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. 2021 Mar 23;16(3):e0248869.
doi: 10.1371/journal.pone.0248869. eCollection 2021.

Fatality and risk features for prognosis in COVID-19 according to the care approach - a retrospective cohort study

Mariano Andrés  1   2 , Jose-Manuel Leon-Ramirez  3 , Oscar Moreno-Perez  2   4 , José Sánchez-Payá  5 , Ignacio Gayá  3 , Violeta Esteban  3 , Isabel Ribes  6 , Diego Torrus-Tendero  7   8 , Pilar González-de-la-Aleja  6 , Pere Llorens  2   9 , Vicente Boix  2   7 , Joan Gil  3 , Esperanza Merino  7 ; COVID19-ALC research group
Affiliations

Fatality and risk features for prognosis in COVID-19 according to the care approach - a retrospective cohort study

Mariano Andrés et al. PLoS One. .

Abstract

Introduction: This study analyzed the impact of a categorized approach, based on patients' prognosis, on major outcomes and explanators in patients hospitalized for COVID-19 pneumonia in an academic center in Spain.

Methods: Retrospective cohort study (March 3 to May 2, 2020). Patients were categorized according to the followed clinical management, as maximum care or limited therapeutic effort (LTE). Main outcomes were all-cause mortality and need for invasive mechanical ventilation (IMV). Baseline factors associated with outcomes were analyzed by multiple logistic regression, estimating odds ratios (OR; 95%CI).

Results: Thirty-hundred and six patients were hospitalized, median age 65.0 years, 57.8% males, 53.3% Charlson index ≥3. The overall all-cause fatality rate was 15.0% (n = 46). Maximum care was provided in 238 (77.8%), IMV was used in 38 patients (16.0%), and 5.5% died. LTE was decided in 68 patients (22.2%), none received IMV and fatality was 48.5%. Independent risk factors of mortality under maximum care were lymphocytes <790/mm3, troponin T >15ng/L and hypotension. Advanced age, lymphocytes <790/mm3 and BNP >240pg/mL independently associated with IMV requirement.

Conclusion: Overall fatality in the cohort was 15% but markedly varied regarding the decided approach (maximum care versus LTE), translating into nine-fold higher mortality and different risk factors.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of COVID-19 cases evaluated in the hospital.
ICU: intensive care unit, TCZ: tocilizumab.
Fig 2
Fig 2. Epidemic curve of hospitalized patients in the health department during the study period (March 3 –May 2, 2020).
Dates indicate the time of admission.
Fig 3
Fig 3
Independent risk factors of death (A) and invasive mechanical ventilation (B) in the maximum care population. Numbers and percentages of patients with each risk factor who had the outcomes (risk factor present) and of patients without each risk factor with favorable evolution (risk factor absent) are shown. The 95% confidence intervals (CIs) of the odds ratios have been adjusted for multiple testing. R2 of models: 0.55 for mortality, 0.45 for invasive mechanical ventilation. In bold, independent predictors associated with the outcomes. BP: blood pressure; eGFR: estimated glomerular filtration rate (by CKD-EPI formula); *on admission; LDH: lactate dehydrogenase; prot: protein; BNP: Brain natriuretic peptides. Multivariate models included 184 and 186 participants, respectively. A comparison between global population and population with complete data for the included covariates is provided in the S2 Table.
Fig 4
Fig 4. Age and comorbidity—adjusted distribution of fatality among reported hospitalized series with >100 patients and Alicante cohort, stratified according to the management approach.
Size of circles represent the magnitude of fatality rate for each series. LTE: limited therapeutic effort, MC: maximum care.
See this image and copyright information in PMC

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