Mortality risk assessment in Spain and Italy, insights of the HOPE COVID-19 registry

Identifier:  imarina:9105064

Handle: https://hdl.handle.net/20.500.11797/imarina9105064

Authors:  Nunez-Gil, Ivan J; Fernandez-Perez, Cristina; Estrada, Vicente; Becerra-Munoz, Victor M; El-Battrawy, Ibrahim; Uribarri, Aitor; Fernandez-Rozas, Inmaculada; Feltes, Gisela; Viana-Llamas, Maria C; Trabattoni, Daniela; Lopez-Pais, Javier; Pepe, Martino; Romero, Rodolfo; Castro-Mejia, Alex F; Cerrato, Enrico; Astrua, Thamar Capel; D'Ascenzo, Fabrizio; Fabregat-Andres, Oscar; Moreu, Jose; Guerra, Federico; Signes-Costa, Jaime; Marin, Francisco; Buosenso, Danilo; Bardaji, Alfredo; Raposeiras-Roubin, Sergio; Elola, Javier; Molino, Angel; Gomez-Doblas, Juan J; Abumayyaleh, Mohammad; Aparisi, Alvaro; Molina, Maria; Guerri, Asuncion; Arroyo-Espliguero, Ramon; Assanelli, Emilio; Mapelli, Massimo; Garcia-Acuna, Jose M; Brindicci, Gaetano; Manzone, Edoardo; Ortega-Armas, Maria E; Bianco, Matteo; Trung, Chinh Pham; Nunez, Maria Jose; Castellanos-Lluch, Carmen; Garcia-Vazquez, Elisa; Cabello-Clotet, Noemi; Jamhour-Chelh, Karim; Tellez, Maria J; Fernandez-Ortiz, Antonio; Macaya, Carlos

Abstract:
Recently the coronavirus disease (COVID-19) outbreak has been declared a pandemic. Despite its aggressive extension and significant morbidity and mortality, risk factors are poorly characterized outside China. We designed a registry, HOPE COVID-19 (NCT04334291), assessing data of 1021 patients discharged (dead or alive) after COVID-19, from 23 hospitals in 4 countries, between 8 February and 1 April. The primary end-point was all-cause mortality aiming to produce a mortality risk score calculator. The median age was 68 years (IQR 52-79), and 59.5% were male. Most frequent comorbidities were hypertension (46.8%) and dyslipidemia (35.8%). A relevant heart or lung disease were depicted in 20%. And renal, neurological, or oncological disease, respectively, were detected in nearly 10%. Most common symptoms were fever, cough, and dyspnea at admission. 311 patients died and 710 were discharged alive. In the death-multivariate analysis, raised as most relevant: age, hypertension, obesity, renal insufficiency, any immunosuppressive disease, 02 saturation < 92% and an elevated C reactive protein (AUC = 0.87; Hosmer-Lemeshow test, p > 0.999; bootstrap-optimist: 0.0018). We provide a simple clinical score to estimate probability of death, dividing patients in four grades (I-IV) of increasing probability. Hydroxychloroquine (79.2%) and antivirals (67.6%) were the specific drugs most commonly used. After a propensity score adjustment, the results suggested a slight improvement in mortality rates (adjusted-ORhydroxychloroquine 0.88; 95% CI 0.81-0.91, p = 0.005; adjusted-ORantiviral 0.94; 95% CI 0.87-1.01; p = 0.115). COVID-19 produces important mortality, mostly in patients with comorbidities with respiratory symptoms. Hydroxychloroquine could be associated with survival benefit, but this data need to be confirmed with further trials. Trial Registration: NCT04334291/EUPAS34399.