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

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Intern Emerg Med


. 2020 Nov 9.
doi: 10.1007/s11739-020-02543-5. Online ahead of print.
Mortality risk assessment in Spain and Italy, insights of the HOPE COVID-19 registry


Iv?n J N??ez-Gil ¹ , Cristina Fern?ndez-P?rez ^{2 3} , Vicente Estrada ⁴ , V?ctor M Becerra-Mu?oz ⁵ , Ibrahim El-Battrawy ⁶ , Aitor Uribarri ⁷ , Inmaculada Fern?ndez-Rozas ⁸ , Gisela Feltes ⁹ , Mar?a C Viana-Llamas ¹⁰ , Daniela Trabattoni ¹¹ , Javier L?pez-Pa?s ² , Martino Pepe ¹² , Rodolfo Romero ¹³ , Alex F Castro-Mej?a ¹⁴ , Enrico Cerrato ^{15 16} , Thamar Capel Astrua ¹⁷ , Fabrizio D'Ascenzo ¹⁸ , Oscar Fabregat-Andres ¹⁹ , Jos? Moreu ²⁰ , Federico Guerra ²¹ , Jaime Signes-Costa ²² , Francisco Mar?n ^{23 24} , Danilo Buosenso ²⁵ , Alfredo Bardaj? ²⁶ , Sergio Raposeiras-Roub?n ²⁷ , Javier Elola ³ , ?ngel Molino ⁴ , Juan J G?mez-Doblas ⁵ , Mohammad Abumayyaleh ⁶ , ?lvaro Aparisi ⁷ , Mar?a Molina ⁸ , Asunci?n Guerri ⁹ , Ram?n Arroyo-Espliguero ¹⁰ , Emilio Assanelli ¹¹ , Massimo Mapelli ^{11 28} , Jos? M Garc?a-Acu?a ² , Gaetano Brindicci ¹² , Edoardo Manzone ¹³ , Mar?a E Ortega-Armas ¹⁴ , Matteo Bianco ¹⁵ , Chinh Pham Trung ¹⁷ , Mar?a Jos? N??ez ⁴ , Carmen Castellanos-Lluch ²² , Elisa Garc?a-V?zquez ^{23 24} , Noem? Cabello-Clotet ⁴ , Karim Jamhour-Chelh ²⁷ , Mar?a J Tellez ⁴ , Antonio Fern?ndez-Ortiz ⁴ , Carlos Macaya ⁴ , HOPE COVID-19 Investigators



Affiliations

• PMID: 33165755
• DOI: 10.1007/s11739-020-02543-5

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-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.

Keywords: COVID-19; Mortality; Prognosis; Registry; Score.