COPD in SARS-CoV-2 pandemic. baseline characteristics related to hospital admissions

ABSTRACT

Objective

To develop a predictive model for COPD patients admitted for COVID-19 to support clinical decision-making.

Method

Retrospective cohort study of 1313 COPD patients with microbiological confirmation of SARS-CoV-2 infection. The sample was randomly divided into two subsamples, for the purposes of derivation and validation of the prediction rule (60% and 40%,respectively). Data collected for this study included sociodemographic characteristics, baseline comorbidities, baseline treatments, and other background data. Multivariable logistic regression analysis was used to develop the predictive model.

Results

Male sex, older age, hospital admissions in the previous year, flu vaccination in the previous season, a Charlson Index>3 and a prescription of renin-angiotensin aldosterone system inhibitors at baseline were the main risk factors for hospital admission. The AUC of the categorized risk score was 0.72 and 0.69 in the derivation and validation samples, respectively. Based on the risk score, four groups were identified with a risk of hospital admission ranging from 21% to 80%.

Conclusions

We propose a classification system to identify COPD people with COVID-19 with a higher risk of hospitalization, and indirectly, more severe disease, that is easy to use in primary care, as well as hospital emergency room settings to help clinical decision-making.

ClinicalTrials.gov Identifier

NCT04463706

KEYWORDS:

• COPD
• emergencies
• hospital admission
• primary health care
• risk factors
• SARS-COV-2

Article highlights

• Older age and male sex are two common key factors in COVID-19 poor prognosis

• Previous hospitalizations for any medical cause, comorbidities, seasonal flu vaccination and baseline prescriptions of renin-angiotensin aldosterone system inhibitors at baseline were added predictors of hospitalization in COPD patients

• We develop a risk score that may help to guide in the clinical decision making process

• Risk of hospitalization in COPD patients is relatively high even for low scores

Acknowledgments

We are grateful for the support of the Basque Health Service-Osakidetza and the Department of Health of the Basque Government. We also gratefully acknowledge the patients who participated in the study. The authors also would like to thank Ideas Need Communicating Language Services for improving the use of English in the manuscript.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Desing of the study: C. Esteban, J.M. Quintana, S. García-Gutierrez.

Analysis of the data: A. Villanueva, J.M. Quintana, S. García-Gutierrez.

Interpretation of the results: C. Esteban, J.M. Quintana, A. Aramburu, IG, S. García-Gutierrez, A. Villanueva.

Acquisition of data: A. Villanueva, S. García-Gutierrez, A. Aramburu. IG

Drafting: C. Esteban, J.M. Quintana, A. Villanueva.

All authors have read and approved the final manuscript.

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethics approval

The study protocol was approved by the Ethics Committee of the Basque Country (reference PI2020059).

Additional information

Funding

This work was supported in part by grants from the Instituto de Salud Carlos III and the European Regional Development Fund COV20/00459; the Health Outcomes Group from Galdakao-Barrualde Integrated Healthcare Organization; the Kronikgune Institute for Health Service Research; and the thematic network– Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC)–of the Instituto de Salud. grants from the Instituto de Salud Carlos III and the European Regional Development Fund COV20/00459; the Health Outcomes Group from Galdakao-Barrualde Integrated Healthcare Organization; the Kronikgune Institute for Health Service Research; and the thematic network– Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC)–of the Instituto de Salud.