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

Berenguer et al., Clinical Microbiology and Infection, doi:10.1016/j.cmi.2020.07.024
Aug 2020  
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Mortality 18% Improvement Relative Risk HCQ for COVID-19  Berenguer et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 3,995 patients in Spain Lower mortality with HCQ (p=0.00012) c19hcq.org Berenguer et al., Clinical Microbiolog.., Aug 2020 FavorsHCQ Favorscontrol 0 0.5 1 1.5 2+
HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
 
*, now with p < 0.00000000001 from 411 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 75 treatments. c19hcq.org
Retrospective 4035 hospitalized patients in Spain showing reduced mortality with HCQ (data is in the supplementary appendix).
risk of death, 18.2% lower, RR 0.82, p < 0.001, treatment 681 of 2,618 (26.0%), control 438 of 1,377 (31.8%), NNT 17.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Berenguer et al., 3 Aug 2020, retrospective, Spain, peer-reviewed, 8 authors, average treatment delay 7.0 days.
This PaperHCQAll
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, Esther Aznar Muñoz, Pedro Gil Divasson, Patricia González Muñiz, Clara Muñoz Aguirre, Juan Carlos López, Margarita Ramírez-Schacke, Isabel Gutiérrez, Francisco Tejerina, Teresa Aldámiz-Echevarría, Cristina Díez, Chiara Fanciulli, Leire Pérez-Latorre, Francisco Parras, Pilar Catalán, María E García-Leoni, Isabel Pérez-Tamayo, Luis Puente, Jamil Cedeño, Juan Berenguer, Marta Díaz Menéndez, Fernando De La Calle Prieto, Marta Arsuaga Vicente, Elena Trigo Esteban, Mª Del Mar Lago Núñez, Rosa De Miguel Buckley, Julen Cadiñaños Loidi, Carmen Busca Arenzana, Alfredo Mican, Marta Mora Rillo, Juan Carlos Ramos Ramos, Belén Loeches Yagüe, José Ignacio Bernardino De La Serna, Julio García Rodríguez, José Ramón Arribas López, Ana Such Diaz, Elena Álvaro Alonso, Elsa Izquierdo García, Juan Torres Macho, Guillermo Cuevas Tascon, Jesús Troya García, Beatriz Mestre Gómez, Eva Jiménez González De Buitrago, Inés Fernández Jiménez, Ana Josefa Tebar Martínez, Fátima Brañas Baztán, Jorge Valencia De La Rosa, Mario Pérez Butragueño, Marta Alvarado Blasco, Pablo Ryan, Mª Antonia Sepúlveda Berrocal, Carmen Yera Bergua, Pilar Toledano Sierra, Verónica Cano Llorente, Sadaf Zafar Iqubal-Mirza, Gema Muñiz, Inmaculada Martín Pérez, Helena Mozas Moriñigo, Ana Alguacil, María Paz García Butenegro, Ana Isabel Peláez Ballesta, Elena Morcillo Rodríguez, Josune Goikoetxea Agirre, María José Blanco Vidal, Javier Nieto Arana, Mikel Del Álamo Martínez De Lagos, Isabel A Pérez Hernández, Inés Pérez Zapata, Rafael Silvariño Fernández, Jon Ugalde Espiñeira, Víctor Asensi Álvarez, Lucia Suárez Pérez, Silvia Suárez Diaz, Carmen Yllera Gutiérrez, Vicente Boix, Marcos Díez Martínez, Melissa Carreres Candela, Cristina Gómez-Ayerbe, Javier Sánchez-Lora, José Luis Velasco Garrido, María López-Jódar, Jesús Santos González, Jesús Ruiz Aragón, Ianire Virto Peña, Vanessa Alende Castro, Ruth Brea Aparicio, Sonia Vega Molpeceres, Estel Pons Viñas, Oscar Del Río Pérez, Silvia Valero Rovira, Judit Villar-García, Joan Gómez-Junyent, Hernando Knobel, María Cecilia Cánepa, Silvia Castañeda Espinosa, Luisa Sorli Redò, Roberto Güerri-Fernández, María Milagro Montero, Juan Pablo Horcajada, Elisa García Vázquez, Encarnación Moral Escudero, Alicia Hernández Torres, Esther García Almodóvar, Carmen Sáez Barberá, Zineb