TY - JOUR
T1 - Prognostic implications of comorbidity patterns in critically ill COVID-19 patients :
T2 - A multicenter, observational study
AU - Benítez, Iván D.
AU - de Batlle, Jordi
AU - Torres, Gerard
AU - González, Jessica
AU - de Gonzalo Calvo, David
AU - Targa, Adriano D.S.
AU - Gort-Paniello, Clara
AU - Moncusí-Moix, Anna
AU - Ceccato, Adrian
AU - Fernández-Barat, Laia
AU - Ferrer, Ricard
AU - Garcia-Gasulla, Dario
AU - Menéndez, Rosario
AU - Motos, Anna
AU - Peñuelas, Oscar
AU - Riera del Brio, Jordi
AU - Bermejo-Martin, Jesús F..
AU - Peñasco, Yhivian
AU - Ricart, Pilar
AU - Martin Delgado, María Cruz
AU - Aguilera, Luciano
AU - Rodríguez, Alejandro
AU - Boado Varela, Maria Victoria
AU - Suarez-Sipmann, Fernando
AU - Pozo-Laderas, Juan Carlos
AU - Solé-Violan, Jordi
AU - Nieto, Maite
AU - Novo, Mariana Andrea
AU - Barberán, José
AU - Amaya-Villar, Rosario
AU - Garnacho-Montero, José
AU - García-Garmendia, Jose Luis
AU - Gómez, José M.
AU - Lorente, José Ángel
AU - Blandino Ortiz, Aaron
AU - Tamayo Lomas, Luis
AU - López-Ramos, Esther
AU - Úbeda, Alejandro
AU - Catalán-González, Mercedes
AU - Sánchez-Miralles, Angel
AU - Martínez Varela, Ignacio
AU - Jorge García, Ruth Noemí
AU - Franco, Nieves
AU - Gumucio-Sanguino, Víctor D.
AU - Huerta Garcia, Arturo
AU - Bustamante-Munguira, Elena
AU - Valdivia, Luis Jorge
AU - Caballero, Jesús
AU - Gallego, Elena
AU - Martínez de la Gándara, Amalia
AU - Castellanos-Ortega, Álvaro
AU - Trenado Alvarez, Josep
AU - Marin-Corral, Judith
AU - Albaiceta, Guillermo M.
AU - de la Torre, Maria del Carmen
AU - Loza-Vázquez, Ana
AU - Vidal, Pablo
AU - Lopez Messa, Juan
AU - Añón, José Manuel
AU - Carbajales Pérez, Cristina
AU - Sagredo, Victor
AU - Bofill, Neus
AU - Carbonell, Nieves
AU - Socias, Lorenzo
AU - Barberà, Carme
AU - Estella, Angel
AU - Valledor Mendez, Manuel
AU - Diaz Santos, Emilio
AU - López Lago, Ana
AU - Torres, Antoni
AU - Barbé, Ferran
PY - 2022
Y1 - 2022
N2 - The clinical heterogeneity of COVID-19 suggests the existence of different phenotypes with prognostic implications. We aimed to analyze comorbidity patterns in critically ill COVID-19 patients and assess their impact on in-hospital outcomes, response to treatment and sequelae. Multicenter prospective/retrospective observational study in intensive care units of 55 Spanish hospitals. 5866 PCR-confirmed COVID-19 patients had comorbidities recorded at hospital admission; clinical and biological parameters, in-hospital procedures and complications throughout the stay; and, clinical complications, persistent symptoms and sequelae at 3 and 6 months. Latent class analysis identified 3 phenotypes using training and test subcohorts: low-morbidity (n=3385; 58%), younger and with few comorbidities; high-morbidity (n=2074; 35%), with high comorbid burden; and renal-morbidity (n=407; 7%), with chronic kidney disease (CKD), high comorbidity burden and the worst oxygenation profile. Renal-morbidity and high-morbidity had more in-hospital complications and higher mortality risk than low-morbidity (adjusted HR (95% CI): 1.57 (1.34-1.84) and 1.16 (1.05-1.28), respectively). Corticosteroids, but not tocilizumab, were associated with lower mortality risk (HR (95% CI) 0.76 (0.63-0.93)), especially in renal-morbidity and high-morbidity. Renal-morbidity and high-morbidity showed the worst lung function throughout the follow-up, with renal-morbidity having the highest risk of infectious complications (6%), emergency visits (29%) or hospital readmissions (14%) at 6 months (p<0.01). Comorbidity-based phenotypes were identified and associated with different expression of in-hospital complications, mortality, treatment response, and sequelae, with CKD playing a major role. This could help clinicians in day-to-day decision making including the management of post-discharge COVID-19 sequelae. ISCIII, UNESPA, CIBERES, FEDER, ESF.
AB - The clinical heterogeneity of COVID-19 suggests the existence of different phenotypes with prognostic implications. We aimed to analyze comorbidity patterns in critically ill COVID-19 patients and assess their impact on in-hospital outcomes, response to treatment and sequelae. Multicenter prospective/retrospective observational study in intensive care units of 55 Spanish hospitals. 5866 PCR-confirmed COVID-19 patients had comorbidities recorded at hospital admission; clinical and biological parameters, in-hospital procedures and complications throughout the stay; and, clinical complications, persistent symptoms and sequelae at 3 and 6 months. Latent class analysis identified 3 phenotypes using training and test subcohorts: low-morbidity (n=3385; 58%), younger and with few comorbidities; high-morbidity (n=2074; 35%), with high comorbid burden; and renal-morbidity (n=407; 7%), with chronic kidney disease (CKD), high comorbidity burden and the worst oxygenation profile. Renal-morbidity and high-morbidity had more in-hospital complications and higher mortality risk than low-morbidity (adjusted HR (95% CI): 1.57 (1.34-1.84) and 1.16 (1.05-1.28), respectively). Corticosteroids, but not tocilizumab, were associated with lower mortality risk (HR (95% CI) 0.76 (0.63-0.93)), especially in renal-morbidity and high-morbidity. Renal-morbidity and high-morbidity showed the worst lung function throughout the follow-up, with renal-morbidity having the highest risk of infectious complications (6%), emergency visits (29%) or hospital readmissions (14%) at 6 months (p<0.01). Comorbidity-based phenotypes were identified and associated with different expression of in-hospital complications, mortality, treatment response, and sequelae, with CKD playing a major role. This could help clinicians in day-to-day decision making including the management of post-discharge COVID-19 sequelae. ISCIII, UNESPA, CIBERES, FEDER, ESF.
KW - Critical Care
KW - COVID-19
KW - Prognosis
U2 - 10.1016/j.lanepe.2022.100422
DO - 10.1016/j.lanepe.2022.100422
M3 - Article
C2 - 35655660
SN - 2666-7762
VL - 18
JO - The Lancet Regional Health - Europe
JF - The Lancet Regional Health - Europe
ER -