AUTHOR=Martín-Conty José L. , Polonio-López Begoña , Sanz-García Ancor , del Pozo Vegas Carlos , Mordillo-Mateos Laura , Bernal-Jiménez Juan José , Conty-Serrano Rosa , Castro Villamor Miguel A. , López-Izquierdo Raúl , Martín-Rodríguez Francisco 

TITLE=COVID-19 as a risk factor for long-term mortality in patients managed by the emergency medical system: A prospective, multicenter, ambulance-based cohort study

JOURNAL=Frontiers in Public Health

VOLUME=Volume 10 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.1076627

DOI=10.3389/fpubh.2022.1076627

ISSN=2296-2565

ABSTRACT=Introduction: COVID-19 has initially been studied in terms of acute phase disease although recently more importance is beginning to be given to the long-term consequences. In this work we explore COVID-19 as an independent risk factor for long-term mortality in patients with acute illness treated by EMS (Emergency Medical Services) who have previously had the disease versus those who have not.

Methods: A prospective, multicenter, ambulance-based, ongoing study was performed, including adult patients with acute disease managed by EMS and transferred with high-priority to emergency department (ED). The study involved six advanced life support units, thirty-eight basic life support units, and five emergency departments from Spain. Socio-demographic inputs, baseline vital signs, prehospital blood tests and comorbidities, including COVID-19, were collected. The main outcome was long-term mortality, defined as 1-year mortality by all-cause and in- and out-hospital. Two main statistical analyses were performed: a longitudinal analysis (Cox regression) and a logistic regression to compare both the COVID-19 vs non-COVID-19 patients, and to compare survival vs non-survival.

Results: Between March 12, 2020 and September 30, 2021, a total of 3017 patients were included in the study, 2594 non-COVID-19 and 513 in previously suffering from COVID-19. The mortality rate in COVID-19 was higher than in non-COVID-19 patients (31.8% vs. 17.9%). A logistic regression showed that patients previously diagnosed of COVID-19 presented higher rates of nursing homes residency, higher number of breaths per minute, suffer from connective disease, dementia and congestive heart failure. The longitudinal analysis showed that COVID-19 was a risk factor for mortality (hazard ratio 1.33 [1.10-1.61]; p<0.001).

Conclusion: The COVID-19 group presented almost double mortality rate than the non-COVID-19 group. The final model adjusted for confusion factors suggested that COVID-19 was a risk factor for long-term mortality.