Comparison of hospitalized COVID-19 and influenza patients requiring supplemental oxygen in a cohort study: clinical impact and resource consumption

López Montesinos, Inmaculada; Arrieta Aldea, Itziar; Dicastillo, Aitor; Zuccarino, Flavio; Sorli Redó, M. Luisa; Güerri Fernández, Roberto; Arnau-Barrés, Isabel; Milagro Montero, Maria; Siverio-Parès, Ana; Duran Jordà, Xavier, 1974-; Arenas-Miras, María Del Mar; Brasé Arnau, Ariadna; Cañas-Ruano, Esperanza; Castañeda, Silvia; Kamber, Ignacio Domingo; Gómez Junyent, Joan; Pelegrín, Iván; Sánchez Martínez, Francisca; Sendra, Elena; Suaya Leiro, Lucía; Villar García, Judit; Nogués Solán, Xavier; Grau Cerrato, Santiago; Knobel Freud, Hernando; Gómez-Zorrilla, Silvia; Horcajada Gallego, Juan Pablo; COVID-MAR Group

doi:http://dx.doi.org/10.1093/cid/ciac314

Comparison of hospitalized COVID-19 and influenza patients requiring supplemental oxygen in a cohort study: clinical impact and resource consumption

Citation

López Montesinos I, Arrieta-Aldea I, Dicastillo A, Zuccarino F, Sorli L, Guerri-Fernández R, et al. Comparison of hospitalized COVID-19 and influenza patients requiring supplemental oxygen in a cohort study: clinical impact and resource consumption. Clin Infect Dis. 2022 Dec 19;75(12):2225-38. DOI: 10.1093/cid/ciac314

Abstract

Background: To compare clinical characteristics, outcomes, and resource consumption of patients with COVID-19 and seasonal influenza requiring supplemental oxygen. Methods: Retrospective cohort study conducted at a tertiary-care hospital. Patients admitted due to seasonal influenza between 2017 and 2019, or with COVID-19 between March and May 2020 requiring supplemental oxygen were compared. Primary outcome: 30-day mortality. Secondary outcomes: 90-day mortality and hospitalization costs. Attempted sample size to detect an 11% difference in mortality was 187 patients per group. Results: COVID-19 cases were younger (median years, 67 (IQR 54-78) vs 76 (IQR 64-83); p < 0.001) and more frequently overweight whereas influenza cases had more hypertension, immunosuppression, and chronic heart, respiratory and renal disease. Compared to influenza, COVID-19 cases had more pneumonia (98% vs 60%, <0.001), higher MEWS and CURB-65 scores and were more likely to show worse progression on the WHO ordinal scale (33% vs 4%; p < 0.001). The 30-day mortality rate was higher for COVID-19 than for influenza: 15% vs 5% (p = 0.001). The median age of non-surviving cases was 81 (IQR 74-88) and 77.5 (IQR 65-84) (p = 0.385), respectively. COVID-19 was independently associated with 30-day (HR 4.6, 95%CI, 2-10.4) and 90-day (HR 5.2, 95%CI, 2.4-11.4) mortality. Sensitivity and subgroup analyses, including a subgroup considering only patients with pneumonia, did not show different trends. Regarding resource consumption, COVID-19 patients had longer hospital stays and higher critical care, pharmacy, and complementary test costs. Conclusions: Although influenza patients were older and had more comorbidities, COVID-19 cases requiring supplemental oxygen on admission had worse clinical and economic outcomes.