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. 2021 Sep 8:95:e202109115.

[Treatment setting, symptomatology, clinical course, severity degree and case-fatality rate in 536 adults over 50 years with laboratory-confirmed COVID-19 in Tarragona, Spain, March-June 2020]

[Article in Spanish]
Ángel Vila-Córcoles  1   2 , Ángel Vila-Rovira  2 , Eva María Satué-Gracia  1   2 , Olga Ochoa-Gondar  1   2 , Cinta de Diego-Cabanes  1 , Immaculada Hospital-Guardiola  1 , María José Forcadell-Peris  1 , Francisco Martín-Luján  1   2 , Josep Basora-Gallisà  2
Affiliations
  • PMID: 34493700
Free article

[Treatment setting, symptomatology, clinical course, severity degree and case-fatality rate in 536 adults over 50 years with laboratory-confirmed COVID-19 in Tarragona, Spain, March-June 2020]

[Article in Spanish]
Ángel Vila-Córcoles et al. Rev Esp Salud Publica. .
Free article

Abstract
in English, Spanish

Objective: Population-based clinical data on COVID-19 is scarce. This study analyzed distinct clinical characteristics of COVID-19 and relationships with lethality among adults.

Methods: Retrospective cohort that included all population ≥50 years with a laboratory-confirmed COVID-19 in Tarragona, Spain, during 01/03/2020-30/06/2020. Treatment setting (outpatient/hospital/nursing-home), pre-existing comorbidities, signs/symptoms, clinical course, severity and lethality (death from any cause in-hospital or within the first 30-day after the diagnosis) were determined. Chi squared and Fisher's test were used to compare percentages.

Results: Of the 536 overall cases (mean age: 74 years; 43.8% male), 150 (28%) were outpatient, 179 (33.4%) were hospitalised and 207 (38.6%) happened in nursing-home/social-health centres. The most prevalent symptoms were fever (57.9%), cough (49.8%), dyspnea (41.5%), general discomfort (36.2%), fatigue (24.4%), diarrhea (19.6%), myalgias (17.3%), headache (14.6%), confusion/lethargy (14.6%), thoracic pain (10%), anosmia (9.8%), disgeusia/ageusia (8.1%) and sore throat (7.7%). Global lethality was 23.1% (1.7% in 50-64 years vs 25.5% in 65-79 years vs 38.7% in ≥80 years, p<0.001; 26.8% in men vs 20.3% in women, p=0.075; 3.3% in outpatient vs 29.6% in hospitalised vs 31.9% in nursing-home/social-health centres, p<0.001). By symptomatology, maximum lethality was observed among patients with confusion/lethargy (77.6%) and minimum among those with ageusia/disgeusia (4.8%), anosmia (3.9%) or myalgias (1.1%). By pre-existing comorbidities, greater lethality happened among patients with neurologic (36.7%), renal (35.4%) and cardiac disease (35.3%).

Conclusions: There was a relatively great lethality of COVID-19 among the general population ≥50 years across the first epidemic wave in the study setting. Increasing age, male sex, nursing-home residence and several signs/symptoms and comorbidities were associated with higher mortality.

Objetivo: Los datos clínicos de ámbito poblacional sobre COVID-19 son escasos. Este estudio analizó distintas características de presentación de la enfermedad y su relación con letalidad en adultos de 50 años y más.

Metodos: Cohorte retrospectiva que incluyó todas las personas mayores o con 50 años con diagnóstico confirmado de COVID-19 en Tarragona del 01/03/2020 al 30/06/2020 (n=536). Se valoró el lugar de atención/tratamiento (ambulatorio/hospital/residencia), las comorbilidades previas, los signos/síntomas de presentación, el curso clínico, la gravedad y la letalidad (muerte por cualquier causa en 30 días post-diagnóstico). Chi cuadrado y test exacto de Fisher se usaron para la comparación de proporciones.

Resultados: De los 536 casos (edad media 74 años, 43,8% varones), 150 (28%) fueron ambulatorios, 179 (33,4%) hospitalizados y 207 (38,6%) ocurrieron en residencias/sociosanitarios. Los síntomas más prevalentes fueron fiebre (57,9%), tos (49,8%), disnea (41,5%, malestar general (36,2%), fatiga (24,4%), diarrea (19,6%), mialgias (17,3%), cefalea (14,6%), confusión/letargia (14,6%), dolor torácico (10%), anosmia (9,8%), disgeusia/ageusia (8,1%) y odinofagia (7,7%). La letalidad global fue 23,1% (1,7% en 50-64 años, 25,5% en 65-79 años y 38,7% en ≥80 años, p<0,001; 26,8% en hombres vs 20,3% en mujeres, p=0,075; 3,3% en ambulatorio/domicilio vs 29,6% en hospitalizados vs 31,9% en residencias/sociosanitarios, p<0,001). Según sintomatología, la máxima letalidad se observó en pacientes con confusión/letargia (77,6%) y la mínima en aquellos con ageusia/disgeusia (4,8%), anosmia (3,9%) o mialgias (1,1%). Según la comorbilidad, la máxima letalidad apareció en pacientes con enfermedad neurológica (36,7%), renal (35,4%) y cardiaca (35,3%).

Conclusiones: Se constata una relativamente alta letalidad de la COVID-19 en la población general mayor o de 50 años durante la primera ola epidémica. La edad avanzada, el sexo varón, la institucionalización y la presencia de algunos signos/síntomas y/o comorbilidades se asociaron con mayor mortalidad.

Keywords: COVID-19; Coronavirus; Lethality; SARS-CoV-2; Spain; Symptoms.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.