COVID-19 in hospitalized patients in Spain: a cohort study in Madrid
Retrospective 1255 patients in Spain showing lower mortality with HCQ. Subject to
confounding by indication.
Although the 23% lower mortality is not statistically significant, it is consistent with the significant 22% lower mortality
[18‑27%] from meta analysis of the
232 mortality results to date.
risk of death, 22.8% lower, RR 0.77, p = 0.26, treatment 251 of 1,148 (21.9%), control 17 of 60 (28.3%), NNT 15.
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Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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Rodriguez-Gonzalez et al., 28 Nov 2020, retrospective, Spain, peer-reviewed, 20 authors, average treatment delay 6.0 days.
Abstract: International Journal of Antimicrobial Agents 57 (2021) 106249
Contents lists available at ScienceDirect
International Journal of Antimicrobial Agents
journal homepage: www.elsevier.com/locate/ijantimicag
COVID-19 in hospitalised patients in Spain: a cohort study in Madrid
Carmen Guadalupe Rodriguez-Gonzalez a,b,∗, Esther Chamorro-de-Vega a,b,
Maricela Valerio b,c, Miguel Angel Amor-Garcia a,b, Francisco Tejerina b,c,
Milagros Sancho-Gonzalez b,d, Alvaro Narrillos-Moraza a,b, Alvaro Gimenez-Manzorro a,b,
Silvia Manrique-Rodriguez a,b, Marina Machado b,c, Maria Olmedo b,c,
Vicente Escudero-Vilaplana a,b, Cristina Villanueva-Bueno a,b, Beatriz Torroba-Sanz a,b,
Alejandra Melgarejo-Ortuño a,b, Juan Vicente-Valor a,b, Ana Herranz a,b, Emilio Bouza b,c,e,f,
Patricia Muñoz b,c,e,f, Maria Sanjurjo a,b
a
Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
c
Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
d
Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
e
CIBERES, CIBER Enfermedades Respiratorias, Madrid, Spain
f
Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Spain
b
a r t i c l e
i n f o
Article history:
Received 16 July 2020
Accepted 22 November 2020
Editor: Professor Jeffrey Lipman
Keywords:
SARS-CoV-2
COVID-19
Risk factors
Mortality
Costs
Spain
a b s t r a c t
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.
© 2020 Published by Elsevier Ltd.
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