Comparison of Hospitalized Coronavirus Disease 2019 and Influenza Patients Requiring Supplemental Oxygen in a Cohort Study: Clinical Impact and Resource Consumption

• Published in: Clinical infectious diseases 2022-12, Vol.75 (12), p.2225-2238
• Main Authors: López Montesinos, Inmaculada, Arrieta-Aldea, Itziar, Dicastillo, Aitor, Zuccarino, Flavio, Sorli, Luisa, Guerri-Fernández, Roberto, Arnau-Barrés, Isabel, Montero, Maria Milagro, Siverio-Parès, Ana, Durán, Xavier, del Mar Arenas, Maria, Arnau, Ariadna Brasé, Cañas-Ruano, Esperanza, Castañeda, Silvia, Kamber, Ignacio Domingo, Gómez-Junyent, Joan, Pelegrín, Iván, Martínez, Francisca Sánchez, Sendra, Elena, Leiro, Lucía Suaya, Villar-García, Judit, Nogués, Xavier, Grau, Santiago, Knobel, Hernando, Gomez-Zorrilla, Silvia, Horcajada, Juan Pablo
• Format: Article
• Language: English
• Subjects: Aged; Cohort Studies; COVID-19; Hospital Mortality; Hospitalization; Humans; Influenza, Human; Oxygen; Retrospective Studies; SARS-CoV-2
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciac314

Abstract Background To compare clinical characteristics, outcomes, and resource consumption of patients with coronavirus disease 2019 (COVID-19) and seasonal influenza requiring supplemental oxygen. Methods Retrospective cohort study conducted at a tertiary-care hospital. Patients admitted because of seasonal influenza between 2017 and 2019, or with COVID-19 between March and May 2020 requiring supplemental oxygen were compared. Primary outcome: 30-day mortality. Secondary outcomes: 90-day mortality and hospitalization costs. Attempted sample size to detect an 11% difference in mortality was 187 patients per group. Results COVID-19 cases were younger (median years of age, 67; interquartile range [IQR] 54–78 vs 76 [IQR 64–83]; P < .001) and more frequently overweight, whereas influenza cases had more hypertension, immunosuppression, and chronic heart, respiratory, and renal disease. Compared with influenza, COVID-19 cases had more pneumonia (98% vs 60%, 65 years) scores and were more likely to show worse progression on the World Health Organization ordinal scale (33% vs 4%; P < .001). The 30-day mortality rate was higher for COVID-19 than for influenza: 15% vs 5% (P = .001). The median age of nonsurviving cases was 81 (IQR 74–88) and 77.5 (IQR 65–84) (P = .385), respectively. COVID-19 was independently associated with 30-day (hazard ratio [HR], 4.6; 95% confidence interval [CI], 2–10.4) and 90-day (HR, 5.2; 95% CI, 2.4–11.4) mortality. Sensitivity and subgroup analyses, including a subgroup considering only patients with pneumonia, did not show different trends. Regarding resource consumption, COVID-19 patients had longer hospital stays and higher critical care, pharmacy, and complementary test costs. Conclusions Although influenza patients were older and had more comorbidities, COVID-19 cases requiring supplemental oxygen on admission had worse clinical and economic outcomes. Coronavirus disease 2019 (COVID-19) cases were younger and healthier than influenza cases requiring supplemental oxygen. COVID-19 cases had higher disease severity and need for respiratory support. Mortality was 3 times higher in COVID-19. COVID-19 patients had longer hospital stay and higher costs.