La neumología pos-COVID-19

Risk Factors of Mortality in Hospitalized Patients With COVID-19 Applying a Machine Learning Algorithm

Introduction

Risk stratification of patients with COVID-19 can be fundamental to support clinical decision-making and optimize resources. The objective of our study is to identify among the routinely tested clinical and analytical parameters those that would allow us to determine patients with the highest risk of dying from COVID-19.

Material and methods

We carried out a retrospective cohort multicentric study by consecutively, including hospitalized patients with COVID-19 admitted in any of the 11 hospitals in the healthcare network of HM Hospitals-Spain. We collected the clinical, demographic, analytical, and radiological data from the patient's medical records.To assess each of the biomarkers' predictive impact and measure the statistical significance of the variables involved in the analysis, we applied a random forest with a permutation method. We used the similarity measure induced by a previously classification model and adjusted the k-groups clustering algorithm based on the energy distance to stratify patients into a high and low-risk group. Finally, we adjusted two optimal classification trees to have a schematic representation of the cut-off points.

Results

We included 1246 patients (average age of 65.36 years, 62% males). During the study one hundred sixty-eight patients (13%) died. High values of age, D-Dimer, White Blood Cell, Na, CRP, and creatinine represent the factors that identify high-risk patients who would die.

Conclusions

Age seems to be the primary predictor of mortality in patients with SARS-CoV-2 infection, while the impact of acute phase reactants and blood cellularity is also highly relevant.

The Emergence of COVID-19 as a Cause of Death in 2020 and its Effect on Mortality by Diseases of the Respiratory System in Spain: Trends and Their Determinants Compared to 2019

Objective

To analyze the causes of death by diseases of the respiratory system in Spain in 2020, with special interest in COVID-19; also its trends and determinants, and compare them with 2019.

Material and methods

Retrospective cohort study. The coding of all those causes of death by diseases of the respiratory system were regrouped. A descriptive analysis of all deaths and by gender, age, and the 17 Autonomous Communities (CC.AA.) was performed. Also, odds ratios of death in crude and multivariate analysis by logistic regression were estimated.

Results

In Spain in 2020, 60,358 deaths were attributed to "COVID-19 virus identified" and another 14,481 to "COVID-19 virus not identified (suspicious)". Regrouping the specific causes of death, in 2020 the diseases of the respiratory system caused a total of 139,880 deaths, which corresponds to 28.3% of all deaths in Spain. Compared to 2019, an increase of 68.5% was observed. By gender, deaths by diseases of the respiratory system were higher in men (32.0%) than in women (24.6%), although in specific causes the percentage was higher in women with suspected COVID-19, asthma, respiratory insufficiency and other diseases of the respiratory system. Finally, the variables associated with death from COVID-19 in the multivariate analysis were being male, increasing age (maximum at 80 years), completed studies up to secondary level, employed, and single or widowed marital status, although with a marked variation by CC.AA.

Conclusions

In Spain in 2020, COVID-19 produced a large increase (68.5%) in deaths by diseases of the respiratory system compared to the previous year.

Radiological management and follow-up of post-COVID-19 patients

Most of the patients who overcome the SARS-CoV-2 infection do not present complications and do not require a specific follow-up, but a significant proportion (especially those with moderate / severe clinical forms of the disease) require clinicalradiological follow-up. Although there are hardly any references or clinical guidelines regarding the long-term follow-up of post-COVID-19 patients, radiological exams are being performed and monographic surveillance consultations are being set up in most of the hospitals to meet their needs. The purpose of this work is to share our experience in the management of the post-COVID-19 patient in two institutions thathave had a high incidence of COVID-19 and to propose general follow-uprecommendations from a clinical and radiological perspective.

Radiological management and follow-up of post-COVID-19 patients

Most of the patients who overcome the SARS-COV-2 infection do not present complications and do not require a specific follow-up, but a significant proportion (especially those with moderate/severe clinical forms of the disease) require clinicalradiological follow-up. Although there are hardly any references or clinical guidelines regarding the long-term follow-up of post-COVID-19 patients, radiological exams are being performed and monographic surveillance consultations are being set up in most of the hospitals to meet their needs. The purpose of this work is to share our experience in the management of the post-COVID-19 patient in two institutions thathave had a high incidence of COVID-19 and to propose general follow-uprecommendations from a clinical and radiological perspective.