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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La enfermedad COVID-19 es un reto que ha puesto a prueba los diferentes sistemas de salud en el mundo<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La mayor&#237;a de los pacientes cursan de forma favorable&#59; sin embargo&#44; el 20&#37; de los pacientes requieren hospitalizaci&#243;n y pueden progresar r&#225;pidamente a un s&#237;ndrome de distr&#233;s respiratorio del adulto &#40;SDRA&#41;&#44; fallo multiorg&#225;nico o&#44; incluso&#44; fallecer<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a>&#46; Adem&#225;s&#44; el cuadro cl&#237;nico se caracteriza por una disociaci&#243;n cl&#237;nico-radiol&#243;gica importante&#44; de manera que el deterioro cl&#237;nico se desarrolla s&#250;bitamente<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a>&#44; por lo que la identificaci&#243;n de estos factores de riesgo es prioritaria para el correcto manejo de estos pacientes&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El registro SEMI-COVID-19<span class="elsevierStyleHsp" style=""></span>ha puesto de manifiesto que la mortalidad en Espa&#241;a lleg&#243; hasta el 21&#37; con datos del 2020<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">4</span></a>&#46; Adem&#225;s&#44; el porcentaje de pacientes que requiri&#243; ventilaci&#243;n mec&#225;nica lleg&#243; a alcanzar el 65&#37;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El objetivo del presente estudio fue identificar los factores de la mala evoluci&#243;n de la infecci&#243;n por SARS-CoV-2 en pacientes hospitalizados por COVID-19&#44; definida como aparici&#243;n de SDRA grave durante el ingreso &#40;PaFi &#8804; 100<span class="elsevierStyleHsp" style=""></span>mmHg&#41; o ingreso en la Unidad de Cuidados Intensivos &#40;UCI&#41; o muerte intrahospitalaria&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">M&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Este es un caso-control anidado dentro de COVID-19 Osakidetza &#40;NCT04463706&#41; en el que se han considerado casos&#44; pacientes ingresados en planta de hospitalizaci&#243;n por COVID-19&#44; que han presentado deterioro cl&#237;nico &#40;presencia a lo largo de la hospitalizaci&#243;n un SDRA grave &#91;PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#8804; 100<span class="elsevierStyleHsp" style=""></span>mmHg&#93; o ingreso en la UCI o fallecimiento intrahospitalario&#41;&#46; Se consider&#243; controles a pacientes ingresados por COVID-19 que no presentaron SDRA grave y fueron emparejados por grupos de edad&#46; Se excluy&#243; a&#58; fallecidos en el servicio de Urgencias&#44; ingresados directamente en UCI o los que presentaron PaFi &#8804; 100<span class="elsevierStyleHsp" style=""></span>mmHg en las primeras 24 h de ingreso&#46; Se identificaron 2<span class="elsevierStyleHsp" style=""></span>controles por caso&#46; El per&#237;odo de inclusi&#243;n fue del 3 de marzo del 2020 al 10 de abril del 2020&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El proyecto fue aprobado por el Comit&#233; de &#233;tica de Euskadi &#40;PI2020059&#41;&#46; El muestreo fue aleatorio simple&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se incluyeron las variables del sistema de explotaci&#243;n de datos de la historia cl&#237;nica electr&#243;nica &#40;HCE&#41; de Osakidetza-Sistema Vasco de Salud y&#44; adem&#225;s&#44; mediante la revisi&#243;n de la HCE por revisores entrenados supervisados por colaboradores cl&#237;nicos&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se recogieron datos sociodemogr&#225;ficos &#40;edad y sexo&#41;&#59; antecedentes personales &#40;comorbilidades recogidas en el &#237;ndice de Charlson&#41;&#59; historia de la enfermedad &#40;s&#237;ntomas y fecha de aparici&#243;n&#44; fecha del primer contacto con el sistema sanitario&#44; persistencia de los s&#237;ntomas&#44; tratamientos instaurados&#44; contactos con Atenci&#243;n Primaria en el mes previo&#41;&#59; episodio de hospitalizaci&#243;n actual &#40;s&#237;ntomas a la llegada a Urgencias&#41;&#44; constantes vitales &#40;incluida la saturaci&#243;n de ox&#237;geno por pulsioximetr&#237;a &#91;SaO<span class="elsevierStyleInf">2</span>p&#93;&#41;&#44; signos y exploraci&#243;n f&#237;sica&#44; y&#44; adem&#225;s&#44; pruebas de laboratorio al ingreso &#40;bioqu&#237;mica&#58; funci&#243;n renal&#44; alb&#250;mina&#44; perfil hep&#225;tico&#59; reactantes de fase aguda&#58; LDH&#44; PCR&#59; hemograma&#44; recuento y f&#243;rmula&#59; coagulaci&#243;n&#44; tiempo de protrombina&#44; d&#237;mero D&#41;&#44; radiograf&#237;a patol&#243;gica a la llegada si presentaba infiltrados o condensaciones no conocidos previamente o datos indicativos de SDRA &#40;presencia de opacidades bilaterales no totalmente explicadas por derrames&#44; colapso lobar o pulmonar o n&#243;dulos&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se calcul&#243; el nivel m&#225;s bajo de PaFi &#40;PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#41; a la llegada a Urgencias&#44; el d&#237;a de llegada a planta y hasta el d&#237;a 3&#46; Se recogi&#243; adem&#225;s el nivel m&#225;s bajo de PaFi alcanzado durante la hospitalizaci&#243;n&#44; tanto en los casos como en los