COVID-19 in hospitalised patients in Spain: a cohort study in Madrid

https://doi.org/10.1016/j.ijantimicag.2020.106249Get rights and content

Highlights

  • Few large series describe the clinical characteristics, outcomes and costs of COVID-19 patients in Western countries.

  • We report our experience with the first 1255 cases receiving anti-COVID-19 treatment at a Spanish hospital.

  • Prevalence of acute respiratory distress syndrome (ARDS) and mortality was high in the early days of the Spanish epidemic.

  • Elderly, diabetes, cardiovascular disease, O2Sat <90%, lymphocytopenia & high CRP were associated with increased risk of death.

  • Treatment costs are high (€0.44 million per 1000 hospitalised patients), attributable to use of tocilizumab for ARDS.

ABSTRACT

Few large series describe the clinical characteristics, outcomes and costs of COVID-19 in Western countries. This cohort reports the first 1255 adult cases receiving anti-COVID-19 treatment at a Spanish hospital (1–24 March 2020). Treatment costs were calculated. A logistic regression model was used to explore risk factors on admission associated with ARDS. A bivariate Cox proportional hazard ratio (HR) model was employed to determine the HR between individual factors and death. We included 1255 patients (median age 65 years; 57.8% male), of which 92.3% required hospitalisation. The prevalence of hypertension, cardiovascular disease and diabetes mellitus (DM) was 45.1%, 31.4% and 19.9%, respectively. Lymphocytopenia (54.8%), elevated alanine aminotransferase (33.0%) and elevated lactate dehydrogenase (58.5%) were frequent. Overall, 36.7% of patients developed ARDS, 10.0% were admitted to an ICU and 21.3% died. The most frequent antiviral combinations were lopinavir/ritonavir plus hydroxychloroquine (44.2%), followed by triple therapy with interferon beta-1b (32.7%). Corticosteroids and tocilizumab were used in 25.3% and 12.9% of patients, respectively. Total cost of anti-COVID-19 agents was €511 825 (€408/patient). By multivariate analysis, risk factors associated with ARDS included older age, obesity, DM, severe hypoxaemia, lymphocytopenia, increased creatine kinase and increased C-reactive protein. In multivariate Cox model, older age (HR 1.07, 95% CI 1.06–1.09), cardiovascular disease (HR 1.34, 95% CI 1.01–1.79), DM (HR 1.45, 95% CI 1.09–1.92), severe hypoxaemia (HR 2.01, 95% CI 1.49–2.72), lymphocytopenia (HR 1.62, 95% CI 1.20–2.20) and increased C-reactive protein (HR 1.04, 95% CI 1.02–1.06) were risk factors for mortality.

Keywords

SARS-CoV-2
COVID-19
Risk factors
Mortality
Costs
Spain

Cited by (0)

View Abstract