The Lancet Regional Health. Europe (Jul 2022)

Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study

  • 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

Journal volume & issue
Vol. 18
p. 100422

Abstract

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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<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. Funding: ISCIII, UNESPA, CIBERES, FEDER, ESF.

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