Mariano Andrés1,2, Jose-Manuel Leon-Ramirez3, Oscar Moreno-Perez2,4, José Sánchez-Payá5, Ignacio Gayá3, Violeta Esteban3, Isabel Ribes6, Diego Torrus-Tendero7,8, Pilar González-de-la-Aleja6, Pere Llorens2,9, Vicente Boix2,7, Joan Gil3, Esperanza Merino7. 1. Department of Rheumatology, Alicante General University Hospital, Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain. 2. Department of Clinical Medicine, Miguel Hernández University, Elche, Spain. 3. Department of Pneumology, Alicante General University Hospital, Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain. 4. Department of Endocrinology and Nutrition, Alicante General University Hospital, Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain. 5. Department of Preventive Medicine, Alicante General University Hospital, Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain. 6. Department of Internal Medicine, Alicante General University Hospital, Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain. 7. Unit of Infectious Diseases, Alicante General University Hospital, Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain. 8. Parasitology Area, Miguel Hernández University, Elche, Spain. 9. Department of Emergency, Alicante General University Hospital, Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
Abstract
INTRODUCTION: This study analyzed the impact of a categorized approach, based on patients' prognosis, on major outcomes and explanators in patients hospitalized for COVID-19 pneumonia in an academic center in Spain. METHODS: Retrospective cohort study (March 3 to May 2, 2020). Patients were categorized according to the followed clinical management, as maximum care or limited therapeutic effort (LTE). Main outcomes were all-cause mortality and need for invasive mechanical ventilation (IMV). Baseline factors associated with outcomes were analyzed by multiple logistic regression, estimating odds ratios (OR; 95%CI). RESULTS: Thirty-hundred and six patients were hospitalized, median age 65.0 years, 57.8% males, 53.3% Charlson index ≥3. The overall all-cause fatality rate was 15.0% (n = 46). Maximum care was provided in 238 (77.8%), IMV was used in 38 patients (16.0%), and 5.5% died. LTE was decided in 68 patients (22.2%), none received IMV and fatality was 48.5%. Independent risk factors of mortality under maximum care were lymphocytes <790/mm3, troponin T >15ng/L and hypotension. Advanced age, lymphocytes <790/mm3 and BNP >240pg/mL independently associated with IMV requirement. CONCLUSION: Overall fatality in the cohort was 15% but markedly varied regarding the decided approach (maximum care versus LTE), translating into nine-fold higher mortality and different risk factors.
INTRODUCTION: This study analyzed the impact of a categorized approach, based on patients' prognosis, on major outcomes and explanators in patients hospitalized for COVID-19 pneumonia in an academic center in Spain. METHODS: Retrospective cohort study (March 3 to May 2, 2020). Patients were categorized according to the followed clinical management, as maximum care or limited therapeutic effort (LTE). Main outcomes were all-cause mortality and need for invasive mechanical ventilation (IMV). Baseline factors associated with outcomes were analyzed by multiple logistic regression, estimating odds ratios (OR; 95%CI). RESULTS: Thirty-hundred and six patients were hospitalized, median age 65.0 years, 57.8% males, 53.3% Charlson index ≥3. The overall all-cause fatality rate was 15.0% (n = 46). Maximum care was provided in 238 (77.8%), IMV was used in 38 patients (16.0%), and 5.5% died. LTE was decided in 68 patients (22.2%), none received IMV and fatality was 48.5%. Independent risk factors of mortality under maximum care were lymphocytes <790/mm3, troponin T >15ng/L and hypotension. Advanced age, lymphocytes <790/mm3 and BNP >240pg/mL independently associated with IMV requirement. CONCLUSION: Overall fatality in the cohort was 15% but markedly varied regarding the decided approach (maximum care versus LTE), translating into nine-fold higher mortality and different risk factors.
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Authors: José Pedro Cidade; L M Coelho; Vasco Costa; Rui Morais; Patrícia Moniz; Luís Morais; Pedro Fidalgo; António Tralhão; Carolina Paulino; David Nora; Bernardino Valério; Vítor Mendes; Camila Tapadinhas; Pedro Povoa Journal: World J Crit Care Med Date: 2022-07-09