Risk factors associated with mortality in hospitalized patients with SARS-CoV-2 infection. A prospective, longitudinal, unicenter study in Reus, Spain

Abstract

Spain is one of the countries that has suffered the most from the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the strain that causes coronavirus disease 2019 (COVID-19). However, there is a lack of information on the characteristics of this disease in the Spanish population. The objective of this study has been to characterize our patients from an epidemiological point of view and to identify the risk factors associated with mortality in our geographical area. We performed a prospective, longitudinal study on 188 hospitalized cases of SARS-Cov-2 infection in Hospital Universitari de Sant Joan, in Reus, Spain, admitted between 15th March 2020 and 30th April 2020. We recorded demographic data, signs and symptoms and comorbidities. We also calculated the Charlson and McCabe indices. A total of 43 deaths occurred during the study period. Deceased patients were older than the survivors (77.7 ± 13.1 vs. 62.8 ± 18.4 years; p < 0.001). Logistic regression analyses showed that fever, pneumonia, acute respiratory distress syndrome, diabetes mellitus and cancer were the variables that showed independent and statistically significant associations with mortality. The Charlson index was more efficient than the McCabe index in discriminating between deceased and survivors. This is one of the first studies to describe the factors associated with mortality in patients infected with SARS-CoV-2 in Spain, and one of the few in the Mediterranean area. We identified the main factors independently associated with mortality in our population. Further studies are needed to complete and confirm our findings.

Fig 1. Flow chart showing the distribution of hospitalized patients and the evolution of their disease.

DIM, Department of Internal Medicine; ICU, Intensive Care Unit; SHU, Social Health Unit.

Fig 2. Distribution of ages, clinical variables, and risk factors among patients with SARS-CoV-2 infection.

The numbers above the bars indicate the number of deceased patients. AKF, acute kidney failure; ARDS, acute respiratory distress syndrome; CKD, chronic kidney disease; CLD, chronic liver disease; CLUD, chronic lung disease; CND, chronic neurological disease; CVD, cardiovascular disease; NFD, non-fatal disease; RFD, rapidly fatal disease; T2DM, type 2 diabetes mellitus; UFD, ultimately fatal disease.

Fig 3. Receiver operating characteristics (ROC) plots of Charlson and McCabe indices in COVID-19 patients and segregated with respect to mortality.

AUC, area under the curve.