학술논문
Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study
Document Type
article
Author
Iván D. Benítez; Jordi de Batlle; Gerard Torres; Jessica González; David de Gonzalo-Calvo; Adriano D.S. Targa; Clara Gort-Paniello; Anna Moncusí-Moix; Adrián Ceccato; Laia Fernández-Barat; Ricard Ferrer; Dario Garcia-Gasulla; Rosario Menéndez; Anna Motos; Oscar Peñuelas; Jordi Riera; Jesús F. Bermejo-Martin; Yhivian Peñasco; Pilar Ricart; María Cruz Martin Delgado; Luciano Aguilera; Alejandro Rodríguez; Maria Victoria Boado Varela; Fernando Suarez-Sipmann; Juan Carlos Pozo-Laderas; Jordi Solé-Violan; Maite Nieto; Mariana Andrea Novo; José Barberán; Rosario Amaya Villar; José Garnacho-Montero; Jose Luis García-Garmendia; José M. Gómez; José Ángel Lorente; Aaron Blandino Ortiz; Luis Tamayo Lomas; Esther López-Ramos; Alejandro Úbeda; Mercedes Catalán-González; Angel Sánchez-Miralles; Ignacio Martínez Varela; Ruth Noemí Jorge García; Nieves Franco; Víctor D. Gumucio-Sanguino; Arturo Huerta Garcia; Elena Bustamante-Munguira; Luis Jorge Valdivia; Jesús Caballero; Elena Gallego; Amalia Martínez de la Gándara; Álvaro Castellanos-Ortega; Josep Trenado; Judith Marin-Corral; Guillermo M Albaiceta; Maria del Carmen de la Torre; Ana Loza-Vázquez; Pablo Vidal; Juan Lopez Messa; Jose M. Añón; Cristina Carbajales Pérez; Victor Sagredo; Neus Bofill; Nieves Carbonell; Lorenzo Socias; Carme Barberà; Angel Estella; Manuel Valledor Mendez; Emili Diaz; Ana López Lago; Antoni Torres; Ferran Barbé
Source
The Lancet Regional Health. Europe, Vol 18, Iss , Pp 100422- (2022)
Subject
Language
English
ISSN
2666-7762
Abstract
Summary: 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