controles&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Se defini&#243; caso como aquel paciente que present&#243; deterioro cl&#237;nico durante la hospitalizaci&#243;n con presencia de una PaFi &#8804; 100<span class="elsevierStyleHsp" style=""></span>mmHg o ingreso en la UCI o fallecimiento intrahospitalario &#40;fecha&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis estad&#237;stico</span><p id="par0055" class="elsevierStylePara elsevierViewall">Se ha realizado una estad&#237;stica descriptiva de las variables&#44; presentando mediante tablas de frecuencia y porcentajes las categ&#243;ricas&#44; y con medias y desviaciones t&#237;picas o medianas y rangos intercuartil las continuas&#46; En el an&#225;lisis univariable&#44; las variables se han comparado entre casos y controles utilizando modelos de regresi&#243;n log&#237;stica condicional&#44; tomando como variable dependiente el deterioro cl&#237;nico y el resto de variables como variables independientes&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Las pruebas de laboratorio al ingreso&#44; recogidas como variables continuas&#44; tambi&#233;n se han analizado categorizadas en 3 grupos&#58; valores en el rango normal &#40;definido en las tablas&#41;&#44; valores reducidos y valores aumentados&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Para el modelo de regresi&#243;n log&#237;stica condicional&#44; se han considerado todas las variables independientes con p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;20 del an&#225;lisis univariable&#46; Los efectos se han considerado significativos con p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Se han calculado las odds ratio &#40;OR&#41; y los intervalos de confianza del 95&#37; &#40;IC del 95&#37;&#41;&#46; La capacidad explicativa del modelo se ha analizado calculando el R<span class="elsevierStyleSup">2</span> y el &#225;rea bajo la curva &#40;AUC&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Se han analizado las diferencias en la PaFi entre casos y controles mediante un diagrama de cajas correspondientes a los valores de PaFi en diferentes momentos del ingreso &#40;Urgencias&#44; llegada a planta&#44; d&#237;a 1&#44; d&#237;a 2&#44; d&#237;a 3 y d&#237;a cr&#237;tico&#41;&#46; Se ha realizado un an&#225;lisis de datos longitudinal para poder identificar diferencias en las tendencias de la evoluci&#243;n de la PaFi&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Todos los an&#225;lisis estad&#237;sticos se han realizado utilizando SAS para Windows&#44; versi&#243;n 9&#46;4 &#40;SAS Institute&#44; Cary&#44; NC&#44; EE&#46; UU&#46;&#41; y R&#169;&#44; versi&#243;n 4&#46;0&#46;0&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0085" class="elsevierStylePara elsevierViewall">Se seleccion&#243; a 366 pacientes aleatoriamente de los 4&#46;447 pacientes que ingresaron en el mismo per&#237;odo en los centros participantes&#46; Una vez excluidos los pacientes no elegibles&#44; nuestra muestra se compone de 99 casos y 205 controles&#44; de los cuales cumpl&#237;an los criterios de selecci&#243;n del estudio 198&#44; siendo la ratio caso&#47;control de 1&#58;2 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">El sexo masculino fue m&#225;s frecuente entre los casos &#40;79&#37; vs&#46; 65&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;014&#41; as&#237; como haber padecido infarto agudo de miocardio &#40;IAM&#41; &#40;14&#37; vs&#46; 4&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#44; diabetes con da&#241;o org&#225;nico &#40;7&#37; vs&#46; 1&#44;5&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;025&#41; e hipertensi&#243;n arterial &#40;63&#37; vs&#46; 49&#44;4&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;031&#41;&#46; Los casos presentaban con menor frecuencia que los controles&#58; tos seca &#40;51&#44;5&#37; vs&#46; 65&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;021&#41; y dolor de garganta &#40;5&#37; vs&#46; 18&#44;7&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#46; Los casos hab&#237;an consultado con m&#225;s frecuencia a su m&#233;dico de Atenci&#243;n Primaria &#40;48&#44;5&#37; vs&#46; 34&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;016&#41;&#46; La radiograf&#237;a simple fue patol&#243;gica con m&#225;s frecuencia en los casos &#40;91&#37; vs&#46; 77&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#46; Exist&#237;a asociaci&#243;n entre los niveles de glucosa&#44; LDH&#44; PCR y plaquetas con el deterioro cl&#237;nico&#44; siendo los pacientes que se deterioraban los que presentaban cifras m&#225;s altas de los 3<span class="elsevierStyleHsp" style=""></span>primeros par&#225;metros y m&#225;s bajos de plaquetas &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Todas las variables descritas en el apartado de metodolog&#237;a se han considerado en el an&#225;lisis univariante &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Cuando se combinaron estas variables en un modelo multivariable&#44; los pacientes que presentaron saturaci&#243;n de O<span class="elsevierStyleInf">2</span> en Urgencias &#8804;<span class="elsevierStyleHsp" style=""></span>90&#37; presentaban un riesgo aumentado de deterioro cl&#237;nico &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#44;57&#44; IC