Characteristics and predictors of death among 4035 consecutively hospitalized patients with COVID-19 in Spain

Abstract

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 C-reactive 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.

Keywords: COVID-19; Coronavirus; Pneumonia; Respiratory distress syndrome; SARS-CoV-2.

Graphical abstract

Fig. 1

(A) Distribution of hospitalized patients with coronavirus disease 2019 (COVID-19) stratified by age and sex. (B) Mortality of patients with COVID-19 stratified by age and sex.

Fig. 2

Univariable (A) and multivariable (B) Cox proportional hazards model of variables associated with death. CRP, C-reactive protein; eGFR, estimated glomerular filtration rate; INR, international normalized ratio; N/L, neutrophil-to-lymphocyte ratio; WBC, white blood cell count.

Fig. 3

Kaplan-Meier plots for death according to age (A) and sex (B).