Mortality risk assessment in Spain and Italy, insights of the HOPE COVID-19 registry

Núñez-Gil, Iván J.; Fernández-Pérez, Cristina; Estrada, Vicente; Becerra-Muñoz, Víctor M.; El-Battrawy, Ibrahim; Uribarri, Aitor; Fernández-Rozas, Inmaculada; Feltes, Gisela; Viana-Llamas, María C.; Trabattoni, Daniela; López-País, Javier; Pepe, Martino; Romero, Rodolfo; Castro-Mejía, Alex F.; Cerrato, Enrico; Astrua, Thamar Capel; D’Ascenzo, Fabrizio; Fabregat-Andres, Oscar; Moreu, José; Guerra, Federico; Signes-Costa, Jaime; Marín, Francisco; Buosenso, Danilo; Bardají, Alfredo; Raposeiras-Roubín, Sergio; Elola, Javier; Molino, Ángel; Gómez-Doblas, Juan J.; Abumayyaleh, Mohammad; Aparisi, Álvaro; Molina, María; Guerri, Asunción; Arroyo-Espliguero, Ramón; Assanelli, Emilio; Mapelli, Massimo; García-Acuña, José M.; Brindicci, Gaetano; Manzone, Edoardo; Ortega-Armas, María E.; Bianco, Matteo; Trung, Chinh Pham; Núñez, María José; Castellanos-Lluch, Carmen; García-Vázquez, Elisa; Cabello-Clotet, Noemí; Jamhour-Chelh, Karim; Tellez, María J.; Fernández-Ortiz, Antonio; Macaya, Carlos

Recently the coronavirus disease (COVID-19) outbreak has been declared a pandemic. Despite its aggressive extension and significant morbidity and mortality, risk factors are poorly characterized outside China. We designed a registry, HOPE COVID-19 (NCT04334291), assessing data of 1021 patients discharged (dead or alive) after COVID-19, from 23 hospitals in 4 countries, between 8 February and 1 April. The primary end-point was all-cause mortality aiming to produce a mortality risk score calculator. The median age was 68 years (IQR 52–79), and 59.5% were male. Most frequent comorbidities were hypertension (46.8%) and dyslipidemia (35.8%). A relevant heart or lung disease were depicted in 20%. And renal, neurological, or oncological disease, respectively, were detected in nearly 10%. Most common symptoms were fever, cough, and dyspnea at admission. 311 patients died and 710 were discharged alive. In the death-multivariate analysis, raised as most relevant: age, hypertension, obesity, renal insufficiency, any immunosuppressive disease, 02 saturation < 92% and an elevated C reactive protein (AUC = 0.87; Hosmer–Lemeshow test, p > 0.999; bootstrap-optimist: 0.0018). We provide a simple clinical score to estimate probability of death, dividing patients in four grades (I–IV) of increasing probability. Hydroxychloroquine (79.2%) and antivirals (67.6%) were the specific drugs most commonly used. After a propensity score adjustment, the results suggested a slight improvement in mortality rates (adjusted-OR(hydroxychloroquine) 0.88; 95% CI 0.81–0.91, p = 0.005; adjusted-OR(antiviral) 0.94; 95% CI 0.87–1.01; p = 0.115). COVID-19 produces important mortality, mostly in patients with comorbidities with respiratory symptoms. Hydroxychloroquine could be associated with survival benefit, but this data need to be confirmed with further trials. Trial Registration: NCT04334291/EUPAS34399. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11739-020-02543-5) contains supplementary material, which is available to authorized users.