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

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 disch...

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Published in:	Internal and emergency medicine Vol. 16; no. 4; pp. 957 - 966
Main Authors:	Núñez-Gil, Iván J., Fernández-Pérez, Cristina, Estrada, Vicente, Becerra-Muñoz, Víctor M., El-Battrawy, Ibrahim, Uribarri, Aitor, Fernández-Rozas, Inmaculada, Feltes, Gisela, Viana-Llamas, María C., Trabattoni, Daniela, López-País, Javier, Pepe, Martino, Romero, Rodolfo, Castro-Mejía, Alex F., Cerrato, Enrico, Astrua, Thamar Capel, D’Ascenzo, Fabrizio, Fabregat-Andres, Oscar, Moreu, José, Guerra, Federico, Signes-Costa, Jaime, Marín, Francisco, Buosenso, Danilo, Bardají, Alfredo, Raposeiras-Roubín, Sergio, Elola, Javier, Molino, Ángel, Gómez-Doblas, Juan J., Abumayyaleh, Mohammad, Aparisi, Álvaro, Molina, María, Guerri, Asunción, Arroyo-Espliguero, Ramón, Assanelli, Emilio, Mapelli, Massimo, García-Acuña, José M., Brindicci, Gaetano, Manzone, Edoardo, Ortega-Armas, María E., Bianco, Matteo, Trung, Chinh Pham, Núñez, María José, Castellanos-Lluch, Carmen, García-Vázquez, Elisa, Cabello-Clotet, Noemí, Jamhour-Chelh, Karim, Tellez, María J., Fernández-Ortiz, Antonio, Macaya, Carlos
Format:	Journal Article
Language:	English
Published:	Cham Springer International Publishing 01-06-2021 Springer Nature B.V
Subjects:	Aged Antiviral agents C-reactive protein Clinical trials Coronary artery disease Coronaviruses Cough COVID-19 COVID-19 - complications COVID-19 - mortality COVID-19 - therapy COVID-19 : diagnosis Dyslipidemia Dyspnea Female Fever Heart diseases Hospitalization Humans Hydroxychloroquine Hypertension Im - Original Immunosuppressive agents Internal Medicine Italy Lung diseases Male management and prognosis Medical prognosis Medicine Medicine & Public Health Middle Aged Morbidity Mortality Multivariate analysis Pandemics Patients Propensity Score Registries Renal insufficiency Respiration Risk Assessment Risk Factors Spain Survival Rate Italy Spain COVID-19 Score Prognosis Registry Mortality
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Summary:	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-OR hydroxychloroquine 0.88; 95% CI 0.81–0.91, p = 0.005; adjusted-OR antiviral 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1828-0447 1970-9366
DOI:	10.1007/s11739-020-02543-5