Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: a multicenter, observational study
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- dc.contributor.author Benítez, Iván D.
- dc.contributor.author Marin Corral, Judith
- dc.contributor.author Barbé, Ferran
- dc.contributor.author CIBERESUCICOVID Project (COV20/00110, ISCIII)
- dc.date.accessioned 2022-12-13T07:37:43Z
- dc.date.available 2022-12-13T07:37:43Z
- dc.date.issued 2022
- dc.description.abstract Background: 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. Methods: 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. Findings: 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). Interpretation: 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.
- dc.format.mimetype application/pdf
- dc.identifier.citation Benítez ID, de Batlle J, Torres G, González J, de Gonzalo-Calvo D, Targa ADS, et. al. Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: a multicenter, observational study. Lancet Reg Health Eur. 2022 May 29; 18: 100422. DOI: 10.1016/j.lanepe.2022.100422
- dc.identifier.doi http://dx.doi.org/10.1016/j.lanepe.2022.100422
- dc.identifier.issn 2666-7762
- dc.identifier.uri http://hdl.handle.net/10230/55115
- dc.language.iso eng
- dc.publisher Elsevier
- dc.rights Copyright © 2022 Benítez ID, de Batlle J, Torres G, González J, de Gonzalo-Calvo D, Targa ADS, et. al. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
- dc.rights.accessRights info:eu-repo/semantics/openAccess
- dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/4.0/
- dc.subject.keyword COVID-19
- dc.subject.keyword Critical Care
- dc.subject.keyword Prognosis
- dc.title Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: a multicenter, observational study
- dc.type info:eu-repo/semantics/article
- dc.type.version info:eu-repo/semantics/publishedVersion