Clustering patients with COVID-19 according to respiratory support requirements, and its impact on short- and long-term outcome (RECOVID study)

Autores de IIS La Fe

• Rosario Menéndez Villanueva

  Autor

• Raúl Méndez Ocaña

  Autor

• Ana María Latorre Campos

  Autor

• Paula González Jiménez

  Autor

• Irene Cano Pumarega

  Autor

• Antonio Torres Marti

  Autor

Participantes ajenos a IIS La Fe

• Peces-Barba, German
• Molina-Molina, Maria
• Espana, Pedro Pablo
• Garcia, Estela
• Consuegra-Vanegas, Angelica
• Garcia-Clemente, Marta Maria
• Panadero, Carolina
• Figueira-Goncalves, Juan Marco
• de la Rosa-carrillo, David
• Sibila, Oriol
• Martinez-Pitarch, Maria Dolores
• Toledo-Pons, Nuria
• Lopez-Ramirez, Cecilia
• Almonte-Batista, Wanda
• Macias-Paredes, Abigail
• Villamon, Mercedes
• Dominguez-alvarez, Marisol
• Perez-Rodas, Eli Nancy
• Lazaro, Javier
• Quiros, Sarai
• Cordovilla, Rosa
• RECOVID

Grupos

• Infecciones Respiratorias

  Investigador Principal

  Raúl Méndez Ocaña

Abstract

IntroductionThe Spanish Society of Pulmonology and Thoracic Surgery created a registry for hospitalised patients with COVID-19 and the different types of respiratory support used (RECOVID). Objectives. To describe the profile of hospitalised patients with COVID-19, comorbidities, respiratory support treatments and setting. In addition, we aimed to identify varying profiles of patients according to outcomes and the complexity of respiratory support needed.MethodsMulticentre, observational study in 49 Spanish hospitals. A protocol collected demographic data, comorbidities, respiratory support, treatment setting and 1-year follow-up. Patients were described using either frequency and percentages or median and interquartile range, as appropriate. A cluster analysis made it possible to identify different types of profile among the patients.ResultsIn total, 2148 of 2454 hospitalised patients (87.5%) received care in the conventional ward, whilst 126 in IRCU and 180 in ICU. In IRCU, 30% required high-flow nasal oxygen whilst 25%, non-invasive mechanical ventilation and 17%, mechanical ventilation. Four clusters of patients were identified. Two clusters were more likely to require IRCU/ICU admission, although primarily Cluster 2: Cluster (C) 1 consisted of patients without comorbidities and C2, those with comorbidities. Both presented higher inflammatory levels and lower lymphocyte count and SpO2/FiO2; however, C2 showed worse values. Two different clusters identified patients requiring less complex respiratory support. C3 presented higher comorbidities and elevated lymphocyte count, SpO2/FiO2 and low C-reactive protein (CRP). C4 included those without comorbidities except for arterial hypertension, lymphopenia and an intermediate CRP. In-hospital mortality and subsequent 1-year mortality were greater for C2 (28.6% and 7.1%) and C1 (11.1%, 8.3%) than for C4 (3.3%, 1.8%) and C3 (0%, 0%).ConclusionsThe cluster analysis identified four clinical phenotypes requiring distinct types of respiratory support, with great differences present per characteristics and outcomes.