Analysis of clinical characteristics and outcomes in patients with COVID-19 based on a series of 1000 patients treated in Spanish emergency departments.

Gil-Rodrigo, Adriana; Miró, Òscar; Piñera, Pascual; Burillo-Putze, Guillermo; Jiménez, Sònia; Martín, Alfonso; Martín-Sánchez, Francisco Javier; Jacob, Javier; Guardiola, Josep María; García-Lamberechts, Eric Jorge; Espinosa, Begoña; Martín Mojarro, Enrique; González Tejera, Matilde; Serrano, Leticia; Agüera, Carmen; Soy, Ester; Llauger, Lluís; Juan, María Ángeles; Palau, Anna; Del Arco, Carmen; Rodríguez Miranda, Belén; Maza Vera, María Teresa; Martín Quirós, Alejandro; Tejada de Los Santos, Laura; Ruiz de Lobera, Noemí; Iglesias Vela, Marta; Torres Garate, Raquel; Alquézar-Arbé, Aitor; González Del Castillo, Juan; Llorens, Pere

OBJECTIVES To describe the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) treated in hospital emergency departments (EDs) in Spain, and to assess associations between characteristics and outcomes. MATERIAL AND METHODS Prospective, multicenter, nested-cohort study. Sixty-one EDs included a random sample of all patients diagnosed with COVID-19 between March 1 and April 30, 2020. Demographic and baseline health information, including concomitant conditions; clinical characteristics related to the ED visit and complementary test results; and treatments were recorded throughout the episode in the ED. We calculated crude and adjusted odds ratios for risk of in-hospital death and a composite outcome consisting of the following events: intensive care unit admission, orotracheal intubation or mechanical ventilation, or in-hospital death. The logistic regression models were constructed with 3 groups of independent variables: the demographic and baseline health characteristics, clinical characteristics and complementary test results related to the ED episode, and treatments. RESULTS The mean (SD) age of patients was 62 (18) years. Most had high- or low-grade fever, dry cough, dyspnea, and diarrhea. The most common concomitant conditions were cardiovascular diseases, followed by respiratory diseases and cancer. Baseline patient characteristics that showed a direct and independent association with worse outcome (death and the composite outcome) were age and obesity. Clinical variables directly associated with worse outcomes were impaired consciousness and pulmonary crackles; headache was inversely associated with worse outcomes. Complementary test findings that were directly associated with outcomes were bilateral lung infiltrates, lymphopenia, a high platelet count, a D-dimer concentration over 500 mg/dL, and a lactate-dehydrogenase concentration over 250 IU/L in blood. CONCLUSION This profile of the clinical characteristics and comorbidity of patients with COVID-19 treated in EDs helps us predict outcomes and identify cases at risk of exacerbation. The information can facilitate preventive measures and improve outcomes.