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Núñez-Gil IJ, Fernández-Pérez C, Estrada V, Becerra-Muñoz VM, El-Battrawy I, Uribarri A, Fernández-Rozas I, Feltes G, Viana-Llamas MC, Trabattoni D, López-País J, Pepe M, Romero R, Castro-Mejía AF, Cerrato E, Astrua TC, D'Ascenzo F, Fabregat-Andres O, Moreu J, Guerra F, Signes-Costa J, Marín F, Buosenso D, Bardají A, Raposeiras-Roubín S, Elola J, Molino Á, Gómez-Doblas JJ, Abumayyaleh M, Aparisi Á, Molina M, Guerri A, Arroyo-Espliguero R, Assanelli E, Mapelli M, García-Acuña JM, Brindicci G, Manzone E, Ortega-Armas ME, Bianco M, Trung CP, Núñez MJ, Castellanos-Lluch C, García-Vázquez E, Cabello-Clotet N, Jamhour-Chelh K, Tellez MJ, Fernández-Ortiz A, Macaya C. Mortality risk assessment in Spain and Italy, insights of the HOPE COVID-19 registry. Intern Emerg Med 2021; 16:957-966. [PMID: 33165755 PMCID: PMC7649104 DOI: 10.1007/s11739-020-02543-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/15/2020] [Indexed: 01/08/2023]
Abstract
Recently the coronavirus disease (COVID-19) outbreak has been declared a pandemic. Despite its aggressive extension and significant morbidity and mortality, risk factors are poorly characterized outside China. We designed a registry, HOPE COVID-19 (NCT04334291), assessing data of 1021 patients discharged (dead or alive) after COVID-19, from 23 hospitals in 4 countries, between 8 February and 1 April. The primary end-point was all-cause mortality aiming to produce a mortality risk score calculator. The median age was 68 years (IQR 52-79), and 59.5% were male. Most frequent comorbidities were hypertension (46.8%) and dyslipidemia (35.8%). A relevant heart or lung disease were depicted in 20%. And renal, neurological, or oncological disease, respectively, were detected in nearly 10%. Most common symptoms were fever, cough, and dyspnea at admission. 311 patients died and 710 were discharged alive. In the death-multivariate analysis, raised as most relevant: age, hypertension, obesity, renal insufficiency, any immunosuppressive disease, 02 saturation < 92% and an elevated C reactive protein (AUC = 0.87; Hosmer-Lemeshow test, p > 0.999; bootstrap-optimist: 0.0018). We provide a simple clinical score to estimate probability of death, dividing patients in four grades (I-IV) of increasing probability. Hydroxychloroquine (79.2%) and antivirals (67.6%) were the specific drugs most commonly used. After a propensity score adjustment, the results suggested a slight improvement in mortality rates (adjusted-ORhydroxychloroquine 0.88; 95% CI 0.81-0.91, p = 0.005; adjusted-ORantiviral 0.94; 95% CI 0.87-1.01; p = 0.115). COVID-19 produces important mortality, mostly in patients with comorbidities with respiratory symptoms. Hydroxychloroquine could be associated with survival benefit, but this data need to be confirmed with further trials. Trial Registration: NCT04334291/EUPAS34399.
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Affiliation(s)
- Iván J Núñez-Gil
- Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Prof Martin Lagos St., 28040, Madrid, Spain.
| | - Cristina Fernández-Pérez
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain
| | - Vicente Estrada
- Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Prof Martin Lagos St., 28040, Madrid, Spain
| | - Víctor M Becerra-Muñoz
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de La Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | | | - Aitor Uribarri
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | | | | | - Javier López-País
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Martino Pepe
- Azienda Ospedaliero-Universitaria Consorziale Policlinico Di Bari, Bari, Italy
| | | | | | - Enrico Cerrato
- Cardiology Division, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
- Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | | | | | | | - José Moreu
- Complejo hospitalario de Toledo, Toledo, Spain
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Ospedali Riuniti "Umberto I-Lancisi-Salesi", Ancona, Italy
| | - Jaime Signes-Costa
- Hospital Clínico Universitario, Incliva, Universidad de Valencia, Valencia, Spain
| | - Francisco Marín
- Hospital Clinico Universitario Virgen de la Arreixaca, Murcia, Spain
- IMIB-Arreixaca, Universidad de Murcia, Murcia, Spain
| | - Danilo Buosenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Javier Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain
| | - Ángel Molino
- Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Prof Martin Lagos St., 28040, Madrid, Spain
| | - Juan J Gómez-Doblas
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de La Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | | | - Álvaro Aparisi
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | | | | | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - José M García-Acuña
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Gaetano Brindicci
- Azienda Ospedaliero-Universitaria Consorziale Policlinico Di Bari, Bari, Italy
| | | | | | - Matteo Bianco
- Cardiology Division, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | | | - María José Núñez
- Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Prof Martin Lagos St., 28040, Madrid, Spain
| | | | - Elisa García-Vázquez
- Hospital Clinico Universitario Virgen de la Arreixaca, Murcia, Spain
- IMIB-Arreixaca, Universidad de Murcia, Murcia, Spain
| | - Noemí Cabello-Clotet
- Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Prof Martin Lagos St., 28040, Madrid, Spain
| | | | - María J Tellez
- Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Prof Martin Lagos St., 28040, Madrid, Spain
| | - Antonio Fernández-Ortiz
- Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Prof Martin Lagos St., 28040, Madrid, Spain
| | - Carlos Macaya
- Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Prof Martin Lagos St., 28040, Madrid, Spain
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Pérez-García CN, Enríquez-Vázquez D, Méndez-Bailón M, Olmos C, Gómez-Polo JC, Iguarán R, Ramos-López N, García-Klepzig JL, Ferrández-Escarabajal M, Jerónimo A, Martínez-Gómez E, Font-Urgelles J, Fragiel-Saavedra M, Paz-Arias P, Romero-Delgado T, Gómez-Álvarez Z, Playán-Escribano J, Jaén E, Vargas G, González E, Orviz E, Burruezo I, Calvo A, Nieto Á, Molino Á, Lorenzo-Villalba N, Andrès E, Macaya C, Vilacosta I. The SADDEN DEATH Study: Results from a Pilot Study in Non-ICU COVID-19 Spanish Patients. J Clin Med 2021; 10:jcm10040825. [PMID: 33670462 PMCID: PMC7922313 DOI: 10.3390/jcm10040825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 12/18/2022] Open
Abstract
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.
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Affiliation(s)
- Carlos Nicolás Pérez-García
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
- Correspondence: ; Tel.: +34-913302712; Fax: +34-913303290
| | - Daniel Enríquez-Vázquez
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Manuel Méndez-Bailón
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Juan Carlos Gómez-Polo
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Rosario Iguarán
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Noemí Ramos-López
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - José Luis García-Klepzig
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Marcos Ferrández-Escarabajal
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Adrián Jerónimo
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Eduardo Martínez-Gómez
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | | | - Marcos Fragiel-Saavedra
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Pilar Paz-Arias
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Teresa Romero-Delgado
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Zaira Gómez-Álvarez
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Julia Playán-Escribano
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Esther Jaén
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Gianna Vargas
- Servicio de Neumología, Hospital Clínico San Carlos, 28040 Madrid, Spain; (G.V.); (E.G.)
| | - Elizabeth González
- Servicio de Neumología, Hospital Clínico San Carlos, 28040 Madrid, Spain; (G.V.); (E.G.)
| | - Eva Orviz
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Irene Burruezo
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Alberto Calvo
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Ángel Nieto
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Ángel Molino
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Noël Lorenzo-Villalba
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (N.L.-V.); (E.A.)
| | - Emmanuel Andrès
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (N.L.-V.); (E.A.)
| | - Carlos Macaya
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
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Durán Botía F, Fernández-Aceñero MJ, Ruiz Adelantado I, de Miguel P, Molino Á, Ortega Medina L. Bone metastasis of papillary thyroid carcinoma simulating a pulmonary origin. Unusual immunohistochemistry leading to misdiagnosis. Rev Esp Patol 2020; 53:264-267. [PMID: 33012498 DOI: 10.1016/j.patol.2019.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/06/2019] [Accepted: 08/15/2019] [Indexed: 06/11/2023]
Abstract
Immunophenotypical features from tumors can be variable and, sometimes, confusing. We herein report a 61 year old woman with two foci of papillary thyroid microcarcinoma who developed a bone lesion four months after total thyroidectomy/central lymphadenectomy (mpT1aN0), with an immunohistochemical pattern suggestive of a pulmonary rather than a thyroid origin (CK7, napsin-A and TTF1 positive; and negative thyroglobulin). Further biomarkers (HBME-1 and PAX8) were performed in order to confirm primary tumor, leading to conclusion of a bone metastasis from thyroid papillary carcinoma. We believe it is always advisable to perform more than one biomarker as part of a panel to get a more reliable diagnosis.
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Affiliation(s)
- Fernando Durán Botía
- Department of Pathology, Hospital Universitario Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain.
| | - María Jesús Fernández-Aceñero
- Department of Pathology, Hospital Universitario Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Irene Ruiz Adelantado
- Department of Pathology, Hospital Universitario Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Paz de Miguel
- Department of Endocrinology, Hospital Universitario Clínico San Carlos, Spain
| | - Ángel Molino
- Department of Internal Medicine, Hospital Universitario Clínico San Carlos, Spain
| | - Luis Ortega Medina
- Department of Pathology, Hospital Universitario Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040 Madrid, Spain
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