Abstract: Clinical Microbiology and Infection 26 (2020) 1525e1536 Contents lists available at ScienceDirect Clinical Microbiology and Infection journal homepage: www.clinicalmicrobiologyandinfection.com Original article Characteristics and predictors of death among 4035 consecutively hospitalized patients with COVID-19 in Spain ~ o 7, 8, 9, Inmaculada Jarrín 4, Juan Berenguer 1, 2, *, y, Pablo Ryan 2, 3, Jesús Rodríguez-Ban  nimo Pacho  n 8, 9, 10, María Yllescas 5, Jose  Ramo  n Arriba 6, 14, y, for  11, 12, 13, Jero Jordi Carratala the COVID-19@Spain Study Groupyy ~o n, Spain Hospital General Universitario Gregorio Maran n Sanitaria Gregorio Maran ~o n (IiSGM), Spain Instituto de Investigacio Hospital Universitario Infanta Leonor, Spain 4) Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Spain 5) n SEIMC/GeSIDA, Spain Fundacio 6) Hospital Universitario La Paz, IdiPAZ, Madrid, Spain 7) Hospital Universitario Virgen Macarena, Spain 8) Instituto de Biomedicina de Sevilla (IBiS), Spain 9) Department of Medicine, Universidad de Sevilla, Spain 10) Hospital Universitario Virgen del Rocío, Seville, Spain 11) Hospital Universitario de Bellvitge, Spain 12) n Biom Instituto de Investigacio edica de Bellvitge (IDIBELL), Spain 13) Universitat de Barcelona, Barcelona, Spain 14) n Hospital Universitario La Paz, La Paz, Spain Instituto de Investigacio 1) 2) 3) a r t i c l e i n f o a b s t r a c t Article history: Received 9 June 2020 Received in revised form 6 July 2020 Accepted 16 July 2020 Available online 4 August 2020 Objectives: To analyse the characteristics and predictors of death in hospitalized patients with coronavirus disease 2019 (COVID-19) 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. Juan Berenguer, Clin Microbiol Infect..