del 95&#37;&#44; 4-68&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; as&#237; como los que hab&#237;an presentado IAM &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#44;72&#44; IC del 95&#37;&#44; 3&#44;3-75&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0006&#41;&#44; hipertensi&#243;n arterial &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;21&#44; IC del 95&#37;&#44; 1&#44;1-4&#44;4&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;024&#41; y EPOC &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;05&#44; IC del 95&#37;&#44; 1&#44;4-6&#44;5&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#46; Adem&#225;s&#44; la presencia de radiolog&#237;a patol&#243;gica supon&#237;a un riesgo 5&#44;6 veces mayor&#46; Los niveles de PCR<span class="elsevierStyleHsp" style=""></span>&#62; 100 se relacionaban positivamente con la posibilidad de deterioro&#44; as&#237; como los niveles de glucemia<span class="elsevierStyleHsp" style=""></span>&#62; 200&#46; Los pacientes con nivel de plaquetas inferiores a 15<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>&#47;&#956;l presentaban 4 veces m&#225;s riesgo de deterioro que los que ten&#237;an cifras de plaquetas en rangos normales o elevados &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">La variabilidad explicada por el modelo medido por el R2 era del 25&#37; y la capacidad predictiva medida por el AUC fue 0&#44;86&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">La PaFi es inferior en los casos&#44; en los diferentes momentos analizados &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 en todos&#41;&#46; La diferencia en la tendencia es tambi&#233;n estad&#237;sticamente significativa entre casos y controles &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; pero se puede dividir en 2<span class="elsevierStyleHsp" style=""></span>intervalos&#58; la diferencia no es significativa de la Urgencia hasta el d&#237;a 1 del ingreso y las tendencias son pr&#225;cticamente paralelas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;64&#41;&#46; Sin embargo&#44; a partir del d&#237;a 1 de ingreso los casos mantienen una tendencia decreciente&#44; mientras que los controles se estabilizan m&#225;s &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; El segundo d&#237;a de ingreso el 75&#37; de los casos toman valores inferiores a 253&#44;6&#44; mientras que el 75&#37; de los controles toman valores superiores a 271&#44;4&#46; La ca&#237;da del tercer d&#237;a de ingreso hasta el d&#237;a que presentaron el deterioro o d&#237;a cr&#237;tico es m&#225;s pronunciada en los casos &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n y conclusiones</span><p id="par0110" class="elsevierStylePara elsevierViewall">El presente estudio pone de manifiesto las caracter&#237;sticas cl&#237;nicas principales de los pacientes hospitalizados por COVID-19 que presentan una mala evoluci&#243;n&#44; definida como PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#8804; 100&#44; ingreso en UCI o muerte&#46; De este modo&#44; se ha podido identificar que la presencia de SaO<span class="elsevierStyleInf">2</span> &#8804; 90&#37;&#44; hiperglucemia&#44; PCR elevada y trombocitopenia&#44; as&#237; como la radiograf&#237;a patol&#243;gica al ingreso y una enfermedad asociada previamente &#40;IAM&#44; EPOC o hipertensi&#243;n arterial&#41; se asociaban con el deterioro cl&#237;nico&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Numerosos estudios coinciden en destacar la edad&#44; el sexo masculino y la presencia de disnea como factores predictores de mortalidad o ingreso en UCI<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; Como en el estudio se han emparejado casos y controles por edad&#44; no hemos podido evaluar el efecto de esta variable de la edad en el resultado&#46; En el presente estudio&#44; el 78&#44;79&#37; de los pacientes que desarrollaron deterioro cl&#237;nico eran varones&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Jain y Yuan<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a> evaluaron en un metaan&#225;lisis los s&#237;ntomas y las comorbilidades predictores de gravedad e ingreso en la UCI en pacientes con COVID-19 y la disnea fue el &#250;nico s&#237;ntoma predictor de ambas variables&#46; A diferencia de los trabajos publicados&#44; la disnea no fue significativamente m&#225;s frecuente entre los casos&#44; lo que probablemente tenga relaci&#243;n con la exclusi&#243;n de los pacientes que requirieron ventilaci&#243;n mec&#225;nica en las primeras 24 h&#44; dado que los pacientes que ingresaban en UCI en ese per&#237;odo lo hac&#237;an por presencia de SDRA grave&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Hay que se&#241;alar que nuestro objetivo principal fue identificar a los pacientes que&#44; hospitalizados en fase pulmonar de la enfermedad seg&#250;n las fases propuestas por Siddiqi y Mehra<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">8</span></a>&#44; presentaron deterioro cl&#237;nico durante la hospitalizaci&#243;n&#46; De este modo&#44; los casos presentaban m&#225;s frecuentemente una SaO<span class="elsevierStyleInf">2</span>p menor que los controles a la llegada al servicio de Urgencias&#46; A pesar de tratarse de valores de ox&#237;geno pr&#225;cticamente