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López Montesinos I, Arrieta-Aldea I, Dicastillo A, Zuccarino F, Sorli L, Guerri-Fernández R, Arnau-Barrés I, Milagro Montero M, Siverio-Parès A, Durán X, del Mar Arenas M, Brasé Arnau A, Cañas-Ruano E, Castañeda S, Domingo Kamber I, Gómez-Junyent J, Pelegrín I, Sánchez Martínez F, Sendra E, Suaya Leiro L, Villar-García J, Nogués X, Grau S, Knobel H, Gomez-Zorrilla S, Pablo Horcajada J. Comparison of Hospitalized Coronavirus Disease 2019 and Influenza Patients Requiring Supplemental Oxygen in a Cohort Study: Clinical Impact and Resource Consumption. Clin Infect Dis 2022; 75:2225-2238. [PMID: 35442442 PMCID: PMC9047197 DOI: 10.1093/cid/ciac314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 04/07/2022] [Accepted: 04/15/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND To compare clinical characteristics, outcomes, and resource consumption of patients with coronavirus disease 2019 (COVID-19) and seasonal influenza requiring supplemental oxygen. METHODS Retrospective cohort study conducted at a tertiary-care hospital. Patients admitted because of seasonal influenza between 2017 and 2019, or with COVID-19 between March and May 2020 requiring supplemental oxygen were compared. Primary outcome: 30-day mortality. Secondary outcomes: 90-day mortality and hospitalization costs. Attempted sample size to detect an 11% difference in mortality was 187 patients per group. RESULTS COVID-19 cases were younger (median years of age, 67; interquartile range [IQR] 54-78 vs 76 [IQR 64-83]; P < .001) and more frequently overweight, whereas influenza cases had more hypertension, immunosuppression, and chronic heart, respiratory, and renal disease. Compared with influenza, COVID-19 cases had more pneumonia (98% vs 60%, <.001), higher Modified Early Warning Score (MEWS) and CURB-65 (confusion, blood urea nitrogen, respiratory rate, systolic blood pressure, and age >65 years) scores and were more likely to show worse progression on the World Health Organization ordinal scale (33% vs 4%; P < .001). The 30-day mortality rate was higher for COVID-19 than for influenza: 15% vs 5% (P = .001). The median age of nonsurviving cases was 81 (IQR 74-88) and 77.5 (IQR 65-84) (P = .385), respectively. COVID-19 was independently associated with 30-day (hazard ratio [HR], 4.6; 95% confidence interval [CI], 2-10.4) and 90-day (HR, 5.2; 95% CI, 2.4-11.4) mortality. Sensitivity and subgroup analyses, including a subgroup considering only patients with pneumonia, did not show different trends. Regarding resource consumption, COVID-19 patients had longer hospital stays and higher critical care, pharmacy, and complementary test costs. CONCLUSIONS Although influenza patients were older and had more comorbidities, COVID-19 cases requiring supplemental oxygen on admission had worse clinical and economic outcomes.
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Affiliation(s)
- Inmaculada López Montesinos
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Spanish Network for Research in Infectious Diseases (REIPI), Barcelona, 08003, Spain
| | - Itziar Arrieta-Aldea
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Spanish Network for Research in Infectious Diseases (REIPI), Barcelona, 08003, Spain
| | - Aitor Dicastillo
- Universitat Pompeu Fabra (UPF), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Flavio Zuccarino
- Department of Radiology, Hospital del Mar, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Luisa Sorli
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Spanish Network for Research in Infectious Diseases (REIPI), Barcelona, 08003, Spain
| | - Roberto Guerri-Fernández
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Spanish Network for Research in Infectious Diseases (REIPI), Barcelona, 08003, Spain
| | | | - Maria Milagro Montero
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Spanish Network for Research in Infectious Diseases (REIPI), Barcelona, 08003, Spain
| | - Ana Siverio-Parès
- Microbiology Service, Laboratori de Referència de Catalunya, El Prat de Llobregat (Barcelona), 08820, Spain
| | - Xavier Durán
- Methodology and Biostatistics Support Unit, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, 08003, Spain
| | - Maria del Mar Arenas
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Spanish Network for Research in Infectious Diseases (REIPI), Barcelona, 08003, Spain
| | - Ariadna Brasé Arnau
- Internal Medicine Service, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Barcelona, 08003, Spain
| | - Esperanza Cañas-Ruano
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Spanish Network for Research in Infectious Diseases (REIPI), Barcelona, 08003, Spain
| | - Silvia Castañeda
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Spanish Network for Research in Infectious Diseases (REIPI), Barcelona, 08003, Spain
| | - Ignacio Domingo Kamber
- Internal Medicine Service, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Barcelona, 08003, Spain
| | - Joan Gómez-Junyent
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Spanish Network for Research in Infectious Diseases (REIPI), Barcelona, 08003, Spain
| | - Iván Pelegrín
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Spanish Network for Research in Infectious Diseases (REIPI), Barcelona, 08003, Spain
| | - Francisca Sánchez Martínez
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Spanish Network for Research in Infectious Diseases (REIPI), Barcelona, 08003, Spain
| | - Elena Sendra
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Spanish Network for Research in Infectious Diseases (REIPI), Barcelona, 08003, Spain
| | - Lucía Suaya Leiro
- Internal Medicine Service, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Barcelona, 08003, Spain
| | - Judit Villar-García
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Spanish Network for Research in Infectious Diseases (REIPI), Barcelona, 08003, Spain
| | - Xavier Nogués
- Internal Medicine Service, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Barcelona, 08003, Spain
| | - Santiago Grau
- Pharmacy Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Barcelona 08003, Spain
| | - Hernando Knobel
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Spanish Network for Research in Infectious Diseases (REIPI), Barcelona, 08003, Spain
| | - Silvia Gomez-Zorrilla
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Spanish Network for Research in Infectious Diseases (REIPI), Barcelona, 08003, Spain,Corresponding author information Silvia Gómez-Zorrilla Infectious Diseases Service, Hospital del Mar (Barcelona, Spain). Passeig Marítim de la Barceloneta, 25-29, 08003, Barcelona, Spain.
| | - Juan Pablo Horcajada
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Spanish Network for Research in Infectious Diseases (REIPI), Barcelona, 08003, Spain
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