Cardiovascular features and risk of mortality in COVID-19 hospitalized patients in Spain during 2020. A nationwide study from the Minimum Basic Data Set

Introduction

During the last two years scientific evidence has been gathered regarding the cardiovascular complications of Covid-19. Nevertheless nationwide studies are still required to better understand both the incidence of less frequent clinical findings, and the prognostic implications of cardiovascular COVID-19 complications.

Purpose

The aim of this study was to estimate the incidence of cardiovascular diseases among COVID-19 hospitalized patients in Spain during 2020, as well as their association with mortality, besides other clinical and epidemiological factors.

Methods

We used the Minimum Basic Data Set from the Spanish Ministry of Health (RAE-CMBD) to analyze the data of all COVID-19 hospitalized patients in Spain during 2020. This national database includes concurrent diagnostics of all studied patients codified according to the Tenth International Classification of Diseases (ICD-10).

Logistic regression analysis was performed to evaluate the influence of the different clinical and epidemiological variables in the evolution of COVID-19 hospitalized patients. Odds ratios were obtained for each variable adjusting by age and sex, and also adjusting by the rest of clinical factors. The software used for analysis was STATA v 16.1.

Results

75585 men (55.15%) and 61468 women (44.85%) were hospitalized due to COVID-19 during 2020 in Spain. The median age was 66 in men and 71 in women. Mortality was 14.92% in males, and 13.81% in females. 9.62% of patients were admitted to intensive care unit (ICU). Mortality in ICU was 29.13%.

Heart Failure (7.8%), Atrial Fibrillation (7.7%), Pulmonary Embolism (3.46%), Supraventricular Arrythmias (1.18%), Cardiomyopathy (1.06%), Acute Coronary Syndrome (0.87%), Ischemic Stroke (0.33%), Myocarditis (0.12%) Pericarditis (0.06%), or Takotsubo Disease (0.05%), were relevant cardiovascular findings in COVID-19 hospitalized patients (Table 1).

In the logistic regression multivariate analysis in COVID-19 patients we found epidemiological predictors of in-hospital mortality such as age (OR 2.38 for each decade), or male sex (OR 1.39). Among the clinical predictors of mortality we differentiated cardiovascular ones as Acute Coronary Syndrome (OR 1.51), Ischemic Stroke (OR 1.46), or Heart Failure (OR 1.43); and non cardiovascular ones such as admission to ICU (OR 3.12), Adult Respiratory Distress Syndrome (OR 2.74), need for Mecanical Ventilation (OR 2.52), Acute Kidney Failure (OR 2.07), Liver damage (OR 1.67), or Dementia (OR 1.66), (Table 2)

Conclusion(s)

Heart Failure, Pulmonary Embolism, Ischaemic Heart Disease, Atrial fibrillation, Ischemic Stroke, or Cardiomyopathy were among the main cardiovascular diseases associated to COVID-19. They increased in a different measure the risk of mortality in COVID-19, together with factors such as Mecanical ventilation, ICU admission, Acute kidney failure, Dementia, Liver damage, Adult Respiratory Distress Syndrome, older age, or male sex.

Funding Acknowledgement

Type of funding sources: None.

Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units

The COVID-19 pandemic has led to the admission of a high number of patients to the ICU, generally due to severe respiratory failure. Since the appearance of the first cases of SARS-CoV-2 infection, at the end of 2019, in China, a huge number of treatment recommendations for this entity have been published, not always supported by sufficient scientific evidence or with methodological rigor necessary. Thanks to the efforts of different groups of researchers, we currently have the results of clinical trials, and other types of studies, of higher quality. We consider it necessary to create a document that includes recommendations that collect this evidence regarding the diagnosis and treatment of COVID-19, but also aspects that other guidelines have not considered and that we consider essential in the management of critical patients with COVID-19. For this, a drafting committee has been created, made up of members of the SEMICYUC Working Groups more directly related to different specific aspects of the management of these patients.

[Management of infectious complications associated with coronavirus infection in severe patients admitted to ICU]

Infections have become one of the main complications of patients with severe SARS-CoV-2 pneumonia admitted in ICU. Poor immune status, frequent development of organic failure requiring invasive supportive treatments, and prolonged ICU length of stay in saturated structural areas of patients are risk factors for infection development. The Working Group on Infectious Diseases and Sepsis GTEIS of the Spanish Society of Intensive Medicine and Coronary Units SEMICYUC emphasizes the importance of infection prevention measures related to health care, the detection and early treatment of major infections in the patient with SARS-CoV-2 infections. Bacterial co-infection, respiratory infections related to mechanical ventilation, catheter-related bacteremia, device-associated urinary tract infection and opportunistic infections are review in the document.

Management of infectious complications associated with coronavirus infection in severe patients admitted to ICU

Infections have become one of the main complications of patients with severe SARS-CoV-2 pneumonia admitted in ICU. Poor immune status, frequent development of organic failure requiring invasive supportive treatments, and prolonged ICU length of stay in saturated structural areas of patients are risk factors for infection development. The Working Group on Infectious Diseases and Sepsis GTEIS of the Spanish Society of Intensive Medicine and Coronary Units SEMICYUC emphasizes the importance of infection prevention measures related to health care, the detection and early treatment of major infections in the patient with SARS-CoV-2 infections. Bacterial co-infection, respiratory infections related to mechanical ventilation, catheter-related bacteremia, device-associated urinary tract infection and opportunistic infections are review in the document.