Characteristics and Outcomes by Ceiling of Care of Subjects Hospitalized with COVID-19 During Four Waves of the Pandemic in a Metropolitan Area: A Multicenter Cohort Study.
Por:
Pallarès N, Tebé C, Abelenda-Alonso G, Rombauts A, Oriol I, Simonetti AF, Rodríguez-Molinero A, Izquierdo E, Diaz de Brito V, Molist G, Gómez Melis G, Carratalà J and Videla S
Publicada:
1 ene 2023
Ahead of Print:
10 dic 2022
Resumen:
INTRODUCTION: The profiles of patients with COVID-19 have been widely studied, but little is known about differences in baseline characteristics and in outcomes between subjects with a ceiling of care assigned at hospital admission and subjects without a ceiling of care. The aim of this study is to compare, by ceiling of care, clinical features and outcomes of hospitalized subjects during four waves of COVID-19 in a metropolitan area in Catalonia. METHODS: Observational study conducted during the first (March-April 2020), second (October-November 2020), third (January-February 2021), and fourth wave (July-August 2021) of COVID-19 in five centers of Catalonia. All subjects were adults (> 18 years old) hospitalized with a proven SARS-CoV-2 infection and with therapeutic ceiling of care assessed by the attending physician at hospital admission. RESULTS: A total of 5813 subjects were analyzed. Subjects with a ceiling of care were mainly older (difference in median age of 20 years), with more comorbidities (Charlson index 3 points higher) and with fewer clinical signs at baseline than patients without a ceiling of care. Some features of their clinical profiles changed among waves. There were differences in treatments received during hospital admission across waves, but not between subjects with and without a ceiling of care. Subjects with a ceiling of care had a death incidence more than four times the death incidence of subjects a without a ceiling of care (risk ratio (RR) ranging from 3.5 in the first wave to almost 6 in the third and fourth). Incidence of severe pneumonia and complications for subjects with a ceiling of care was around 1.5 times the incidence in subjects without a ceiling of care. DISCUSSION: Analysis of hospitalized subjects with SARS-CoV-2 infection should be stratified according to therapeutic ceiling of care to avoid bias and outcome misestimation.
Filiaciones:
Pallarès N:
Biostatistics Unit of the Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Avinguda de la Granvia de l'Hospitalet, 199, 08908, Barcelona, Spain
Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
Tebé C:
Biostatistics Unit of the Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Avinguda de la Granvia de l'Hospitalet, 199, 08908, Barcelona, Spain.
Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
Abelenda-Alonso G:
Department of Infectious Diseases, Bellvitge University Hospital, Barcelona, Spain
Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
Rombauts A:
Department of Infectious Diseases, Bellvitge University Hospital, Barcelona, Spain
Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
Oriol I:
Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
Department of Internal Medicine, Consorci Sanitari Integral, Barcelona, Spain
Simonetti AF:
CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
Department of Internal Medicine, Consorci Sanitari Alt Penedès Garraf, Barcelona, Spain
Rodríguez-Molinero A:
Research Area, Consorci Sanitari Alt Penedès Garraf, Barcelona, Spain
Izquierdo E:
Department of Anaesthesiology, Viladecans Hospital, Barcelona, Spain
Diaz de Brito V:
Department Infectious Diseases, Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain
Molist G:
Biostatistics Unit of the Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Avinguda de la Granvia de l'Hospitalet, 199, 08908, Barcelona, Spain
Gómez Melis G:
Department of Statistics and Operations Research, Universitat Politècnica de Catalunya/Barcelonatech, Barcelona, Spain
Carratalà J:
Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
Department of Infectious Diseases, Bellvitge University Hospital, Barcelona, Spain
Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
Videla S:
Department of Clinical Pharmacology, Bellvitge University Hospital, Barcelona, Spain
Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
gold, Green Published
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