Karroud, José Hernández Quero, David Vinuesa García, José Luis García Fogeda, José Antonio Peregrina, María Novella Mena, Cristina Hernández Gutiérrez, José Sanz Moreno, Ramón Pérez Tanoira, Rodrigo Sierra Rodríguez, David Alonso Menchén, Aida Gutiérrez García, Alberto Arranz Caso, Juan Cuadros González, Melchor Álvarez De Mon Soto, Vicente Ferrer Díaz De Brito Fernández, Montserrat Sanmarti Vilamala, Aina Gabarrell Pascuet, Daniel Molina Morant, Sergio España Cueto, Jonathan Cámara Fernández, Albert Sabater Gil, Laura Muñoz López, Paula Sáez Escolano, Esperanza Bejarano Tello, Marco Antonio Sempere Alcocer, Salvador Álvarez Martin, Ignacio De Los Santos Gil, Lucio García-Fraile, Miguel Sampedro Núñez, Ana Barrios Blandino, Carlos Rodríguez Franco, Daniel Useros Brañas, Almudena Villa Martí, Javier Oliver Ortega, Alexia Costanza Espiño Álvarez, Jesús Sanz Sanz, María Rexach Fumaña, Ivette Abascal Cambras, Ana Del Cielo Pérez Jaén, Clara Sala Jofre, Susana Casas Rodríguez, Cecilia Tortajada Alamilla, Carmina Oltra, Mar Masiá Canuto, Félix Gutiérrez Rodero, Ana Ferrer Ribera, Carlos Bea Serrano, Miguel Pedromingo Kus, María Ángeles Garcinuño, Silvana Fiorante, Sergio Pérez Pinto, Pilar Hernández Machín, Alba Alastrué Violeta, María Carmen Fariñas Álvarez, Claudia González Rico, Francisco Arnaiz De Las Revillas, Jorge Calvo, Mónica Gozalo, Francisco Mora Gómez, Ana Milagro Beamonte, Miriam Latorre-Millán, Antonio Rezusta López, Ana Martínez Sapiña, Yolanda Meije, Alejandra Duarte Borges, Julia Pareja Coca, Mercedes Clemente Presas, Juan Emilio Losa García, Ana Vegas Serrano, M Teresa Pérez-Rodríguez, Alexandre Pérez González, Moncef Belhassen-García, Beatriz Rodríguez-Alonso, Amparo López-Bernus, Cristina Carbonell, Rafael Torres Perea, Juan Cantón De Seoane, Blanca Alonso, Sara Lidia Kamal, Lucia Cajuela, David Roa, Miguel Cervero, Alberto Oreja, Juan Pablo Avilés, Lidia Martín, Iván Pelegrín Senent, Rosana Rouco Esteves Marques, Jorge Parra Ruiz, Violeta Ramos Sesma, Jessica Abadia Otero, Juan Salillas Hernando, Robert Torres Sánchez Del Arco, Miguel Torralba González De Suso, Alberto Serrano Martínez, Sergio Gilaberte Reyzábal, Marina Pacheco Martínez-Atienza, Mónica Liébana Gómez, Sara Fernández Rodríguez, Álvaro Varela Plaza, Henar Calvo Sánchez, Patricia Martínez Martín, Patricia González- Ruano, Eduardo Malmierca Corral, Isabel Rábago Lorite, Beatriz Pérez-Monte Mínguez, Ángeles García Flores, Pere Comas Casanova, Merce Sirisi, Richard Rojas, José Luis Díaz De Tuesta Del Arco, Ruth Figueroa Cerón, Ander González Sarria, Remedios Alemán Valls, María Del Mar Alonso Socas, Oscar Sanz Peláez, Karim Mohamed Ramírez, Melchor Riera Jaume, Helem Haydee Vilchez, Francesc Albertí, Ana Isabel Cañabate, Víctor J Moreno Cuerda, Silvia Álvarez Kaelis, Beatriz Álvarez Zapatero, Alejandro García García, Elena Isaba Ares, Covadonga Morcate Fernández, Andrea Pérez Rodríguez, Lucía Ramos Merino, Laura Castelo Corral, María Rodríguez Mahía, Mónica González Bardanca, Efrén Sánchez Vidal, Enrique Míguez Rey, Javier De La Torre Lima, José Mª García De Lomas Guerrero, Elena Morte, Silvia Loscos, Ana Camón
Clinical Microbiology and Infection, doi:10.1016/j.cmi.2020.07.024
Objectives: To analyse the characteristics and predictors of death in hospitalized patients with coronavirus disease 2019 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 Creactive 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.
