Characteristics and Outcomes by Ceiling of Care of Subjects Hospitalized with COVID-19 During Four Waves of the Pandemic in a Metropolitan Area: A Multicenter Cohort Study
Introduction The profiles of patients with COVID-19 have been widely studied, but little is known about differences in baseline characteristics and in outcomes between subjects with a ceiling of care assigned at hospital admission and subjects without a ceiling of care. The aim of this study is to compare, by ceiling of care, clinical features and outcomes of hospitalized subjects during four waves of COVID-19 in a metropolitan area in Catalonia. Methods Observational study conducted during the first (March–April 2020), second (October–November 2020), third (January–February 2021), and fourth wave (July–August 2021) of COVID-19 in five centers of Catalonia. All subjects were adults (> 18 years old) hospitalized with a proven SARS-CoV-2 infection and with therapeutic ceiling of care assessed by the attending physician at hospital admission. Results A total of 5813 subjects were analyzed. Subjects with a ceiling of care were mainly older (difference in median age of 20 years), with more comorbidities (Charlson index 3 points higher) and with fewer clinical signs at baseline than patients without a ceiling of care. Some features of their clinical profiles changed among waves. There were differences in treatments received during hospital admission across waves, but not between subjects with and without a ceiling of care. Subjects with a ceiling of care had a death incidence more than four times the death incidence of subjects a without a ceiling of care (risk ratio (RR) ranging from 3.5 in the first wave to almost 6 in the third and fourth). Incidence of severe pneumonia and complications for subjects with a ceiling of care was around 1.5 times the incidence in subjects without a ceiling of care. Discussion Analysis of hospitalized subjects with SARS-CoV-2 infection should be stratified according to therapeutic ceiling of care to avoid bias and outcome misestimation..
| Medienart: |
Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:12 |
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| Enthalten in: |
Infectious diseases and therapy - 12(2022), 1 vom: 10. Dez., Seite 273-289 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Pallarès, Natàlia [VerfasserIn] |
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| Links: |
Volltext [lizenzpflichtig] |
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| Themen: |
COVID-19 |
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| Anmerkungen: |
© The Author(s) 2022 |
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| doi: |
10.1007/s40121-022-00705-w |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
OLC2133502440 |
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| 245 | 1 | 0 | |a Characteristics and Outcomes by Ceiling of Care of Subjects Hospitalized with COVID-19 During Four Waves of the Pandemic in a Metropolitan Area: A Multicenter Cohort Study |
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| 520 | |a Introduction The profiles of patients with COVID-19 have been widely studied, but little is known about differences in baseline characteristics and in outcomes between subjects with a ceiling of care assigned at hospital admission and subjects without a ceiling of care. The aim of this study is to compare, by ceiling of care, clinical features and outcomes of hospitalized subjects during four waves of COVID-19 in a metropolitan area in Catalonia. Methods Observational study conducted during the first (March–April 2020), second (October–November 2020), third (January–February 2021), and fourth wave (July–August 2021) of COVID-19 in five centers of Catalonia. All subjects were adults (> 18 years old) hospitalized with a proven SARS-CoV-2 infection and with therapeutic ceiling of care assessed by the attending physician at hospital admission. Results A total of 5813 subjects were analyzed. Subjects with a ceiling of care were mainly older (difference in median age of 20 years), with more comorbidities (Charlson index 3 points higher) and with fewer clinical signs at baseline than patients without a ceiling of care. Some features of their clinical profiles changed among waves. There were differences in treatments received during hospital admission across waves, but not between subjects with and without a ceiling of care. Subjects with a ceiling of care had a death incidence more than four times the death incidence of subjects a without a ceiling of care (risk ratio (RR) ranging from 3.5 in the first wave to almost 6 in the third and fourth). Incidence of severe pneumonia and complications for subjects with a ceiling of care was around 1.5 times the incidence in subjects without a ceiling of care. Discussion Analysis of hospitalized subjects with SARS-CoV-2 infection should be stratified according to therapeutic ceiling of care to avoid bias and outcome misestimation. | ||
| 650 | 4 | |a Therapeutic ceiling of care | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Cohort studies | |
| 650 | 4 | |a Real-world data | |
| 700 | 1 | |a Tebé, Cristian |4 aut | |
| 700 | 1 | |a Abelenda-Alonso, Gabriela |4 aut | |
| 700 | 1 | |a Rombauts, Alexander |4 aut | |
| 700 | 1 | |a Oriol, Isabel |4 aut | |
| 700 | 1 | |a Simonetti, Antonella F. |4 aut | |
| 700 | 1 | |a Rodríguez-Molinero, Alejandro |4 aut | |
| 700 | 1 | |a Izquierdo, Elisenda |4 aut | |
| 700 | 1 | |a Díaz-Brito, Vicens |4 aut | |
| 700 | 1 | |a Molist, Gemma |4 aut | |
| 700 | 1 | |a Gómez Melis, Guadalupe |4 aut | |
| 700 | 1 | |a Carratalà, Jordi |4 aut | |
| 700 | 1 | |a Videla, Sebastián |4 aut | |
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