Pérez-García Carlos Nicolás, Enríquez-Vázquez Daniel, Méndez-Bailón Manuel, Olmos Carmen, Gómez-Polo Juan Carlos, Iguarán Rosario, Ramos-López Noemí, García-Klepzig José Luis, Ferrández-Escarabajal Marcos, Jerónimo Adrián, Martínez-Gómez Eduardo, Font-Urgelles Judit, Fragiel-Saavedra Marcos, Paz-Arias Pilar, Romero-Delgado Teresa, Gómez-Álvarez Zaira, Playán-Escribano Julia, Jaén Esther, Vargas Gianna, González Elizabeth, Orviz Eva, Burruezo Irene, Calvo Alberto, Nieto Ángel, Molino Ángel, Lorenzo-Villalba Noël, Andrès Emmanuel, Macaya Carlos, Vilacosta Isidre
Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain.
Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain.
J Clin Med. 2021 Feb 18;10(4):825. doi: 10.3390/jcm10040825.
The worldwide pandemic, coronavirus disease 2019 (COVID-19) is a novel infection with serious clinical manifestations, including death. Our aim is to describe the first non-ICU Spanish deceased series with COVID-19, comparing specifically between unexpected and expected deaths. In this single-centre study, all deceased inpatients with laboratory-confirmed COVID-19 who had died from March 4 to April 16, 2020 were consecutively included. Demographic, clinical, treatment, and laboratory data, were analyzed and compared between groups. Factors associated with unexpected death were identified by multivariable logistic regression methods. In total, 324 deceased patients were included. Median age was 82 years (IQR 76-87); 55.9% males. The most common cardiovascular risk factors were hypertension (78.4%), hyperlipidemia (57.7%), and diabetes (34.3%). Other common comorbidities were chronic kidney disease (40.1%), chronic pulmonary disease (30.3%), active cancer (13%), and immunosuppression (13%). The Confusion, BUN, Respiratory Rate, Systolic BP and age ≥65 (CURB-65) score at admission was >2 in 40.7% of patients. During hospitalization, 77.8% of patients received antivirals, 43.3% systemic corticosteroids, and 22.2% full anticoagulation. The rate of bacterial co-infection was 5.5%, and 105 (32.4%) patients had an increased level of troponin I. The median time from initiation of therapy to death was 5 days (IQR 3.0-8.0). In 45 patients (13.9%), the death was exclusively attributed to COVID-19, and in 254 patients (78.4%), both COVID-19 and the clinical status before admission contributed to death. Progressive respiratory failure was the most frequent cause of death (92.0%). Twenty-five patients (7.7%) had an unexpected death. Factors independently associated with unexpected death were male sex, chronic kidney disease, insulin-treated diabetes, and functional independence. This case series provides in-depth characterization of hospitalized non-ICU COVID-19 patients who died in Madrid. Male sex, insulin-treated diabetes, chronic kidney disease, and independency for activities of daily living are predictors of unexpected death.
2019冠状病毒病（COVID-19）这一全球大流行疾病是一种具有严重临床表现（包括死亡）的新型感染病。我们的目的是描述西班牙首个非重症监护病房（ICU）的COVID-19死亡病例系列，特别比较意外死亡和预期死亡情况。在这项单中心研究中，连续纳入了所有于2020年3月4日至4月16日期间死亡的实验室确诊COVID-19住院患者。对各组的人口统计学、临床、治疗及实验室数据进行了分析和比较。通过多变量逻辑回归方法确定与意外死亡相关的因素。总共纳入了324例死亡患者。中位年龄为82岁（四分位间距76 - 87岁）；男性占55.9%。最常见的心血管危险因素为高血压（78.4%）、高脂血症（57.7%）和糖尿病（34.3%）。其他常见合并症为慢性肾脏病（40.1%）、慢性肺病（30.3%）、活动性癌症（13%）和免疫抑制（13%）。入院时意识模糊、血尿素氮、呼吸频率、收缩压及年龄≥65岁（CURB - 65）评分>2分的患者占40.7%。住院期间，77.8%的患者接受了抗病毒药物治疗，43.3%接受了全身用糖皮质激素治疗，22.2%接受了充分抗凝治疗。细菌合并感染率为5.5%，105例（32.4%）患者肌钙蛋白I水平升高。从开始治疗到死亡的中位时间为5天（四分位间距3.0 - 8.0天）。45例患者（13.9%）的死亡完全归因于COVID-19，254例患者（78.4%）的死亡是COVID-19和入院前临床状况共同导致的。进行性呼吸衰竭是最常见的死亡原因（92.0%）。25例患者（7.7%）意外死亡。与意外死亡独立相关的因素为男性、慢性肾脏病、胰岛素治疗的糖尿病和功能独立。该病例系列对马德里死亡的非ICU COVID-19住院患者进行了深入描述。男性、胰岛素治疗的糖尿病、慢性肾脏病和日常生活活动独立是意外死亡的预测因素。
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