Abstract: Internal and Emergency Medicine https://doi.org/10.1007/s11739-020-02543-5 IM - ORIGINAL Mortality risk assessment in Spain and Italy, insights of the HOPE COVID‑19 registry Iván J. Núñez‑Gil1 · Cristina Fernández‑Pérez9,24 · Vicente Estrada1 · Víctor M. Becerra‑Muñoz2 · Ibrahim El‑Battrawy3 · Aitor Uribarri4 · Inmaculada Fernández‑Rozas5 · Gisela Feltes6 · María C. Viana‑Llamas7 · Daniela Trabattoni8 · Javier López‑País9 · Martino Pepe10 · Rodolfo Romero11 · Alex F. Castro‑Mejía12 · Enrico Cerrato13,27 · Thamar Capel Astrua14 · Fabrizio D’Ascenzo15 · Oscar Fabregat‑Andres16 · José Moreu17 · Federico Guerra18 · Jaime Signes‑Costa19 · Francisco Marín20,26 · Danilo Buosenso21 · Alfredo Bardají22 · Sergio Raposeiras‑Roubín23 · Javier Elola24 · Ángel Molino1 · Juan J. Gómez‑Doblas2 · Mohammad Abumayyaleh3 · Álvaro Aparisi4 · María Molina5 · Asunción Guerri6 · Ramón Arroyo‑Espliguero7 · Emilio Assanelli8 · Massimo Mapelli8,25 · José M. García‑Acuña9 · Gaetano Brindicci10 · Edoardo Manzone11 · María E. Ortega‑Armas12 · Matteo Bianco13 · Chinh Pham Trung14 · María José Núñez1 · Carmen Castellanos‑Lluch19 · Elisa García‑Vázquez20,26 · Noemí Cabello‑Clotet1 · Karim Jamhour‑Chelh23 · María J. Tellez1 · Antonio Fernández‑Ortiz1 · Carlos Macaya1 on behalf of HOPE COVID-19 Investigators Received: 11 May 2020 / Accepted: 15 October 2020 © Società Italiana di Medicina Interna (SIMI) 2020 Abstract 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-ORhydroxychloroquine 0.88; 95% CI 0.81–0.91, p = 0.005; adjusted-ORantiviral 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. Iván J. Núñez-Gil, Cristina Fernández-Pérez and Vicente Estrada contributed equally to this work. The members of Hope COVID-19 investigators, scientific committee and Collaborators are listed in..