COVID-19 Outcomes in 4712 consecutively confirmed SARS-CoV2 cases in the city of Madrid

  1. Sarah Heili-Frades
  2. Pablo Minguez
  3. Ignacio Mahillo Fernández
  4. Tomás Prieto-Rumeau
  5. Antonio Herrero González
  6. Lorena de la Fuente
  7. María Jesús Rodríguez Nieto
  8. Germán Peces-Barba Romero
  9. Mario Peces-Barba
  10. María del Pilar Carballosa de Miguel
  11. Itziar Fernández Ormaechea
  12. Alba Naya prieto
  13. Farah Ezzine de Blas
  14. Luis Jiménez Hiscock
  15. Cesar Perez Calvo
  16. Arnoldo Santos
  17. Luis Enrique Muñoz Alameda
  18. Fredeswinda Romero Bueno
  19. Miguel Górgolas Hernández-Mora
  20. Alfonso Cabello Úbeda
  21. Beatriz Álvarez Álvarez
  22. Elizabet Petkova
  23. Nerea Carrasco
  24. Dolores Martín Ríos
  25. Nicolás González Mangado
  26. Olga Sánchez Pernaute
  27. and the COVID FJD-TEAM

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Abstract

There is limited information describing features and outcomes of patients requiring hospitalization for COVID19 disease and still no treatments have clearly demonstrated efficacy. Demographics and clinical variables on admission, as well as laboratory markers and therapeutic interventions were extracted from electronic Clinical Records (eCR) in 4712 SARS-CoV2 infected patients attending 4 public Hospitals in Madrid. Patients were stratified according to age and stage of severity. Using multivariate logistic regression analysis, cut-off points that best discriminated mortality were obtained for each of the studied variables. Principal components analysis and a neural network (NN) algorithm were applied.

A high mortality incidence associated to age >70, comorbidities (hypertension, neurological disorders and diabetes), altered vitals such as fever, heart rhythm disturbances or elevated systolic blood pressure, and alterations in several laboratory tests. Remarkably, analysis of therapeutic options either taken individually or in combination drew a universal relationship between the use of Cyclosporine A and better outcomes as also a benefit of tocilizumab and/or corticosteroids in critically ill patients.

We present a large Spanish population-based study addressing factors influencing survival in current SARS CoV2 pandemic, with particular emphasis on the effectivity of treatments. In addition, we have generated an NN capable of identifying severity predictors of SARS CoV2. A rapid extraction and management of data protocol from eCR and artificial intelligence in-house implementations allowed us to perform almost real time monitoring of the outbreak evolution.

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    SciScore for 10.1101/2020.05.22.20109850: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    De-identified medical records were confidentially collected from Microsoft Sql Integration Services (SSIS) reporting database and analysed using R version 3.5.2 (R Project for Statistical Computing; R Foundation), MATLAB 9.7-R2019b and IBM SPSS Statistics-25.
    R Project for Statistical
    suggested: (R Project for Statistical Computing, RRID:SCR_001905)
    MATLAB
    suggested: (MATLAB, RRID:SCR_001622)
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: Thank you for sharing your code.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Only recently have we started to use anakinra in combination to standard of care in those patients showing a poor clinical course either in case of limitation of therapeutic efferorts or in substitution of the second tocilizumab infusion. Corticosteroids alone did not show benefit in our series, a finding that at first sight could argue against their use in COVID-19 pneumonia in accordance with current WHO guidance25. However, in agreement with previous observations26, we found that their combination with other drugs was consistently associated to a higher survival of our critically ill cases, as can be concluded from the results of the NN in Figure 4 where they stand as second therapy after tocilizumab in increasing chance of survival. Tocilizumab is currently undergoing a clinical trial, but preliminary results published as a press release27 and also data from a pilot study28 suggest that it could have a beneficial effect in this viral pneumonia. Notably, we were able to observe that most of the specific therapies in our protocol could improve survival. In particular, given that it is the ICU admitted subgroup of patients the one exposed to a larger combination of drugs, in relationship with severity and use of maximum therapeutic effort, we explored the impact of medications in these patients. Figure 4 specifically shows patients who were admitted to ICU and survived, albeit 40 of these patients have not been discharged yet. In order of importance, the 5 drugs that were ab...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  2. Version published to 10.1101/2020.05.22.20109850v2 on medRxiv
  3. Version published to 10.1101/2020.05.22.20109850v1 on medRxiv