Characteristics and Outcomes by Ceiling of Care of Subjects Hospitalized with COVID-19 During Four Waves of the Pandemic in a Metropolitan Area: A Multicenter Cohort Study

• Published in: Infectious diseases and therapy 2023-01, Vol.12 (1), p.273-289
• Main Authors: Pallarès, Natàlia, Tebé, Cristian, Abelenda-Alonso, Gabriela, Rombauts, Alexander, Oriol, Isabel, Simonetti, Antonella F., Rodríguez-Molinero, Alejandro, Izquierdo, Elisenda, Díaz-Brito, Vicens, Molist, Gemma, Gómez Melis, Guadalupe, Carratalà, Jordi, Videla, Sebastián
• Format: Article
• Language: English
• Subjects: Cohort analysis; COVID-19; Hospitalization; Infectious Diseases; Internal Medicine; Medicine; Medicine & Public Health; Metropolitan areas; Observational studies; Original Research; Pandemics; Severe acute respiratory syndrome coronavirus 2
• ISSN: 2193-8229; 2193-6382
• DOI: 10.1007/s40121-022-00705-w

Introduction The profiles of patients with COVID-19 have been widely studied, but little is known about differences in baseline characteristics and in outcomes between subjects with a ceiling of care assigned at hospital admission and subjects without a ceiling of care. The aim of this study is to compare, by ceiling of care, clinical features and outcomes of hospitalized subjects during four waves of COVID-19 in a metropolitan area in Catalonia. Methods Observational study conducted during the first (March–April 2020), second (October–November 2020), third (January–February 2021), and fourth wave (July–August 2021) of COVID-19 in five centers of Catalonia. All subjects were adults (> 18 years old) hospitalized with a proven SARS-CoV-2 infection and with therapeutic ceiling of care assessed by the attending physician at hospital admission. Results A total of 5813 subjects were analyzed. Subjects with a ceiling of care were mainly older (difference in median age of 20 years), with more comorbidities (Charlson index 3 points higher) and with fewer clinical signs at baseline than patients without a ceiling of care. Some features of their clinical profiles changed among waves. There were differences in treatments received during hospital admission across waves, but not between subjects with and without a ceiling of care. Subjects with a ceiling of care had a death incidence more than four times the death incidence of subjects a without a ceiling of care (risk ratio (RR) ranging from 3.5 in the first wave to almost 6 in the third and fourth). Incidence of severe pneumonia and complications for subjects with a ceiling of care was around 1.5 times the incidence in subjects without a ceiling of care. Discussion Analysis of hospitalized subjects with SARS-CoV-2 infection should be stratified according to therapeutic ceiling of care to avoid bias and outcome misestimation.