The SADDEN DEATH Study: Results from a Pilot Study in Non-ICU COVID-19 Spanish Patients

• Main Authors: Carlos Nicolás Pérez-García, Daniel Enríquez-Vázquez, Manuel Méndez-Bailón, Carmen Olmos, Juan Carlos Gómez-Polo, Rosario Iguarán, Noemí Ramos-López, José Luis García-Klepzig, Marcos Ferrández-Escarabajal, Adrián Jerónimo, Eduardo Martínez-Gómez, Judit Font-Urgelles, Marcos Fragiel-Saavedra, Pilar Paz-Arias, Teresa Romero-Delgado, Zaira Gómez-Álvarez, Julia Playán-Escribano, Esther Jaén, Gianna Vargas, Elizabeth González, Eva Orviz, Irene Burruezo, Alberto Calvo, Ángel Nieto, Ángel Molino, Noël Lorenzo-Villalba, Emmanuel Andrès, Carlos Macaya, Isidre Vilacosta
• Format: Article
• Language: English
• Published: MDPI AG 2021-02-01
• Series: Journal of Clinical Medicine
• Subjects: COVID-19; unexpected death; mortality
• Online Access: https://www.mdpi.com/2077-0383/10/4/825

<b>Introduction:</b> The worldwide pandemic, coronavirus disease 2019 (COVID-19) is a novel infection with serious clinical manifestations, including death. Our aim is to describe the first non-ICU Spanish deceased series with COVID-19, comparing specifically between unexpected and expected deaths. <b>Methods:</b> In this single-centre study, all deceased inpatients with laboratory-confirmed COVID-19 who had died from March 4 to April 16, 2020 were consecutively included. Demographic, clinical, treatment, and laboratory data, were analyzed and compared between groups. Factors associated with unexpected death were identified by multivariable logistic regression methods. <b>Results:</b> In total, 324 deceased patients were included. Median age was 82 years (IQR 76–87); 55.9% males. The most common cardiovascular risk factors were hypertension (78.4%), hyperlipidemia (57.7%), and diabetes (34.3%). Other common comorbidities were chronic kidney disease (40.1%), chronic pulmonary disease (30.3%), active cancer (13%), and immunosuppression (13%). The Confusion, BUN, Respiratory Rate, Systolic BP and age ≥65 (CURB-65) score at admission was >2 in 40.7% of patients. During hospitalization, 77.8% of patients received antivirals, 43.3% systemic corticosteroids, and 22.2% full anticoagulation. The rate of bacterial co-infection was 5.5%, and 105 (32.4%) patients had an increased level of troponin I. The median time from initiation of therapy to death was 5 days (IQR 3.0–8.0). In 45 patients (13.9%), the death was exclusively attributed to COVID-19, and in 254 patients (78.4%), both COVID-19 and the clinical status before admission contributed to death. Progressive respiratory failure was the most frequent cause of death (92.0%). Twenty-five patients (7.7%) had an unexpected death. Factors independently associated with unexpected death were male sex, chronic kidney disease, insulin-treated diabetes, and functional independence. <b>Conclusions:</b> This case series provides in-depth characterization of hospitalized non-ICU COVID-19 patients who died in Madrid. Male sex, insulin-treated diabetes, chronic kidney disease, and independency for activities of daily living are predictors of unexpected death.