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Vol. 45. Issue 1.
Pages 14-26 (January - February 2021)
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Vol. 45. Issue 1.
Pages 14-26 (January - February 2021)
Original
DOI: 10.1016/j.medine.2020.09.004
Comparison of the demographic characteristics and comorbidities of patients with COVID-19 who died in Spanish hospitals based on whether they were or were not admitted to an intensive care unit
Comparación de las características demográficas y comorbilidad de los pacientes con COVID-19 fallecidos en hospitales españoles, en función de si ingresaron o no en Cuidados Intensivos
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Ò. Miróa,
Corresponding author
omiro@clinic.cat

Corresponding author.
, A. Alquézar-Arbéb, P. Llorensc, F.J. Martín-Sánchezd, S. Jiméneza, A. Martíne, G. Burillo-Putzef, J. Jacobg, E.J. García-Lamberetchsd, P. Piñerah, J. González del Castillod, on behalf of the SIESTA research network
a Servicio de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
b Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
c Servicio de Urgencias, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
d Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
e Servicio de Urgencias, Hospital Universitario de Móstoles, Madrid, Spain
f Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, Spain
g Servicio de Urgencias, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
h Servicio de Urgencias, Hospital General Universitario Reina Sofía, Murcia, Spain
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Tables (3)
Table 1. Demographic characteristics, individual comorbidities, and comorbidity index of the patients with COVID-19 that died, with comparison between those admitted to the ICU versus those not admitted to the ICU prior to death.
Table 2. Treatments and tests during stay in the emergency department in the patients with COVID-19 that died with and without prior admission to the ICU.
Table 3. Results of the sensitivity analysis of the adjusted estimations of the effect of the basal characteristics of the patients with COVID-19 that died upon admission to the ICU before death.
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Abstract
Objective

To describe and compare the demographic characteristics and comorbidities of patients with COVID-19 who died in Spanish hospitals during the 2020 pandemic based on whether they were or were not admitted to an intensive care unit (ICU) prior to death.

Methods

We performed a secondary analysis of COVID-19 patients who died during hospitalization included by 62 Spanish emergency departments in the SIESTA cohort. We collected the demographic characteristics and comorbidities, determined both individually and estimated globally by the Charlson index (ChI). Independent factors related to ICU admission were identified and different analyses of sensitivity were performed to contrast the consistency of the findings of the principal analysis.

Results

We included the 338 patients from the SIESTA cohort that died during hospitalization. Of these, 77 (22.8%) were admitted to an ICU before dying. After multivariate adjustment, 3 out of the 20 basal characteristics analyzed in the present study were independently associated with ICU admission: dementia (no patients with dementia who died were admitted to the ICU: OR=0, 95%CI=not calculable), active cancer (OR=0.07; 95%CI=0.02–0.21) and age (<70 years: OR=1, reference; 70–74 years: OR=0.21; 95%CI=0.08–0.54; 75–79 years: OR=0.21; 95%CI=0.08–0.54; ≥80 years: OR=0.02; 95%CI=0.01–0.05). The probability of ICU admission significantly increased in parallel to the ChI, even after adjustment for age (ChI 0 points: OR=0, reference; ChI 1 point: OR=0.36; 95%CI=0.16–0.83; ChI 2 points: OR=0.36; 95%CI=0.16–0.83; ChI >2 points: OR=0.09; 95%CI=0.04–0.23). The sensitivity analyses showed no gross differences compared to the principal analysis.

Conclusions

The profile of COVID-19 patients who died without ICU admission is similar to that observed in the usual medical practice before the pandemic. The basal characteristics limiting their admission were age and global burden due to comorbidity, especially dementia and active cancer.

Keywords:
COVID-19
Clinical characteristics
Comorbidities
SARS-CoV-2
Emergency departments
Resumen
Objetivo

Describir las características demográficas y de comorbilidad de los pacientes con COVID-19 fallecidos en hospitales españoles durante el brote pandémico de 2020 y compararlas según si ingresaron o no en una Unidad de Cuidados Intensivos (UCI) antes del fallecimiento.

Métodos

Análisis secundario de los pacientes de la cohorte SIESTA (formada por pacientes COVID de 62 hospitales españoles) fallecidos durante la hospitalización. Se recogieron sus características demográficas y comorbilidades, individuales y globalmente, estimadas mediante el índice de comorbilidad de Charlson (ICC). Se identificaron los factores independientes relacionados con ingreso en UCI, y se realizaron diversos análisis de sensibilidad para contrastar la consistencia de los hallazgos del análisis principal.

Resultados

Se incluyeron los 338 pacientes de la cohorte SIESTA fallecidos; de ellos, 77 (22,8%) accedieron a una UCI previamente al fallecimiento. En el análisis multivariable, tres de las 20 características basales analizadas se asociaron independientemente con ingreso en UCI de los pacientes fallecidos: demencia (no hubo pacientes fallecidos con demencia que ingresasen en UCI; OR = 0, IC 95% = no calculable), cáncer activo (OR = 0,07, IC 95% = 0,02-0,21) y edad (<70 años: OR = 1, referencia; 70-74 años: OR = 0,21, IC 95% = 0,08-0,54; 75-79 años: OR = 0,21, IC 95% = 0,08-0,54; ≥ 80 años: OR = 0,02, IC 95% = 0,01-0,05). La probabilidad de ingreso en UCI de los pacientes que fallecieron disminuyó significativamente al aumentar el ICC, incluso tras ajustarla por edad (ICC 0 puntos: OR = 1, referencia; ICC 1 punto: OR = 0,36, IC 95% = 0,16-0,83; ICC 2 puntos: OR = 0,36, IC 95% = 0,16-0,83; ICC > 2 puntos: OR = 0,09, IC 95% = 0,04-0,23). Los análisis de sensibilidad no mostraron diferencias destacables respecto al análisis principal.

Conclusiones

El perfil de los pacientes COVID fallecidos sin ingresar en UCI se ajustó a lo observado en la práctica médica habitual antes de la pandemia, y las características basales que limitaron su ingreso fueron la edad y la carga de comorbilidad global, especialmente la demencia y el cáncer activo.

Palabras clave:
COVID-19
Características clínicas
Comorbilidades
SARS-CoV-2
Servicios de urgencias

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