Trends in mortality of hospitalised COVID-19 patients: A single centre observational cohort study from Spain
Background: We aimed to describe changes in characteristics and treatment strategies of hospitalised patients with COVID-19 and detail the mortality trend over time. Methods: Observational cohort study of all consecutive patients admitted ≥ 48 h to Hospital Clinic of Barcelona for COVID-19 (1 March–...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-04-01
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| Series: | The Lancet Regional Health. Europe |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666776221000181 |
| _version_ | 1818936898293334016 |
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| author | Carolina Garcia-Vidal Alberto Cózar-Llistó Fernanda Meira Gerard Dueñas Pedro Puerta-Alcalde Catia Cilloniz Nicole Garcia-Pouton Mariana Chumbita Celia Cardozo Marta Hernández Verónica Rico Marta Bodro Laura Morata Pedro Castro Alex Almuedo-Riera Felipe García Josep Mensa José Antonio Martínez Gemma Sanjuan Antoni Torres JM Nicolás Alex Soriano |
| author_facet | Carolina Garcia-Vidal Alberto Cózar-Llistó Fernanda Meira Gerard Dueñas Pedro Puerta-Alcalde Catia Cilloniz Nicole Garcia-Pouton Mariana Chumbita Celia Cardozo Marta Hernández Verónica Rico Marta Bodro Laura Morata Pedro Castro Alex Almuedo-Riera Felipe García Josep Mensa José Antonio Martínez Gemma Sanjuan Antoni Torres JM Nicolás Alex Soriano |
| author_sort | Carolina Garcia-Vidal |
| collection | DOAJ |
| description | Background: We aimed to describe changes in characteristics and treatment strategies of hospitalised patients with COVID-19 and detail the mortality trend over time. Methods: Observational cohort study of all consecutive patients admitted ≥ 48 h to Hospital Clinic of Barcelona for COVID-19 (1 March–30 September 2020). Findings: A total of 1645 consecutive patients with COVID-19 were assessed over a 7-month period. Overall mortality (≤30 days) was 9.7% (159 patients), 7.7% in patients hospitalised in regular wards and 16.7 % in patients requiring ICU admission. Overall mortality decreased from 11.6% in the first month to 1.4% in the last month, reflecting a progressive, significant downward trend (p for trend <0.001). Patients’ age changed over time, peaking in June. Most changes in the use of antivirals and anti-inflammatory treatments were documented. Age (OR 1.1, CI 1.1–1.12), chronic heart disease, (OR 1.7, CI 1.1–2.9), D-dimer>700 ng/mL (OR 2.3, CI 1.3–4.1), ferritin>489 ng/mL (OR 1.9; CI 1.5–3.2), C-RP>7 mg/dL (OR 2.6; CI 1.5–4.6), and shorter duration from symptom onset to hospital admission (OR 1.11; CI 1.04–1.17) were factors associated with 30-day mortality at hospital admission. Conversely, hospital admission in the last months (OR 0.80; CI 0.65–0.98) was significantly associated with lower mortality. Interpretation: In-hospital mortality has decreased in patients with COVID-19 over the last, few months, even though main patient characteristics remain similar. Several changes made when managing patients may explain this decreasing trend. Our study provides current data on mortality of patients hospitalised with COVID-19 that might be useful in establishing quality of standard of care. Funding: EIT Health, European Union´s Horizon 2020 Research and Innovation Programme), EDRD. PPA [CM18/00132], NGP [FI19/00133], and CGV [FIS PI18/01061], have received grants from Ministerio de Sanidad y Consumo, ISCIII. Resumen: Contexto: Nuestro objetivo es describir los cambios en las características y las estrategias de tratamiento de los pacientes hospitalizados por COVID-19, y detallar la tendencia de la mortalidad en el tiempo. Métodos: Estudio observacional de cohortes de todos los pacientes consecutivos, ingresados por COVID-19 durante más de 48 horas, en el Hospital Clínic de Barcelona (del 1 de marzo al 30 de septiembre de 2020). Resultados: Un total de 1645 pacientes consecutivos fueron evaluados durante un período de 7 meses. La mortalidad global (≤30 días) fue del 9.7% (159 pacientes): 7.7% en pacientes hospitalizados en salas convencionales, y 16.7% en pacientes que requirieron ingreso en UCI. La mortalidad global disminuyó del 11.6% en el primer mes al 1.4% en el último mes evaluado, reflejando una progresiva y significativa tendencia a la baja (p para la tendencia <0.001). La edad de los pacientes ha cambiado con el tiempo, habiendo alcanzado su pico en junio. La mayoría de cambios en el uso de antivirales y antiinflamatorios se han documentado. La edad (OR 1.1; CI 1.1–1.12), cardiopatía crónica (OR 1.7; CI 1.1–2.9), dímero-D>700 ng/mL (OR 2.3; CI 1.3–4.1), ferritina>489 ng/mL (OR 1.9; CI 1.5–3.2), PCR>7 mg/dL (OR 2.6; CI 1.5–4.6), y una menor duración desde el inicio de