Appendix A. Supplementary data Supplementary data to this article can be found online at https://doi.org/10.1016/j.cmi.2020.07.024.
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'family': 'Carratalà', 'sequence': 'additional', 'affiliation': []}, {'given': 'Gabriela', 'family': 'Abelenda-Alonso', 'sequence': 'additional', 'affiliation': []}, {'given': 'Carmen', 'family': 'Ardanuy', 'sequence': 'additional', 'affiliation': []}, {'given': 'Alba', 'family': 'Bergas', 'sequence': 'additional', 'affiliation': []}, {'given': 'Guillermo', 'family': 'Cuervo', 'sequence': 'additional', 'affiliation': []}, {'given': 'María Ángeles', 'family': 'Domínguez', 'sequence': 'additional', 'affiliation': []}, {'given': 'Miguel', 'family': 'Fernández-Huerta', 'sequence': 'additional', 'affiliation': []}, {'given': 'Carlota', 'family': 'Gudiol', 'sequence': 'additional', 'affiliation': []}, {'given': 'Laia', 'family': 'Lorenzo-Esteller', 'sequence': 'additional', 'affiliation': []}, {'given': 'Jordi', 'family': 'Niubó', 'sequence': 'additional', 'affiliation': []}, {'given': 'Sandra', 'family': 'Pérez-Recio', 'sequence': 'additional', 'affiliation': []}, {'given': 'Daniel', 'family': 'Podzamczer', 'sequence': 'additional', 'affiliation': []}, {'given': 'Miquel', 'family': 'Pujol', 'sequence': 'additional', 'affiliation': []}, {'given': 'Alexander', 'family': 'Rombauts', 'sequence': 'additional', 'affiliation': []}, {'given': 'Núria', 'family': 'Trullen', 'sequence': 'additional', 'affiliation': []}, {'given': 'Miguel', 'family': 'Salavert Lletí', 'sequence': 'additional', 'affiliation': []}, {'given': 'Iván', 'family': 'Castro Hernández', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Adriana', 'family': 'Hernández Belmonte', 'sequence': 'additional', 'affiliation': []}, {'given': 'Raquel', 'family': 'Martínez Goñi', 'sequence': 'additional', 'affiliation': []}, {'given': 'Marta', 'family': 'Navarro Vilasaró', 'sequence': 'additional', 'affiliation': []}, {'given': 'Sonia', 'family': 'Calzado Isbert', 'sequence': 'additional', 'affiliation': []}, {'given': 'Manuel', 'family': 'Cervantes García', 'sequence': 'additional', 'affiliation': []}, {'given': 'Aina', 'family': 'Gomila Grange', 'sequence': 'additional', 'affiliation': []}, {'given': 'Oriol', 'family': 'Gasch Blasi', 'sequence': 'additional', 'affiliation': []}, { 'given': 'María Luisa', 'family': 'Machado Sicilia', 'sequence': 'additional', 'affiliation': []}, {'given': 'Eva', 'family': 'Van den Eynde Otero', 'sequence': 'additional', 'affiliation': []}, {'given': 'Luis', 'family': 'Falgueras López', 'sequence': 'additional', 'affiliation': []}, { 'given': 'María del Carmen', 'family': 'Navarro Sáez', 'sequence': 'additional', 'affiliation': []}, {'given': 'Esteban', 'family': 'Martínez', 'sequence': 'additional', 'affiliation': []}, {'given': 'Mª Ángeles', 'family': 'Marcos', 'sequence': 'additional', 'affiliation': []}, {'given': 'Mar', 'family': 'Mosquera', 'sequence': 'additional', 'affiliation': []}, {'given': 'José Luis', 'family': 'Blanco', 'sequence': 'additional', 'affiliation': []}, {'given': 'Montserrat', 'family': 'Laguno', 'sequence': 