Mortality risk assessment in Spain and Italy, insights of the HOPE COVID-19 registry
Internal and Emergency Medicine, doi:10.1007/s11739-020-02543-5
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-OR hydroxychloroquine 0.88; 95% CI 0.81-0.91, p = 0.005; adjusted-OR antiviral 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.
Author contributions ING, CFS and VE designed and analyzed the data. ING, CFS, VE, AFO, CM drafted the manuscript. All of the other collaborators lead the registry in their respective centers and enrolled patients. The order of authorship was determined upon recruitment and HOPE involvement. Finally, all authors had full access to the manuscript and agree with it. Funding Non-conditioned grant (FUNDACIÓN INTERHOSPITA-LARIA PARA LA INVESTIGACIÓN CARDIOVASCULAR, FIC. Madrid, Spain). This nonprofit institution had no role in the study design; in the collection, analysis, interpretation of data; in the writing of the report; nor in the decision to submit the paper for publication.
Compliance with ethical standards Conflict of interest The author(s) declare that they have no conflict of interest.
Statements on human and animal rights Our study was performed in accordance with the ethical standards of our institutional (Hospital Clinico San Carlos, Spain) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent Written informed consent was waived by a central ethics committee, considering this an anonymized observational study in a pandemic situation.
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