dentro de la normalidad&#44; existe una repercusi&#243;n cl&#237;nica objetiva ya que&#44; en consonancia&#44; los casos tambi&#233;n presentaban con m&#225;s frecuencia taquipnea&#44; sin duda&#44; un factor determinante para la mala evoluci&#243;n en las neumon&#237;as e incluida en escalas de gravedad para COVID-19<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Fu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a> llevaron a cabo un estudio en 200 pacientes y observaron que tanto la edad y las comorbilidades como una baja oxigenaci&#243;n se asociaban con una mayor mortalidad&#46; Por lo tanto&#44; parece que los valores m&#225;s bajos de oxigenaci&#243;n al ingreso pueden predecir un deterioro posterior&#46; M&#225;s all&#225;&#44; tal y como muestra la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#44; existe un punto de inflexi&#243;n en la oxigenaci&#243;n&#44; el denominado d&#237;a cr&#237;tico de los pacientes&#46; Por eso resulta crucial una correcta identificaci&#243;n de las caracter&#237;sticas cl&#237;nicas de estos pacientes con alto riesgo de empeorar&#46; La afectaci&#243;n pulmonar bilateral y las opacidades en vidrio deslustrado han demostrado ser la forma de presentaci&#243;n radiol&#243;gica m&#225;s frecuente en la literatura<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">11&#44;12</span></a>&#46; Si bien es cierto que en nuestro estudio no se pudo constatar el tipo de afectaci&#243;n radiol&#243;gica&#58; los pacientes que desarrollaron deterioro cl&#237;nico en la evoluci&#243;n presentaban alg&#250;n tipo de alteraci&#243;n radiol&#243;gica inicial frente a los controles con radiograf&#237;a normal&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En el caso de las enfermedades asociadas&#44; parece l&#243;gico pensar que aquellos pacientes con enfermedades cr&#243;nicas como la EPOC&#44; que presentan una inflamaci&#243;n cr&#243;nica del par&#233;nquima pulmonar&#44; limitaci&#243;n al flujo a&#233;reo espiratorio y una mayor susceptibilidad a las infecciones&#44; sean m&#225;s vulnerables a la enfermedad<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">12</span></a>&#46; Asimismo&#44; coincidiendo con otras cohortes espa&#241;olas<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">13</span></a>&#44; se ha observado una mayor asociaci&#243;n entre la EPOC y el deterioro cl&#237;nico en probable relaci&#243;n con la presencia de un mayor n&#250;mero de comorbilidades que habitualmente presentan estos pacientes<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">La hipertensi&#243;n arterial y el IAM se relacionan de forma significativa con el deterioro cl&#237;nico<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a>&#46; Zhao et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a> identificaron que la edad<span class="elsevierStyleHsp" style=""></span>&#62; 60 a&#241;os&#44; la enfermedad cardiovascular&#44; la hipertensi&#243;n y la diabetes eran factores independientes de la mortalidad por COVID-19&#46; Otros 2<span class="elsevierStyleHsp" style=""></span>estudios recientes se&#241;alan que estos pacientes presentan con m&#225;s frecuencia da&#241;o mioc&#225;rdico y arritmias durante el ingreso&#44; lo cual se asocia con una mayor mortalidad<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">17&#44;18</span></a>&#46; La afectaci&#243;n viral directa&#44; as&#237; como la inflamaci&#243;n secundaria a la tormenta de citocinas existente en la infecci&#243;n por SARS-CoV-2&#44; podr&#237;a estar detr&#225;s del da&#241;o mioc&#225;rdico<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">19</span></a>&#46; A&#250;n queda por dilucidar el potencial impacto que este da&#241;o tendr&#225; a largo plazo&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Por &#250;ltimo&#44; la elevaci&#243;n de los niveles de glucosa y de la PCR fueron predictores del deterioro cl&#237;nico&#44; ambos par&#225;metros anal&#237;ticos ampliamente estudiados en las neumon&#237;as&#46; La hiperglucemia&#44; bien secundaria al estr&#233;s de la infecci&#243;n o a la presencia de diabetes&#46; o un s&#237;ndrome metab&#243;lico subyacente pueden aumentar la mortalidad de los pacientes con COVID-19<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">20-22</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">La diabetes es una de las comorbilidades m&#225;s frecuentes en la COVID-19 y que&#44; adem&#225;s&#44; puede empeorar el pron&#243;stico<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">23</span></a>&#46; Una respuesta inmunitaria inadecuada junto a la exacerbaci&#243;n de la cascada proinflamatoria podr&#237;an explicar dicha asociaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">24</span></a>&#46; Sin duda&#44; un correcto manejo y control de los niveles de glucemia deber&#237;a formar parte primordial del tratamiento de la COVID-19&#46; En cuanto a la PCR&#44; su elevaci&#243;n se ha asociado con la gravedad de la enfermedad y&#44; adem&#225;s&#44; parece haber superado a otros biomarcadores m&#225;s com&#250;nmente utilizados en la sepsis<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Por el contrario&#44; los casos presentaron niveles m&#225;s bajos de plaquetas que los controles&#46; En un estudio retrospectivo reciente