Maestre-Muñiz Modesto M, Arias Ángel, Arias-González Laura, Angulo-Lara Basilio, Lucendo Alfredo J
Department of Internal Medicine, Hospital General de Tomelloso, 13700 Ciudad Real, Spain.
Research Unit, Hospital General La Mancha Centro, Alcázar de San Juan, 13600 Ciudad Real, Spain.
J Clin Med. 2021 Jan 16;10(2):318. doi: 10.3390/jcm10020318.
Risk factors for in-hospital mortality from severe coronavirus disease 2019 (COVID-19) infection have been identified in studies mainly carried out in urban-based teaching hospitals. However, there is little data for rural populations attending community hospitals during the first wave of the pandemic.
A retrospective, single-center cohort study was undertaken among inpatients at a rural community hospital in Spain. Electronic medical records of the 444 patients (56.5% males) admitted due to severe SARS-CoV-2 infection during 26 February 2020-31 May 2020 were reviewed.
Mean age was 71.2 ± 14.6 years (rank 22-98), with 69.8% over 65. At least one comorbidity was present in 410 patients (92.3%), with chronic obstructive pulmonary disease (COPD) present in 21.7%. Overall in-hospital mortality was 32%. Multivariate analysis of factors associated with death identified patients' age (with a cumulative effect per decade), COPD as a comorbidity, and respiratory insufficiency at the point of admission. No additional comorbid conditions proved significant. Among analytical values, increased serum creatinine, LDH > 500 mg/dL, thrombocytopenia (<150 × 10/per L), and lymphopenia (<1000 cells/µL) were all independently associated with mortality during admission.
Age remained the major determinant for COVID-19-caused mortality; COPD was the only comorbidity independently associated with in-hospital death, together with respiratory insufficiency and analytical markers at admission.
2019年冠状病毒病（COVID-19）严重感染导致住院死亡的风险因素已在主要于城市教学医院开展的研究中得到确认。然而，在疫情第一波期间，关于农村社区医院就诊人群的数据很少。
在西班牙一家农村社区医院对住院患者进行了一项回顾性单中心队列研究。回顾了2020年2月26日至2020年5月31日期间因严重SARS-CoV-2感染入院的444例患者（男性占56.5%）的电子病历。
平均年龄为71.2±14.6岁（排名第22 - 98），65岁以上者占69.8%。410例患者（92.3%）至少有一种合并症，慢性阻塞性肺疾病（COPD）占21.7%。总体住院死亡率为32%。对与死亡相关因素的多变量分析确定了患者年龄（每十年有累积影响）、COPD作为合并症以及入院时的呼吸功能不全。没有其他合并症被证明具有显著性。在分析指标中，血清肌酐升高、乳酸脱氢酶（LDH）>500 mg/dL、血小板减少（<150×10⁹/L）和淋巴细胞减少（<1000个细胞/µL）均与住院期间死亡率独立相关。
年龄仍然是COVID-19导致死亡的主要决定因素；COPD是唯一与住院死亡独立相关的合并症，同时还有入院时的呼吸功能不全和分析指标。
