Clinical characteristics and outcomes of 1,331 patients with COVID-19: HM Spanish Cohort.

OBJECTIVE: Spain is one of the European countries most affected by the COVID-19 pandemic. Epidemiologic studies are warranted to improve the disease understanding, evaluate the care procedure and prepare for futures waves. The aim of the study was to describe epidemiologic characteristics associated with hospitalized patients with COVID-19. METHODS: This real-world, observational, multicenter and retrospective study screened all consecutive patients admitted to 8 Spanish private hospitals. Inclusion criteria: hospitalized adults (age≥18 years old) with clinically and radiologically findings compatible with COVID-19 disease from March 1st to April 5th, 2020. Exclusion criteria: patients presenting negative PCR for SARS-CoV-2 during the first 7 days from hospital admission, transfer to a hospital not belonging to the HM consortium, lack of data and discharge against medical advice in emergency departments. RESULTS: One thousand and three hundred thirty-one COVID-19 patients (medium age 66.9 years old; males n= 841, medium length of hospital stayed 8 days, non-survivors n=233) were analyzed. One hundred and fifteen were admitted to intensive care unit (medium length of stay 16 days, invasive mechanical ventilation n= 95, septic shock n= 37 and renal replacement therapy n= 17). Age, male gender, leukocytes, platelets, oxygen saturation, chronic therapy with steroids and treatment with hydroxychloroquine/azithromycin were independent factors associated with mortality. The proportion of patients that survive and received tocilizumab and steroids were lesser and higher respectively than those that die, but their association was not significant. CONCLUSIONS: Overall crude mortality rate was 17.5%, rising up to 36.5% in the subgroup of patients that were admitted to the intensive care unit. Seven factors impact in hospital mortality. No immunomodulatory intervention were associated with in-hospital mortality.

COVID-19 impact and predictive factors for mortality in cancer patients

Background: SARS-CoV-2 is a novel coronavirus that has been responsible for the largest pandemic in the last century: COVID-19. This disease has widely affected Spain with a high lethality in ancient patients (pts) and with comorbidities. Oncological pts were not an exception. Methods: We evaluated the association between COVID-19 mortality and clinical/laboratory/radiological parameters in cancer pts from March to April 2020 at our institution. Past medical history and COVID-19-related parameters (symptoms, laboratory/x-ray findings and treatments) were retrospectively collected. Univariate analysis (UA) has been done using Fisher exact and U-Mann-Withney test for qualitative and quantitative variables, respectively. Multivariant analysis (MA) has been done using logistic regression. Results: Forty three hospitalized pts were diagnosed with COVID-19;30 pts (69.8%) were symptomatic on admission and 13 pts (30.2%) were hospital-acquired cases. Median age was 68.8 ± 7.8 years. Most part of the pts had gastrointestinal (GI) (13;30.2%), thoracic (Tx) (12;27.9%) and breast (6;14%) cancer. A higher prevalence of Tx tumours compared to our new pts prevalence is observed (9%). Fever was the most common symptom (27;62.8%) and bilateral pneumonia was observed in 24 pts (55.8%). SARS-Co-V-2 PCR was positive in 34 pts (79.1%). Hydroxychloroquine was administered in 35 pts (81.4%), steroids and antiretrovirals in 19 pts (44.1%) and tocilizumab in 12 pts (27.9%). Mortality rate due to COVID-19 was 30.23% (13 pts) and 8 pts could resume oncological treatment. Hypertension (HTA) and previous daily steroids given during last month before admission;as well as performance status, fever, Curb-65, SOFA score and D-Dimer (DD) at admission were associated with COVID-19 mortality in UA. Similarly, high flow oxygen requirements during hospitalization and DD at 72 hours are predictors of mortality. HTA [OR: 8.3 (1-5-70.1)], steroids [OR: 10.7 (1.3 – 143.8)] and fever [OR: 0.09 (0.01 – 0.55)]were also associated in MA. Conclusions: COVID-19 showed a relative higher incidence in pts with Tx and GI tumours. Some clinical and laboratory parameters were found to be predictive factors for mortality as previously reported in non-cancer pts. Further investigations with larger number of pts are needed. Legal entity responsible for the study: HM Hospitales. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

COVID-19 severe pneumonia in cancer patients: Impact and predictive factors

Background: SARS-CoV-2 is a novel coronavirus that has been responsible for the largest pandemic in the last century: COVID-19. Some patients (pts) develop a severe pneumonia with higher mortality rate. Oncological population could be at higher risk. Methods: We evaluated the association between COVID-19 severe pneumonia and clinical/laboratory/radiological parameters in cancer pts admitted to our institution from March to April 2020. We considered a severe pneumonia if the patient required more than 5L supplemental oxygen. Past medical history and COVID-19-related parameters (such as symptoms, laboratory/x-ray findings and specific treatments for the COVID-19) were retrospectively collected. Univariate and multivariate analysis have been done using logistic regression. Results: Forty-three cancer pts were hospitalized with COVID-19 diagnosis;27 pts (62.8%) were male. Median age was 68.8 ± 7.8 years. Most part of the pts had gastrointestinal (13;30.2%), thoracic (12;27.9%) and breast (6;14%) cancer. 33 pts (83.7%) presented pneumonia, which was bilateral in 24 pts (55.8%). Median basal saturation of oxygen (O2) was 92% (87-94.5). Severe pneumonia was observed in 23 pts (53.5%). In these patients, the most common symptoms were dyspnea (16;69.6%), cough (14;60.9%) and fever (11;47.8%). Hydroxychloroquine was administered in 20 pts (87%), antiretrovirals in 14 pts (60.9%), steroids in 13 pts (56.5%) and tocilizumab in 9 pts (39%). Mortality rate due to COVID-19 was 84.6% in pts with severe pneumonia versus 15.4% in the rest of patients (p=0.03). Thoracic cancer and diabetes were associated with severe pneumonia development in univariate analysis. Thoracic cancer [OR: 12.0 (1.8 – 246.5)] was also associated in multivariate analysis. Conclusions: Severe pneumonia was frequent in cancer patients with COVID-19 admitted to our institution and was associated with a high mortality rate. Thoracic tumours were found to be a risk factor for developing severe pneumonia. Further investigations with larger number of pts are needed. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.