con 1&#46;476 pacientes incluidos observaron que el 20&#44;7&#37; de la muestra presentaba trombocitopenia y adem&#225;s se asociaba de forma significativa con la mortalidad intrahospitalaria<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">26</span></a>&#46; Se ha observado que la coagulaci&#243;n intravascular diseminada es frecuente entre los fallecidos por la infecci&#243;n SARS-CoV-2&#44; lo que podr&#237;a justificar el aumento de consumo de plaquetas<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">27</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">El presente estudio posee ciertas limitaciones inherentes al dise&#241;o caso-control&#46; Adem&#225;s&#44; no pudo identificarse el tipo de afectaci&#243;n radiol&#243;gica espec&#237;fica&#59; existen algunas p&#233;rdidas en las variables anal&#237;ticas y los resultados no son extrapolables a los pacientes excluidos del estudio por deterioro en las primeras 24 h&#46; Seg&#250;n el per&#237;odo de estudio&#44; en las primeras fases de la pandemia es menos probable que los pacientes ingresaran con afectaci&#243;n leve-moderada&#44; siendo en su mayor&#237;a pacientes graves&#46; Adem&#225;s&#44; no se han incluido variables que luego han resultado ser predictoras de mala evoluci&#243;n en estos pacientes porque en el momento del reclutamiento no se ped&#237;an de manera rutinaria &#40;p&#46; ej&#46;&#44; la ferritina&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Se necesita seguir con estudios nuevos que ayuden a identificar a los pacientes con riesgo de deterioro cl&#237;nico para que los profesionales sanitarios puedan tomar decisiones adecuadas sobre su destino y tratamiento&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Financiaci&#243;n</span><p id="par0170" class="elsevierStylePara elsevierViewall">Este proyecto ha sido financiado por el Instituto de Salud Carlos III en la convocatoria extraordinaria de proyectos de investigaci&#243;n sobre el SARS-CoV-2 y la enfermedad COVID-19&#44; n&#250;mero de expediente COV20&#47;0459&#44; y la Red de Investigaci&#243;n en Servicios Sanitarios en Enfermedades Cr&#243;nicas &#40;REDISSEC&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicto de intereses</span><p id="par0175" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de inter&#233;s&#46;</p></span></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Existe controversia sobre los mejores factores predictores de deterioro cl&#237;nico en la COVID-19&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Identificar factores predictores de riesgo de deterioro en pacientes hospitalizados por COVID-19&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos Dise&#241;o</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">caso-control anidado dentro de una cohorte&#46; &#193;mbito&#58; 13 centros de agudos de Osakidetza-Servicio Vasco de Salud&#46; Participantes&#58; se consider&#243; casos a pacientes hospitalizados por COVID-19 con deterioro cl&#237;nico&#44; definido como la aparici&#243;n de s&#237;ndrome de distr&#233;s respiratorio del adulto grave&#44; ingreso en UCI o fallecimiento&#46; Se emparejaron 2<span class="elsevierStyleHsp" style=""></span>controles por caso en funci&#243;n de la edad&#46; Se recogieron variables sociodemogr&#225;ficas&#44; comorbilidades&#44; tratamientos basales&#44; s&#237;ntomas y fecha de inicio&#44; consultas previas&#44; as&#237; como variables cl&#237;nicas&#44; anal&#237;ticas y radiol&#243;gicas&#46; Se cre&#243; un modelo explicativo del deterioro cl&#237;nico mediante regresi&#243;n log&#237;stica condicional&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 99 casos y 198 controles&#46; Mediante an&#225;lisis de regresi&#243;n log&#237;stica las variables independientes asociadas con deterioro cl&#237;nico fueron&#58; saturaci&#243;n de O<span class="elsevierStyleInf">2</span> en Urgencias &#8804; 90&#37; &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#44;6&#44; IC del 95&#37;&#44; 4-68&#41;&#44; radiograf&#237;a de t&#243;rax patol&#243;gica &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#44;6&#44; IC del 95&#37;&#44; 1&#44;7-18&#44;4&#41;&#44; PCR<span class="elsevierStyleHsp" style=""></span>&#62; 100<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;62&#44; IC del 95&#37; 1&#44;62-8&#41; y trombocitopenia &#60;<span class="elsevierStyleHsp" style=""></span>150&#46;000 plaquetas &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44; IC del 95&#37;&#44; 1&#44;84-8&#44;6&#41; y&#44; entre los antecedentes&#44; haber padecido infarto agudo de miocardio &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#44;7&#44; IC del 95&#37;&#44; 3&#44;29-75&#44;09&#41;&#44; EPOC &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;05&#44; IC del 95&#37;&#44; 1&#44;43-6&#44;5&#41; o hipertensi&#243;n arterial &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;21&#44; IC del 95&#37;1&#44;11-4&#44;4&#41;&#46; El &#225;rea bajo la curva alcanzado por el modelo fue 0&#44;86&#46; En el an&#225;lisis univariado&#44; se asociaron con mejor evoluci&#243;n cl&#237;nica el sexo femenino&#44; la presencia de tos seca y dolor de garganta&#44; pero no resultaron significativas en el an&#225;lisis multivariado&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusi&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Las