Analysis of clinical characteristics and outcomes in patients with COVID-19 based on a series of 1000 patients treated in Spanish emergency departments
Por:
Gil-Rodrigo A, Miró Ò, Piñera P, Burillo-Putze G, Jiménez S, Martín A, Martín-Sánchez FJ, Jacob J, Guardiola JM, García-Lamberechts EJ, Espinosa B, Martín Mojarro E, González Tejera M, Serrano L, Agüera C, Soy E, Llauger L, Juan MÁ, Palau A, Del Arco C, Rodríguez Miranda B, Maza Vera MT, Martín Quirós A, Tejada de Los Santos L, Ruiz de Lobera N, Iglesias Vela M, Torres Garate R, Alquézar-Arbé A, González Del Castillo J and Llorens P
Publicada:
1 ago 2020
Categoría:
Emergency medicine
Resumen:
Objectives. To describe the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) treated in hospital emergency departments (EDs) in Spain, and to assess associations between characteristics and outcomes.
Methods. Prospective, multicenter, nested-cohort study. Sixty-one EDs included a random sample of all patients diagnosed with COVID-19 between March 1 and April 30,2020. Demographic and baseline health information, including concomitant conditions; clinical characteristics related to the ED visit and complementary test results; and treatments were recorded throughout the episode in the ED. We calculated crude and adjusted odds ratios for risk of in-hospital death and a composite outcome consisting of the following events: intensive care unit admission, orotracheal intubation or mechanical ventilation, or in-hospital death. The logistic regression models were constructed with 3 groups of independent variables: the demographic and baseline health characteristics, clinical characteristics and complementary test results related to the ED episode, and treatments.
Results. The mean (SD) age of patients was 62 (18) years. Most had high- or low-grade fever, dry cough, dyspnea, and diarrhea. The most common concomitant conditions were cardiovascular diseases, followed by respiratory diseases and cancer. Baseline patient characteristics that showed a direct and independent association with worse outcome (death and the composite outcome) were age and obesity. Clinical variables directly associated with worse outcomes were impaired consciousness and pulmonary crackles; headache was inversely associated with worse outcomes. Complementary test findings that were directly associated with outcomes were bilateral lung infiltrates, lymphopenia, a high platelet count, a D-dimer concentration over 500 mg/dL, and a lactate-dehydrogenase concentration over 250 IU/L in blood.
Conclusion. This profile of the clinical characteristics and comorbidity of patients with COVID-19 treated in EDs helps us predict outcomes and identify cases at risk of exacerbation. The information can facilitate preventive measures and improve outcomes.
Filiaciones:
Gil-Rodrigo A:
Servicio de Urgencias, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Elche, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), España
Miró Ò:
Servicio de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
Piñera P:
Servicio de Urgencias, Hospital General Universitario Reina Sofía, Murcia, España
Burillo-Putze G:
Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, España
Jiménez S:
Servicio de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
Martín A:
Servicio de Urgencias, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
Martín-Sánchez FJ:
Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, España
Jacob J:
Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
Guardiola JM:
Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
García-Lamberechts EJ:
Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, España
Espinosa B:
Servicio de Urgencias, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Elche, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), España
Martín Mojarro E:
Servicio de Urgencias, Hospital Santa Tecla, Tarragona, España
:
Servicio de Urgencias, Hospital General de Elche, Alicante, España
Serrano L:
Servicio de Urgencias, Hospital Politécnico La Fe, Valencia, España
Agüera C:
Servicio de Urgencias, Hospital Costa del Sol, Marbella, Málaga, España
Soy E:
Servicio de Urgencias, Hospital Universitari Doctor Josep Trueta, Girona, España
Llauger L:
Servicio de Urgencias, Hospital Universitari de Vic, Barcelona, España
:
Servicio de Urgencias, Hospital Doctor Peset, Valencia, España
Palau A:
Servicio de Urgencias, Hospital Universitari Joan XXIII, Tarragona, España
Del Arco C:
Servicio de Urgencias, Hospital La Princesa, Madrid, España
Rodríguez Miranda B:
Servicio de Urgencias, Hospital Rey Juan Carlos, Madrid, España
Maza Vera MT:
Servicio de Urgencias, Complejo Hospitalario Universitario de Vigo. Hospital Álvaro Cunqueiro de Vigo, Pontevedra, España
Martín Quirós A:
Servcio de Urgencias, Hospital Universitario La Paz, Madrid, España
Tejada de Los Santos L:
Servicio de Urgencias, Complejo Asistencial de Soria, España
Ruiz de Lobera N:
Servicio de Urgencias, Hospital San Pedro, Logroño, España
Iglesias Vela M:
Servicio de Urgencias, Hospital de León, España
Torres Garate R:
Servicio de Urgencias, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
Alquézar-Arbé A:
Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
González Del Castillo J:
Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, España
Llorens P:
Servicio de Urgencias, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Elche, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), España
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