Factors associated with mortality in patients hospitalized for COVID-19 in Spain. Data from the RERFAR registry

• Published in: Farmacia hospitalaria Vol. 46; no. 2; pp. 57 - 71
• Main Authors: de Labry-Lima, Antonio Olry, la Fuente, Javier Saez-de, Martin, Laila Abdel-Kader, Rey, Emilio Jesús Alegre-del, García-Cabrera, Emilio, Sierra-Sánchez, Jesús F.
• Format: Journal Article
• Language: English; Spanish
• Published: Spain Elsevier España, S.L.U 01-03-2022
• Subjects: 2019-nCoV; Coronavirus; COVID-19; España; Humans; Mortalidad; Mortality; Prospective Studies; Registries; Retrospective Studies; SARS-CoV-2; Spain; Spain - epidemiology; Spain; COVID-19; SARS-CoV-2; Coronavirus; Mortality; Mortalidad; España; 2019-nCoV; Spain
• ISSN: 1130-6343; 2171-8695
• DOI: 10.7399/fh.11714

To determine the baseline characteristics associated with higher mortality at 42 days in patients hospitalized for COVID-19 in Spain.
The study analyzed a prospective cohort of hospitalized COVID-19 patients. The dependent variable was 42-day mortality. Data on the subjects’ demographic and clinical characteristics, comorbidities, usual therapy and supportive interventions and treatments was collected within 48 hours from admission. To determine the potential association of the data with mortality, a multivariate analysis was performed using logistic regression.
15,628 patients were included, 18.2% of whom (n = 2,806) died during the study period. According to the multivariate analysis, the variables that were significantly associated (p < 0.05) with mortality upon admission were: being referred from a nursing home (OR 1.9); having a high respiratory rate (OR 1,5); having moderate (OR 1.7) or severe (OR 2.9) pneumonia (CURB-65); aspartate aminotransferase transaminase ≥ 100 IU/1 (OR 2.1); lactate dehydrogenase ≥ 360 IU/L (OR 1.6); procalcitonin > 0.5 ng/mL (OR 1.8); creatine kinase ≥ 294 U/L (OR 1.5); D-dimer > 3,000 ng/mL (OR 1.5); hemoglobin < 11.6 g/dL (OR 1.4) and C-reactive protein > 120 mg/L (OR 1.2; requiring respiratory support within the first 48 hours (oxygen therapy [OR 2.0], non-invasive ventilation [OR 2.8], and mechanical ventilation [OR 3.5]); and being treated with interferon-beta (OR 1.5). On the contrary, being under 80 years of age was associated with lower mortality.
The analysis, based on the data in the RERFAR registry, showed that the factors associated with poorer prognosis were older age, assessed using the CURB-65 scale, level of respiratory support required, severe pneumonia (CURB-65), hypertransaminasemia, elevated creatine kinase, lactate dehydrogenase, and D-dimer levels, anemia, and elevated respiratory rate.
Determinar las características basales que se asocian a una mayor mortalidad a los 42 días en aquellos pacientes hospitalizados por COVID-19 en España.
Cohorte prospectiva de pacientes COVID-19 hospitalizados. La variable dependiente fue la mortalidad a los 42 días. Además, se recogieron características demográficas, clínicas, comorbilidades, tratamiento habitual, intervenciones de soporte y tratamientos en las primeras 48 horas del ingreso. Para determinar la asociación con la mortalidad, se realizó un análisis multivariante mediante regresión logística.
Se incluyeron 15.628 pacientes, de ellos falleció el 18,2% (n = 2.806). El análisis multivariante mostró que las variables asociadas significativamente (p < 0,05) con la mortalidad al ingreso fueron: proceder de un centro sociosanitario (odds ratio OR 1,9), frecuencia respiratoria (odds ratio 1,5), gravedad de neumonía (CURB-65) moderada (odds ratio 1,7) o alta (odds ratio 2,9), transaminasa aspartato aminotransferasa ≥ 100 U/l (odds ratio 2,1), lactato-deshidrogenasa ≥ 360 UI/l (odds ratio 1,6), procalcitonina > 0,5 ng/ml (odds ratio 1,8), creatina-quinasa ≥ 294 U/l (odds ratio 1,5), dímero D > 3.000 ng/ml (odds ratio 1,5), hemoglobina < 11,6 g/dl (odds ratio 1,4) y proteina C reactiva > 120 mg/l (odds ratio 1,2), necesidad de soporte respiratorio en las primeras 48 horas (odds ratio 2,0 de oxigenoterapia; odds ratio 2,8 ventilación no invasiva y odds ratio 3,5 ventilación mecánica) y tratamiento con interferón-beta (odds ratio 1,5). Por el contrario, ser menor de 80 años se asoció a una menor mortalidad.
El análisis del Registro Español de Resultados de Farmacoterapia frente a COVID-19 muestra que los factores asociados a peor pronóstico son: mayor edad, valoración mediante la escala CURB-65, el nivel de requerimiento de soporte respiratorio, neumonía grave (CURB-65), hipertransaminasemia, elevación de creatina-quinasa, lactato-deshidroge- nasa, y dímero-D, anemia y elevación de la frecuencia respiratoria.