Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study

BACKGROUND: The clinical heterogeneity of COVID-19 suggests the existence of different phenotypes with prognostic implications. We aimed to analyze comorbidity patterns in critically ill COVID-19 patients and assess their impact on in-hospital outcomes, response to treatment and sequelae. METHODS: M...

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Detalles Bibliográficos
Autores principales: Benítez, Iván D., de Batlle, Jordi, Torres, Gerard, González, Jessica, de Gonzalo-Calvo, David, Targa, Adriano D.S., Gort-Paniello, Clara, Moncusí-Moix, Anna, Ceccato, Adrián, Fernández-Barat, Laia, Ferrer, Ricard, Garcia-Gasulla, Dario, Menéndez, Rosario, Motos, Anna, Peñuelas, Oscar, Riera, Jordi, Bermejo-Martin, Jesús F., Peñasco, Yhivian, Ricart, Pilar, Martin Delgado, María Cruz, Aguilera, Luciano, Rodríguez, Alejandro, Boado Varela, Maria Victoria, Suarez-Sipmann, Fernando, Pozo-Laderas, Juan Carlos, Solé-Violan, Jordi, Nieto, Maite, Novo, Mariana Andrea, Barberán, José, Amaya Villar, Rosario, Garnacho-Montero, José, García-Garmendia, Jose Luis, Gómez, José M., Lorente, José Ángel, Blandino Ortiz, Aaron, Tamayo Lomas, Luis, López-Ramos, Esther, Úbeda, Alejandro, Catalán-González, Mercedes, Sánchez-Miralles, Angel, Martínez Varela, Ignacio, Jorge García, Ruth Noemí, Franco, Nieves, Gumucio-Sanguino, Víctor D., Huerta Garcia, Arturo, Bustamante-Munguira, Elena, Valdivia, Luis Jorge, Caballero, Jesús, Gallego, Elena, Martínez de la Gándara, Amalia, Castellanos-Ortega, Álvaro, Trenado, Josep, Marin-Corral, Judith, Albaiceta, Guillermo M, de la Torre, Maria del Carmen, Loza-Vázquez, Ana, Vidal, Pablo, Lopez Messa, Juan, Añón, Jose M., Carbajales Pérez, Cristina, Sagredo, Victor, Bofill, Neus, Carbonell, Nieves, Socias, Lorenzo, Barberà, Carme, Estella, Angel, Valledor Mendez, Manuel, Diaz, Emili, López Lago, Ana, Torres, Antoni, Barbé, Ferran
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Articles
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9148543/
https://www.ncbi.nlm.nih.gov/pubmed/35655660
http://dx.doi.org/10.1016/j.lanepe.2022.100422
Descripción
Sumario:BACKGROUND: The clinical heterogeneity of COVID-19 suggests the existence of different phenotypes with prognostic implications. We aimed to analyze comorbidity patterns in critically ill COVID-19 patients and assess their impact on in-hospital outcomes, response to treatment and sequelae. METHODS: Multicenter prospective/retrospective observational study in intensive care units of 55 Spanish hospitals. 5866 PCR-confirmed COVID-19 patients had comorbidities recorded at hospital admission; clinical and biological parameters, in-hospital procedures and complications throughout the stay; and, clinical complications, persistent symptoms and sequelae at 3 and 6 months. FINDINGS: Latent class analysis identified 3 phenotypes using training and test subcohorts: low-morbidity (n=3385; 58%), younger and with few comorbidities; high-morbidity (n=2074; 35%), with high comorbid burden; and renal-morbidity (n=407; 7%), with chronic kidney disease (CKD), high comorbidity burden and the worst oxygenation profile. Renal-morbidity and high-morbidity had more in-hospital complications and higher mortality risk than low-morbidity (adjusted HR (95% CI): 1.57 (1.34-1.84) and 1.16 (1.05-1.28), respectively). Corticosteroids, but not tocilizumab, were associated with lower mortality risk (HR (95% CI) 0.76 (0.63-0.93)), especially in renal-morbidity and high-morbidity. Renal-morbidity and high-morbidity showed the worst lung function throughout the follow-up, with renal-morbidity having the highest risk of infectious complications (6%), emergency visits (29%) or hospital readmissions (14%) at 6 months (p<0.01). INTERPRETATION: Comorbidity-based phenotypes were identified and associated with different expression of in-hospital complications, mortality, treatment response, and sequelae, with CKD playing a major role. This could help clinicians in day-to-day decision making including the management of post-discharge COVID-19 sequelae. FUNDING: ISCIII, UNESPA, CIBERES, FEDER, ESF.

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