síntomas a la hospitalización (OR 1.11; CI 1.04–1.17) fueron factores asociados a la mortalidad intrahospitalaria a 30 días. Por el contrario, el ingreso hospitalario previo en los últimos meses (OR 0.80; CI 0.65–0.98) se asoció significativamente a una menor mortalidad. Discusión: La mortalidad intrahospitalaria ha disminuido en los pacientes con COVID-19 durante los últimos meses, incluso siendo similares las características de los pacientes. Algunos cambios realizados en el manejo de estos pacientes podrían explicar esta tendencia decreciente. Nuestro estudio aporta datos actualizados en la mortalidad de los pacientes hospitalizados con COVID-19, que podrían ser útiles de cara a establecer unos cuidados estándar de calidad. Financiación: EIT Health, European Union´s Horizon 2020 Research and Innovation Programme, EDRD. PPA [CM18/00132], NGP [FI19/00133] y CGV [FIS PI18/01061], han recibido becas del Ministerio de Sanidad y Consumo, ISCIII. |
| first_indexed | 2024-12-20T05:43:23Z |
| format | Article |
| id | doaj.art-62647ee780a54746aadd6087d3950c3c |
| institution | Directory Open Access Journal |
| issn | 2666-7762 |
| language | English |
| last_indexed | 2024-12-20T05:43:23Z |
| publishDate | 2021-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Europe |
| spelling | doaj.art-62647ee780a54746aadd6087d3950c3c2022-12-21T19:51:23ZengElsevierThe Lancet Regional Health. Europe2666-77622021-04-013100041Trends in mortality of hospitalised COVID-19 patients: A single centre observational cohort study from SpainCarolina Garcia-Vidal0Alberto Cózar-Llistó1Fernanda Meira2Gerard Dueñas3Pedro Puerta-Alcalde4Catia Cilloniz5Nicole Garcia-Pouton6Mariana Chumbita7Celia Cardozo8Marta Hernández9Verónica Rico10Marta Bodro11Laura Morata12Pedro Castro13Alex Almuedo-Riera14Felipe García15Josep Mensa16José Antonio Martínez17Gemma Sanjuan18Antoni Torres19JM Nicolás20Alex Soriano21Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain; Corresponding author.Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, SpainDepartment of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, SpainDepartment of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, SpainDepartment of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, SpainDepartment of Pneumology, Hospital Clinic of Barcelona, Spain; Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, SpainDepartment of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, SpainDepartment of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, SpainDepartment of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, SpainDepartment of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, SpainDepartment of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, SpainDepartment of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, SpainDepartment of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, SpainMedical Intensive Care Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, SpainCentre for Research in International Health (CRESIB), Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, SpainDepartment of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, SpainDepartment of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, SpainDepartment of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, SpainDepartment of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain; Computer System Unit, Hospital Clinic, Barcelona, SpainDepartment of Pneumology, Hospital Clinic of Barcelona, Spain; Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, SpainMedical Intensive Care Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, SpainDepartment of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, C/ Villarroel 170, 08036 Barcelona, SpainBackground: We aimed to describe changes in characteristics and treatment strategies of hospitalised patients with COVID-19 and detail the mortality trend over time. Methods: Observational cohort study of all consecutive patients admitted ≥ 48 h to Hospital Clinic of Barcelona for COVID-19 (1 March–30 September 2020). Findings: A total of 1645 consecutive patients with COVID-19 were assessed over a 7-month period. Overall mortality (≤30 days) was 9.7% (159 patients), 7.7% in patients hospitalised in regular wards and 16.7 % in patients requiring ICU admission. Overall mortality decreased from 11.6% in the first month to 1.4% in the last month, reflecting a progressive, significant downward trend (p for trend <0.001). Patients’ age changed over time, peaking in June. Most changes in the use of antivirals and anti-inflammatory treatments were documented. Age (OR 1.1, CI 1.1–1.12), chronic heart disease, (OR 1.7, CI 1.1–2.9), D-dimer>700 ng/mL (OR 2.3, CI 1.3–4.1), ferritin>489 ng/mL (OR 1.9; CI 1.5–3.2), C-RP>7 mg/dL (OR 2.6; CI 1.5–4.6), and shorter duration from symptom onset to hospital admission (OR 1.11; CI 1.04–1.17) were factors associated with 30-day mortality at hospital admission. Conversely, hospital admission in the last months (OR 0.80; CI 0.65–0.98) was significantly associated with lower mortality. Interpretation: In-hospital mortality has decreased in patients with COVID-19 over the last, few months, even though main patient characteristics remain similar. Several changes made when managing patients may explain this decreasing trend. Our study provides current data on mortality of patients hospitalised with COVID-19 that might be useful in establishing quality of standard of care. Funding: EIT Health, European Union´s Horizon 2020 Research and Innovation Programme), EDRD. PPA [CM18/00132], NGP [FI19/00133], and CGV [FIS PI18/01061], have received grants from Ministerio de Sanidad y Consumo, ISCIII. Resumen: Contexto: Nuestro objetivo es describir los cambios en las características y las estrategias de tratamiento de los pacientes hospitalizados por COVID-19, y detallar la tendencia de la mortalidad en el tiempo. Métodos: Estudio observacional de cohortes de todos los pacientes consecutivos, ingresados por COVID-19 durante más de 48 horas, en el Hospital Clínic de Barcelona (del 1 de marzo al 30 de septiembre de 2020). Resultados: Un total de 1645 pacientes consecutivos fueron evaluados durante un período de 7 meses. La mortalidad global (≤30 días) fue del 9.7% (159 pacientes): 7.7% en pacientes hospitalizados en salas convencionales, y 16.7% en pacientes que requirieron ingreso en UCI. La mortalidad global disminuyó del 11.6% en el primer mes al 1.4% en el último mes evaluado, reflejando una progresiva y significativa tendencia a la baja (p para la tendencia <0.001). La edad de los pacientes ha cambiado con el tiempo, habiendo alcanzado su pico en junio. La mayoría de cambios en el uso de antivirales y antiinflamatorios se han documentado. La edad (OR 1.1; CI 1.1–1.12), cardiopatía crónica (OR 1.7; CI 1.1–2.9), dímero-D>700 ng/mL (OR 2.3; CI 1.3–4.1), ferritina>489 ng/mL (OR 1.9; CI 1.5–3.2), PCR>7 mg/dL (OR 2.6; CI 1.5–4.6), y una menor duración desde el inicio de síntomas a la hospitalización (OR 1.11; CI 1.04–1.17) fueron factores asociados a la mortalidad intrahospitalaria a 30 días. Por el contrario, el ingreso hospitalario previo en los últimos meses (OR 0.80; CI 0.65–0.98) se asoció significativamente a una menor mortalidad. Discusión: La mortalidad intrahospitalaria ha disminuido en los pacientes con COVID-19 durante los últimos meses, incluso siendo similares las características de los pacientes. Algunos cambios realizados en el manejo de estos pacientes podrían explicar esta tendencia decreciente. Nuestro estudio aporta datos actualizados en la mortalidad de los pacientes hospitalizados con COVID-19, que podrían ser útiles de cara a establecer unos cuidados estándar de calidad. Financiación: EIT Health, European Union´s Horizon 2020 Research and Innovation Programme, EDRD. PPA [CM18/00132], NGP [FI19/00133] y CGV [FIS PI18/01061], han recibido becas del Ministerio de Sanidad y Consumo, ISCIII.http://www.sciencedirect.com/science/article/pii/S2666776221000181COVID-19ICU admissionOutcomesMortality |
| spellingShingle | Carolina Garcia-Vidal Alberto Cózar-Llistó Fernanda Meira Gerard Dueñas Pedro Puerta-Alcalde Catia Cilloniz Nicole Garcia-Pouton Mariana Chumbita Celia Cardozo Marta Hernández Verónica Rico Marta Bodro Laura Morata Pedro Castro Alex Almuedo-Riera Felipe García Josep Mensa José Antonio Martínez Gemma Sanjuan Antoni Torres JM Nicolás Alex Soriano Trends in mortality of hospitalised COVID-19 patients: A single centre observational cohort study from Spain The Lancet Regional Health. Europe COVID-19 ICU admission Outcomes Mortality |
| title | Trends in mortality of hospitalised COVID-19 patients: A single centre observational cohort study from Spain |
| title_full | Trends in mortality of hospitalised COVID-19 patients: A single centre observational cohort study from Spain |
| title_fullStr | Trends in mortality of hospitalised COVID-19 patients: A single centre observational cohort study from Spain |
| title_full_unstemmed | Trends in mortality of hospitalised COVID-19 patients: A single centre observational cohort study from Spain |
| title_short | Trends in mortality of hospitalised COVID-19 patients: A single centre observational cohort study from Spain |
| title_sort | trends in mortality of hospitalised covid 19 patients a single centre observational cohort study from spain |
| topic | COVID-19 ICU admission Outcomes Mortality |
| url | http://www.sciencedirect.com/science/article/pii/S2666776221000181 |
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