variables identificadas podr&#237;an ser de utilidad en la pr&#225;ctica cl&#237;nica para la detecci&#243;n de pacientes con alto riesgo de mala evoluci&#243;n&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">There is controversy regarding the best predictors of clinical deterioration in COVID-19&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objective</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">This work aims to identify predictors of risk factors for deterioration in patients hospitalized due to COVID-19&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methods Design</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Nested case-control study within a cohort&#46; Setting&#58; 13 acute care centers of the Osakidetza-Basque Health Service&#46; Participants&#58; Patients hospitalized for COVID-19 with clinical deterioration&#8212;defined as onset of severe ARDS&#44; ICU admission&#44; or death&#8212;were considered cases&#46; Two controls were matched to each case based on age&#46; Sociodemographic data&#59; comorbidities&#59; baseline treatment&#59; symptoms&#59; date of onset&#59; previous consultations&#59; and clinical&#44; analytical&#44; and radiological variables were collected&#46; An explanatory model of clinical deterioration was created by means of conditional logistic regression&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A total of 99 cases and 198 controls were included&#46; According to the logistic regression analysis&#44; the independent variables associated with clinical deterioration were&#58; emergency department O<span class="elsevierStyleInf">2</span> saturation &#8804;90&#37; &#40;OR 16&#46;6&#59; 95&#37;CI 4-68&#41;&#44; pathological chest X-ray &#40;OR 5&#46;6&#59; 95&#37;CI 1&#46;7-18&#46;4&#41;&#44; CRP<span class="elsevierStyleHsp" style=""></span>&#62;100<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;OR 3&#46;62&#59; 95&#37;CI 1&#46;62-8&#41;&#44; thrombocytopenia with &#60;<span class="elsevierStyleHsp" style=""></span>150&#44;000 platelets &#40;OR 4&#59; 95&#37;CI 1&#46;84-8&#46;6&#41;&#59; and a medical history of acute myocardial infarction &#40;OR 15&#46;7&#59; 95&#37;CI&#44; 3&#46;29-75&#46;09&#41;&#44; COPD &#40;OR 3&#46;05&#59; 95&#37;CI 1&#46;43-6&#46;5&#41;&#44; or HT &#40;OR 2&#46;21&#59; 95&#37;CI 1&#46;11-4&#46;4&#41;&#46; The model&#39;s AUC was 0&#46;86&#46; On the univariate analysis&#44; female sex and presence of dry cough and sore throat were associated with better clinical progress&#44; but were not found to be significant on the multivariate analysis&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusion</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The variables identified could be useful in clinical practice for the detection of patients at high risk of poor outcomes&#46;</p></span>"
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            "apendice" => "<p id="par0180" class="elsevierStylePara elsevierViewall">El grupo de trabajo COVID-Osakidetza incluye a los siguientes investigadores&#58; Susana Garc&#237;a-Guti&#233;rrez&#44; Miren Orive&#44; Nerea Gonz&#225;lez&#44; Iratxe Lafuente&#44; Ane Ant&#243;n&#44; Ane Villanueva&#44; Josune Mart&#237;n&#44; Cristina Mu&#241;oz&#44; Mar&#237;a Jos&#233; Legarreta&#44; Urko Aquirre y Jos&#233; Mar&#237;a Quintana &#40;Unidad de investigaci&#243;n&#44; Hospital de Galdakao-Usansolo&#41;&#59; Pedro Pablo Espa&#241;a Yandiola&#44; Ane Uranga&#44; Mikel Egurrola&#44; Amaia Aramburu&#44; Amaia Artaraz&#44; Leire Chasco&#44; Olaia Bronte&#44; Patricia Garc&#237;a&#44; Ana Jodar&#44; Virginia Fern&#225;ndez y Crist&#243;bal Esteban &#40;Unidad respiratoria&#44; Hospital de Galdakao-Usansolo&#41;&#59; Naia Mas &#40;UCI&#44; Hospital de Galdakao-Usansolo&#41;&#59; Esther Pulido &#40;Urgencias&#44; Hospital de Galdakao-Usansolo&#41;&#59; Itxaso Bengoetxea &#40;Hospitalizaci&#243;n a domicilio&#44; Organizaci&#243;n Sanitaria Galdakao-Barrualde&#41;&#59; Antonio Escobar Mart&#237;nez&#44; Amaia Bilbao y I&#241;igo Gorostiza &#40;Unidad de investigaci&#243;n&#44; Hospital Universitario de Basurto&#41;&#59; I&#241;aki Arriaga &#40;Unidad respiratoria&#44; Hospital Universitario de Basurto&#41;&#59; Jos&#233; Joaqu&#237;n Portu Zapiarain &#40;Medicina Interna&#44; Instituto Bioaraba&#41;&#59; Naiara Parraza &#40;Unidad de investigaci&#243;n&#44; Instituto Bioaraba&#41;&#59; Milagros Iriberri&#44; Rafael Zalaca&#237;n&#44; Luis Alberto Ruiz y Leyre Serrano &#40;Unidad respiratoria&#44; Hospital Universitario de Cruces&#41;&#59; Adriana Couto y Oier Ateka &#40;Medicina Interna&#44; Hospital Universitario Donostia&#41;&#59; Arantza Cano &#40;Unidad respiratoria&#44; Hospital Santa Marina&#41;&#59; Maria Olatz Ibarra &#40;Farmacia&#44; Hospital de Urduliz&#41;&#59; Eduardo Mill&#225;n&#44; Mayte Bacigalupe&#44; Jon Letona y Andoni Arcelay &#40;Servicios Centrales Osakidetza&#41; e I&#241;aki Berraondo &#40;Departamento de Salud&#44; Gobierno Vasco&#41;&#46;</p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Anexo 1"
