Benítez, Iván D.Batlle, Jordi deTorres, GerardGonzález, JessicaGonzalo Calvo, David deTarga, Adriano D.S.Gort Paniello, ClaraMoncusí Moix, AnnaCeccato, AdrianFernández Barat, LaiaFerrer, RicardGarcia Gasulla, DarioMenéndez, RosarioMotos, AnaPeñuelas, OscarRiera, JordiBermejo Martin, Jesús F.Peñasco, YhivianRicart, PilarMartin Delgado, María CruzAguilera, LucianoRodríguez, AlejandroBoado Varela, Maria VictoriaSuarez Sipmann, FernandoPozo Laderas, Juan CarlosSolé Violán, JordiNieto, MaiteNovo, Mariana AndreaBarberán, JoséAmaya Villar, RosarioGarnacho Montero, JoséGarcía Garmendia, José LuisGómez, José M.Lorente, José ÁngelBlandino Ortiz, AaronTamayo Lomas, LuisLópez Ramos, EstherÚbeda, AlejandroCatalán González, MercedesSánchez Miralles, AngelMartínez Varela, IgnacioJorge García, Ruth NoemíFranco, NievesGumucio Sanguino, Víctor D.Huerta Garcia, ArturoBustamante Munguira, ElenaValdivia, Luis JorgeCaballero, JesúsGallego, ElenaMartínez de la Gándara, AmaliaCastellanos Ortega, ÁlvaroTrenado Álvarez, JoséMarin Corral, JudithAlbaiceta, Guillermo M.De La Torre, Maria Del CarmenLoza-vázquez, AnaVidal, PabloLópez Messa, JuanAñón, José M.Carbajales Pérez, CristinaSagredo, VíctorBofill, NeusCarbonell, NievesSocias, LorenzoBarberà, CarmeEstella, ÁngelValledor Mendez, ManuelDiaz, EmiliLópez Lago, AnaTorres Martí, AntoniBarbé, FerranCIBERESUCICOVID Project (COV20/00110, ISCIII)2022-06-272022-06-272022-06-012666-7762https://hdl.handle.net/2445/187027Background 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.16 p.application/pdfengcc by-nc-nd (c) Benítez, Iván D. et al, 2022http://creativecommons.org/licenses/by-nc-nd/3.0/es/ComorbiditatCOVID-19ComorbidityCOVID-19info:eu-repo/semantics/article2022-06-27info:eu-repo/semantics/openAccess35655660