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Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/187027
Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study
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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. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.
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BENÍTEZ, Iván d., BATLLE, Jordi de, TORRES, Gerard, GONZÁLEZ, Jessica, GONZALO CALVO, David de, TARGA, Adriano d.s., GORT PANIELLO, Clara, MONCUSÍ MOIX, Anna, CECCATO, Adrian, FERNÁNDEZ BARAT, Laia, FERRER, Ricard, GARCIA GASULLA, Dario, MENÉNDEZ, Rosario, MOTOS, Ana, 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 VIOLÁN, Jordi, NIETO, Maite, NOVO, Mariana andrea, BARBERÁN, José, AMAYA VILLAR, Rosario, GARNACHO MONTERO, José, GARCÍA GARMENDIA, José 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 ÁLVAREZ, José, MARIN CORRAL, Judith, ALBAICETA, Guillermo m., DE LA TORRE, Maria del carmen, LOZA-VÁZQUEZ, Ana, VIDAL, Pablo, LÓPEZ MESSA, Juan, AÑÓN, José m., CARBAJALES PÉREZ, Cristina, SAGREDO, Víctor, BOFILL, Neus, CARBONELL, Nieves, SOCIAS, Lorenzo, BARBERÀ, Carme, ESTELLA, Ángel, VALLEDOR MENDEZ, Manuel, DIAZ, Emili, LÓPEZ LAGO, Ana, TORRES MARTÍ, Antoni, BARBÉ, Ferran, CIBERESUCICOVID PROJECT (COV20/00110, Isciii). Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study. _The Lancet Regional Health - Europe_. 2022. Vol. 18. [consulta: 14 de gener de 2026]. ISSN: 2666-7762. [Disponible a: https://hdl.handle.net/2445/187027]