COVID-19 in hospitalized patients in Spain: a cohort study in Madrid.

ABSTRACT Few large series describe the clinical characteristics, outcomes and costs of COVID-19 in western countries. This cohort reports the first 1,255 adult cases who received anti-COVID-19 treatment at a Spanish hospital from March 1 to 24, 2020. The cost of treatment was calculated. Logistic regression model was used to explore the risk factors present on admission associated with ARDS. Bivariate Cox proportional hazard ratio model was employed to determine the hazard ratio (HR) between individual factors and death. We included 1,255 patients (median age 65 years; 57.8% male), of which 92.3% required hospitalization. Prevalence of hypertension, cardiovascular diseases and diabetes mellitus was 45.1%, 31.4%, and 19.9%, respectively. Lymphocytopenia (54.8%), elevated alanine aminotransferase (33.0%) and elevated lactate dehydrogenase (58.5%) were frequent. Overall, 36.7% of patients developed ARDS, 10.0% were admitted to an intensive care unit and 21.3% died. Most frequent antiviral combinations used were lopinavir/ritonavir plus hydroxychloroquine (44.2%), followed by triple therapy with β-interferon 1b (32.5%). Corticosteroids and tocilizumab were used in 25.2% and 12.9% of patients, respectively. The total cost of anti-COVID-19 agents was €511,825 (€408 per patient). In the multivariate analysis, risk factors associated with ARDS included older age, obesity, diabetes mellitus, severe hypoxemia, lymphocytopenia, increased creatine kinase and increased C-reactive protein. In the multivariate Cox model, older age (HR 1.07 -95%CI 1.06-1.09), cardiovascular disease (HR 1.34 -95%CI 1.01-1.79), diabetes mellitus (HR 1.45 -95%CI 1.09-1.92), severe hypoxemia (HR 2.01 -95%CI 1.49-2.72), lymphocytopenia (HR 1.62 -95%CI 1.20-2.20) and increased C-reactive protein (HR 1.04 -95%CI 1.02-1.06) were risk factors for mortality.