COVID-19 in hospitalised patients in Spain: a cohort study in Madrid
Carmen Guadalupe Rodriguez-Gonzalez, Esther Chamorro-De-Vega, Maricela Valerio, Miguel Angel Amor-Garcia, Francisco Tejerina, Milagros Sancho-Gonzalez, Alvaro Narrillos-Moraza, Alvaro Gimenez-Manzorro, Silvia Manrique-Rodriguez, Marina Machado, Maria Olmedo, Vicente Escudero-Vilaplana, Cristina Villanueva-Bueno, Beatriz Torroba-Sanz, Alejandra Melgarejo-Ortuño, Juan Vicente-Valor, Ana Herranz, Emilio Bouza, Patricia Muñoz, Maria Sanjurjo
International Journal of Antimicrobial Agents, doi:10.1016/j.ijantimicag.2020.106249
Few large series describe the clinical characteristics, outcomes and costs of COVID-19 in Western countries. This cohort reports the first 1255 adult cases receiving anti-COVID-19 treatment at a Spanish hospital (1-24 March 2020). Treatment costs were calculated. A logistic regression model was used to explore risk factors on admission associated with ARDS. A bivariate Cox proportional hazard ratio (HR) model was employed to determine the HR between individual factors and death. We included 1255 patients (median age 65 years; 57.8% male), of which 92.3% required hospitalisation. The prevalence of hypertension, cardiovascular disease and diabetes mellitus (DM) was 45.1%, 31.4% and 19.9%, respectively. Lymphocytopenia (54.8%), elevated alanine aminotransferase (33.0%) and elevated lactate dehydrogenase (58.5%) were frequent. Overall, 36.7% of patients developed ARDS, 10.0% were admitted to an ICU and 21.3% died. The most frequent antiviral combinations were lopinavir/ritonavir plus hydroxychloroquine (44.2%), followed by triple therapy with interferon beta-1b (32.7%). Corticosteroids and tocilizumab were used in 25.3% and 12.9% of patients, respectively. Total cost of anti-COVID-19 agents was €511 825 ( €408/patient). By multivariate analysis, risk factors associated with ARDS included older age, obesity, DM, severe hypoxaemia, lymphocytopenia, increased creatine kinase and increased C-reactive protein. In multivariate Cox model, older age (HR 1.07, 95% CI 1.06-1.09), cardiovascular disease (HR 1.34, 95% CI 1.01-1.79), DM (HR 1.45, 95% CI 1.09-1.92), severe hypoxaemia (HR 2.01, 95% CI 1.49-2.72), lymphocytopenia (HR 1.62, 95% CI 1.20-2.20) and increased C-reactive protein (HR 1.04, 95% CI 1.02-1.06) were risk factors for mortality.
Supplementary materials Supplementary material associated with this article can be found, in the online version, at doi: 10.1016/j.ijantimicag.2020. 106249 .
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