Evaluación de las características clínicas y evolución de pacientes con COVID-19 a partir de una serie de 1000 pacientes atendidos en servicios de urgencias españoles

OBJETIVO: Describir las caracteristicas clinicas de los pacientes con COVID-19 atendidos en los servicios de urgencias hospitalarios (SUH) espanoles y evaluar su asociacion con los resultados de su evolucion METODOS: Estudio multicentrico, anidado en una cohorte prospectiva Participaron 61 SUH que incluyeron pacientes seleccionados aleatoriamente de todos los diagnosticados de COVID-19 entre el 1 de marzo y el 30 de abril de 2020 Se recogieron caracteristicas basales, clinicas, de exploraciones complementarias y terapeuticas del episodio en los SUH Se calcularon las odds ratio (OR) asociadas a la mortalidad intrahospitalaria y al evento combinado formado por el ingreso en unidad de cuidados intensivos (UCI), la intubacion orotraqueal o ventilacion mecanica invasiva (IOT/ VMI), crudas y ajustadas con modelos de regresion logistica para tres grupos de variables independientes: basales, clinicas y de exploraciones complementarias RESULTADOS: La edad media fue de 62 anos (DE 18) La mayoria manifestaron fiebre, tos seca, disnea, febricula y diarrea Las comorbilidades mas frecuentes fueron las enfermedades cardiovasculares, seguidas de las respiratorias y el cancer Las variables basales que se asociaron independientemente y de forma directa a peores resultados evolutivos (tanto a mortalidad como a evento combinado) fueron edad y obesidad;las variables clinicas fueron disminucion de consciencia y crepitantes a la auscultacion pulmonar, y de forma inversa cefalea;y las variables de resultados de exploraciones complementarias fueron infiltrados pulmonares bilaterales y cardiomegalia radiologicos, y linfopenia, hiperplaquetosis, dimero-D >500 mg/dL y lactato-deshidrogenasa >250 UI/L en la analitica CONCLUSIONES: Conocer las caracteristicas clinicas y la comorbilidad de los pacientes con COVID-19 atendidos en urgencias permite identificar precozmente a la poblacion mas susceptible de empeorar, para prever y mejorar los resultados 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 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