Mortality of patients admitted for COVID-19 in Spanish intensive care was 31%

Hospital mortality among patients admitted to Spanish intensive care units (ICUs) during the pandemic was 31%, and factors associated with a poorer prognosis are associated with the need for mechanical ventilation, age, severity. initial COPD associated with decreased platelets and increased creatinine. , by comparing days 1 and 3 of artificial ventilation. These are the main conclusions of the project Factores de riesgo y pronóstico de pacientes infectados por COVID (Risk factors and prognosis of patients infected with COVID) and the follow-up one year later of patients in Spanish ICUs (CIBERESUCICOVID), developed by researchers of the Respiratory Diseases Network Biomedical Research Center (CIBERES).

The project is part of the research launched by the COVID-19 Fund throughout 2020 and managed by ISCIII, and which received a total funding of 1,750,000 euros. It has also benefited from the support of the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) and the Sociedad Española de Neumología y Cirugía Torácica (SEPAR), as well as the participation of the Barcelona Supercomputing Center (BSC).

The results of this multicenter study, led by the CIBERES group leader at the Clínic Hospital in Barcelona, ​​Antoni Torres, were presented at a hybrid event organized at the Campus de Madrid del Instituto de Salud Carlos III, during which the risk and prognostic factors of patients infected with COVID-19 admitted to the 69 participating Spanish intensive care units since the start of the pandemic in Spain have been described.

In addition, patients were also closely monitored for up to 6 months after discharge from intensive care and discharge from hospital to determine the death rate one year after discharge of COVID-19 patients who survived after the disease. admission to intensive care, and this rate was set at 1%.

Since fieldwork began with the first patient in June 2020, CIBERESUCICOVID, which will run until December 31, 2021, has studied over 5,700 patients and analyzed 1,068 blood samples for epigenetic and biomarker studies, far exceeding the initial objectives set.

Among the main results, CIBERES researchers identified the acquisition of pneumonia in hospital upon admission as a factor associated with the persistence of coronavirus symptoms at 3 months. In addition, explains Antoni Torres, “we have studied the effect of corticosteroids on hospital mortality, finding several phenotypes in which no benefit is observed depending on age, initial severity, inflammatory state. and the absence of lymphopenia. help determine which critical patients should receive corticosteroids.

Lack of control over virus replication: key to the problem

Serious illnesses caused by COVID-19 are characterized by a lack of control over virus replication by the immune system, reflected by systemic viral shedding, which is accompanied by a deregulated host response associated with a more prognosis. dark.

According to CIBERES researcher Jesús Bermejo, who also participated in the project, “the high levels of viral RNA in plasma, the presence of antigenemia, i.e. when the proteins of SARS-CoV-2 pass in the blood, reflecting poor control of virus replication with damage to the alveolar-capillary barrier and low levels of anti-S antibodies are predictors of poor prognosis, but they are also potential predictive markers of ‘enrichment to better guide treatments with antiviral or monoclonal antibodies in this disease. “

The severe clinical conditions show characteristic profiles in plasma and bronchial secretions, which provide molecular information on the mechanisms involved in the deterioration of the critically ill patient, and “are useful tools in clinical decision making”, also indicates Antoni Torres .

Likewise, functional and structural pulmonary alterations in survivors of severe COVID-19 are associated with specific transcriptomic and proteomic blood patterns, and the multifactorial mechanisms linked to these profiles form the basis for the development of therapeutic strategies.

The CIBERESUCICOVID project was the driving force behind the development of the patent “In vitro method for predicting mortality in COVID-19 patients”. Their findings have been reported in 18 scientific publications, including the Journal of Internal Medicine last October; the results were also presented at national and international conferences and congresses and were widely disseminated in national and international media.

Provided by the Consorcio Centro de Investigación Biomédica en Red MP