Abstract

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.

Details

Title
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
Author
Pallarès, Natàlia 1   VIAFID ORCID Logo  ; Tebé, Cristian 1 ; Abelenda-Alonso, Gabriela 2 ; Rombauts, Alexander 2 ; Oriol, Isabel 3 ; Simonetti, Antonella F. 4 ; Rodríguez-Molinero, Alejandro 5 ; Izquierdo, Elisenda 6 ; Díaz-Brito, Vicens 7 ; Molist, Gemma 8 ; Gómez Melis, Guadalupe 9 ; Carratalà, Jordi 10 ; Videla, Sebastián 11 ; Gudiol, Carlota; Aranda-Lobo, Judit; Arroyo, Marta; Pérez-López, Carlos; Sanmartí, Montserrat; Moreno, Encarna; Alvarez, Maria C. Mª; Faura, Ana; Gónzalez, Martha; Cruz, Paula; Colom, Mireia; Perez, Andrea; Serrano, Laura; Besalú, Mireia; Cobo, Erik; Cortés, Jordi; Fernández, Daniel; Garmendia, Leire; Hereu, Pilar; Langohr, Klaus; Pérez-Álvarez, Núria; Piulachs, Xavier

1  L’Hospitalet de Llobregat, Biostatistics Unit of the Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain (GRID:grid.417656.7); University of Barcelona, Department of Clinical Sciences, School of Medicine and Health Sciences, Barcelona, Spain (GRID:grid.5841.8) (ISNI:0000 0004 1937 0247) 
2  Bellvitge University Hospital, Department of Infectious Diseases, Barcelona, Spain (GRID:grid.411129.e) (ISNI:0000 0000 8836 0780); Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain (GRID:grid.418284.3) (ISNI:0000 0004 0427 2257) 
3  University of Barcelona, Department of Clinical Sciences, School of Medicine and Health Sciences, Barcelona, Spain (GRID:grid.5841.8) (ISNI:0000 0004 1937 0247); Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain (GRID:grid.418284.3) (ISNI:0000 0004 0427 2257); Consorci Sanitari Integral, Department of Internal Medicine, Barcelona, Spain (GRID:grid.418284.3) 
4  CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain (GRID:grid.413448.e) (ISNI:0000 0000 9314 1427); Consorci Sanitari Alt Penedès Garraf, Department of Internal Medicine, Barcelona, Spain (GRID:grid.413448.e) 
5  Consorci Sanitari Alt Penedès Garraf, Research Area, Barcelona, Spain (GRID:grid.413448.e) 
6  Viladecans Hospital, Department of Anaesthesiology, Barcelona, Spain (GRID:grid.413448.e) 
7  Parc Sanitari Sant Joan de Deu, Department Infectious Diseases, Barcelona, Spain (GRID:grid.466982.7) (ISNI:0000 0004 1771 0789) 
8  L’Hospitalet de Llobregat, Biostatistics Unit of the Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain (GRID:grid.417656.7) 
9  Universitat Politècnica de Catalunya/Barcelonatech, Department of Statistics and Operations Research, Barcelona, Spain (GRID:grid.6835.8) (ISNI:0000 0004 1937 028X) 
10  University of Barcelona, Department of Clinical Sciences, School of Medicine and Health Sciences, Barcelona, Spain (GRID:grid.5841.8) (ISNI:0000 0004 1937 0247); Bellvitge University Hospital, Department of Infectious Diseases, Barcelona, Spain (GRID:grid.411129.e) (ISNI:0000 0000 8836 0780); Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain (GRID:grid.418284.3) (ISNI:0000 0004 0427 2257); CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain (GRID:grid.413448.e) (ISNI:0000 0000 9314 1427) 
11  Bellvitge University Hospital, Department of Clinical Pharmacology, Barcelona, Spain (GRID:grid.411129.e) (ISNI:0000 0000 8836 0780); University of Barcelona, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, Barcelona, Spain (GRID:grid.5841.8) (ISNI:0000 0004 1937 0247) 
Pages
273-289
Publication year
2023
Publication date
Jan 2023
Publisher
Springer Nature B.V.
ISSN
21938229
e-ISSN
21936382
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1007/s40121-022-00705-w
ProQuest document ID
2867127835
Copyright
© The Author(s) 2022. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.