'additional', 'affiliation': []}, {'given': 'Jhon', 'family': 'Rojas', 'sequence': 'additional', 'affiliation': []}, {'given': 'Ana', 'family': 'González-Cordón', 'sequence': 'additional', 'affiliation': []}, {'given': 'Alexy', 'family': 'Inciarte', 'sequence': 'additional', 'affiliation': []}, {'given': 'Berta', 'family': 'Torres', 'sequence': 'additional', 'affiliation': []}, {'given': 'Lorena', 'family': 'De la Mora', 'sequence': 'additional', 'affiliation': []}, {'given': 'Alex', 'family': 'Soriano', 'sequence': 'additional', 'affiliation': []}, {'given': 'Olalla', 'family': 'Martínez Macias', 'sequence': 'additional', 'affiliation': []}, {'given': 'Virginia', 'family': 'Pérez Doñate', 'sequence': 'additional', 'affiliation': []}, {'given': 'Alfonso', 'family': 'Cabello Úbeda', 'sequence': 'additional', 'affiliation': []}, {'given': 'Nerea', 'family': 'Carrasco Antón', 'sequence': 'additional', 'affiliation': []}, {'given': 'Beatriz', 'family': 'Álvarez Álvarez', 'sequence': 'additional', 'affiliation': []}, {'given': 'Elizabet', 'family': 'Petkova Saiz', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Miguel', 'family': 'Górgolas Hernández-Mora', 'sequence': 'additional', 'affiliation': []}, {'given': 'Laura', 'family': 'Prieto Pérez', 'sequence': 'additional', 'affiliation': []}, {'given': 'Irene', 'family': 'Carrillo Acosta', 'sequence': 'additional', 'affiliation': []}, {'given': 'Sara', 'family': 'Heili Frades', 'sequence': 'additional', 'affiliation': []}, {'given': 'Felipe', 'family': 'Villar Álvarez', 'sequence': 'additional', 'affiliation': []}, {'given': 'Ricardo', 'family': 'Fernández Roblas', 'sequence': 'additional', 'affiliation': []}, {'given': 'José María', 'family': 'Milicua Muñoz', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Virginia', 'family': 'Fernández Espinilla', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Carlos Jesús', 'family': 'Dueñas Gutiérrez', 'sequence': 'additional', 'affiliation': []}, {'given': 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'family': 'Navas Clemente', 'sequence': 'additional', 'affiliation': []}, { 'given': 'María Isabel', 'family': 'Quijano Contreras', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Luis Alberto', 'family': 'Nieto Fernández del Campo', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Guillermo', 'family': 'Jiménez Álvarez', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Mercedes', 'family': 'Guillamón Sánchez', 'sequence': 'additional', 'affiliation': []}, {'given': 'Josefina', 'family': 'García García', 'sequence': 'additional', 'affiliation': []}, {'given': 'Constanza', 'family': 'Muñoz Hornero', 'sequence': 'additional', 'affiliation': []}, {'given': 'Ana', 'family': 'Mariño Callejo', 'sequence': 'additional', 'affiliation': []}, {'given': 'Nieves', 'family': 'Valcarce Pardeiro', 'sequence': 'additional', 'affiliation': []}, {'given': 'Alex', 'family': 'Smithson Amat', 'sequence': 'additional', 'affiliation': []}, {'given': 'Cristina', 'family': 'Chico 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Late treatment
is less effective
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