for COVID-19, being admitted to a hospital for COVID-19, having cardiovascular disease, dementia, respiratory disease, liver disease, diabetes with organ damage, or cancer while being on anticoagulants was protective. The AUC was 0.941 for this model's risk score and 0.938 in the validation subsample. Our risk scores could help physicians identify high-risk groups and establish preventive measures and better follow-up for patients at high risk of dying.ClinicalTrials.gov Identifier: NCT04463706.

Keywords: COVID-19; Clinical prediction rules; Cohort study; Mortality; Prognostic factors.

Conflict of interest statement

The authors declare that they have no conflict of interest.

© 2021. Società Italiana di Medicina Interna (SIMI).

Figures

Fig. 1
Fig. 1
Kaplan–Meier curves of short-term mortality according to the risk classes in the derivation and validation samples. The log-rank test detected statistically significant differences between all risk classes in both derivation and validation samples, except between the risk classes with score 4–5 and score 6–10 in the validation sample of nursing home residents (p = 0.612)

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