Journal of Clinical Medicine (Feb 2021)

The SADDEN DEATH Study: Results from a Pilot Study in Non-ICU COVID-19 Spanish Patients

  • Carlos Nicolás Pérez-García,
  • Daniel Enríquez-Vázquez,
  • Manuel Méndez-Bailón,
  • Carmen Olmos,
  • Juan Carlos Gómez-Polo,
  • Rosario Iguarán,
  • Noemí Ramos-López,
  • José Luis García-Klepzig,
  • Marcos Ferrández-Escarabajal,
  • Adrián Jerónimo,
  • Eduardo Martínez-Gómez,
  • Judit Font-Urgelles,
  • Marcos Fragiel-Saavedra,
  • Pilar Paz-Arias,
  • Teresa Romero-Delgado,
  • Zaira Gómez-Álvarez,
  • Julia Playán-Escribano,
  • Esther Jaén,
  • Gianna Vargas,
  • Elizabeth González,
  • Eva Orviz,
  • Irene Burruezo,
  • Alberto Calvo,
  • Ángel Nieto,
  • Ángel Molino,
  • Noël Lorenzo-Villalba,
  • Emmanuel Andrès,
  • Carlos Macaya,
  • Isidre Vilacosta

DOI
https://doi.org/10.3390/jcm10040825
Journal volume & issue
Vol. 10, no. 4
p. 825

Abstract

Read online

Introduction: The worldwide pandemic, coronavirus disease 2019 (COVID-19) is a novel infection with serious clinical manifestations, including death. Our aim is to describe the first non-ICU Spanish deceased series with COVID-19, comparing specifically between unexpected and expected deaths. Methods: In this single-centre study, all deceased inpatients with laboratory-confirmed COVID-19 who had died from March 4 to April 16, 2020 were consecutively included. Demographic, clinical, treatment, and laboratory data, were analyzed and compared between groups. Factors associated with unexpected death were identified by multivariable logistic regression methods. Results: In total, 324 deceased patients were included. Median age was 82 years (IQR 76–87); 55.9% males. The most common cardiovascular risk factors were hypertension (78.4%), hyperlipidemia (57.7%), and diabetes (34.3%). Other common comorbidities were chronic kidney disease (40.1%), chronic pulmonary disease (30.3%), active cancer (13%), and immunosuppression (13%). The Confusion, BUN, Respiratory Rate, Systolic BP and age ≥65 (CURB-65) score at admission was >2 in 40.7% of patients. During hospitalization, 77.8% of patients received antivirals, 43.3% systemic corticosteroids, and 22.2% full anticoagulation. The rate of bacterial co-infection was 5.5%, and 105 (32.4%) patients had an increased level of troponin I. The median time from initiation of therapy to death was 5 days (IQR 3.0–8.0). In 45 patients (13.9%), the death was exclusively attributed to COVID-19, and in 254 patients (78.4%), both COVID-19 and the clinical status before admission contributed to death. Progressive respiratory failure was the most frequent cause of death (92.0%). Twenty-five patients (7.7%) had an unexpected death. Factors independently associated with unexpected death were male sex, chronic kidney disease, insulin-treated diabetes, and functional independence. Conclusions: This case series provides in-depth characterization of hospitalized non-ICU COVID-19 patients who died in Madrid. Male sex, insulin-treated diabetes, chronic kidney disease, and independency for activities of daily living are predictors of unexpected death.

Keywords