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                  \t\t\t\t">128 &#40;64&#44;65&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Consulta &#250;ltimo mes por s&#237;ntomas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">258 &#40;87&#44;16&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">81 &#40;81&#44;82&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">177 &#40;89&#44;95&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Contacto con Atenci&#243;n Primaria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tiempo entre inicio de los s&#237;ntomas y primer contacto<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">50 &#40;51&#44;55&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">129 &#40;65&#44;15&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Astenia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;13&#44;27&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;19&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;18&#44;69&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>101-200&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 300&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Taquipneico en Urgencias</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Saturaci&#243;n O</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">en Urgencias</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">0001</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 90&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbilidades</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IAM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22 &#40;7&#44;41&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">0030</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad vascular perif&#233;rica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Demencia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;3&#44;54&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">8028</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>EPOC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86 &#40;28&#44;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;34&#44;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52 &#40;26&#44;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">1327</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad hep&#225;tica leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;8&#44;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;13&#44;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;6&#44;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">0718</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DM con da&#241;o org&#225;nico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;3&#44;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;7&#44;07&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;1&#44;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">0256</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad renal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;8&#44;08&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;11&#44;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;6&#44;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">1707</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HTA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">160 &#40;53&#44;87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;62&#44;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98 &#40;49&#44;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">0306</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Coagulopat&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;2&#44;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;4&#44;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">1094</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sangrado gastrointestinal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;3&#44;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;5&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;2&#44;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">1720</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Asma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;14&#44;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;15&#44;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;14&#44;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">8137</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Anal&#237;ticas basales</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Creatinina<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;01 &#40;0&#44;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;09 &#40;0&#44;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;96 &#40;0&#44;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">1459</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Glucosa<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">109 &#91;97-126&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">117 &#91;102-140&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">105 &#91;95 - 120&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">0009</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LDH<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">286&#44;06 &#91;229-368&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">323&#44;21 &#91;259-425&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">273 &#91;217&#44;28-330&#44;27&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">0006</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PCR<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#44;37 &#91;27&#44;67-106&#44;57&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#44;97 &#91;44&#44;7-122&#44;12&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#44;3 &#91;21&#44;12-89&#44;48&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0</span>&#44;<span class="elsevierStyleBold">0008</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sodio<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;43 &#40;1&#44;709-14&#44;295&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;0032&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Disnea &#40;s&#237; vs<span class="elsevierStyleItalic">&#46;</span> no&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;19 &#40;0&#44;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;454 &#40;0&#44;874-2&#44;418&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1495&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Radiograf&#237;a patol&#243;gica &#40;s&#237; vs&#46; no&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;65 &#40;0&#44;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;692 &#40;1&#44;514-9&#44;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;0041&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>101-200 vs&#46;<span class="elsevierStyleHsp" style=""></span>&#62; 300&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;0&#44;46 &#40;0&#44;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;250 &#40;0&#44;023-2&#44;757&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;3113&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>201-300 vs&#46;<span class="elsevierStyleHsp" style=""></span>&#62; 300&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;0&#44;46 &#40;0&#44;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;250 &#40;0&#44;017-3&#44;660&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;4235&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Taquipneico en Urgencias &#40;s&#237; vs&#46; no&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;36 &#40;0&#44;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;041 &#40;1&#44;096-3&#44;799&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;0245&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Saturaci&#243;n O</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">en Urgencias &#40;&#8804; 90 vs&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#62; 90&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;92 &#40;0&#44;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;291 &#40;2&#44;517-15&#44;722&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IAM &#40;s&#237; vs&#46; no&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;78 &#40;0&#44;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;785 &#40;1&#44;699-13&#44;477&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;0030&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad vascular perif&#233;rica &#40;s&#237; vs&#46; no&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;37 &#40;0&#44;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;0828&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;826 &#40;0&#44;185-3&#44;697&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;8028&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>EPOC &#40;s&#237; vs&#46; no&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;21 &#40;0&#44;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;526 &#40;0&#44;880-2&#44;646&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1327&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad hep&#225;tica leve &#40;s&#237; vs&#46; no&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;36 &#40;0&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;066 &#40;0&#44;938-4&#44;552&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DM con da&#241;o org&#225;nico &#40;s&#237; vs&#46; no&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;77 &#40;0&#44;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;667 &#40;1&#44;207-18&#44;046&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;0256&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad renal &#40;s&#237; vs&#46; no&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;31 &#40;0&#44;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;846 &#40;0&#44;768-4&#44;436&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1707&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HTA &#40;s&#237; vs&#46; no&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;28 &#40;0&#44;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;755 &#40;1&#44;054-2&#44;923&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;0306&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;79 &#40;0&#44;35&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;211 &#40;1&#44;112-4&#44;397&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;0237&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Saturaci&#243;n O<span class="elsevierStyleInf">2</span> &#8804; 90&#37; en urgencias &#40;s&#237; vs&#46; no&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;81 &#40;0&#44;72&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16&#44;571 &#40;4&#44;030-68&#44;130&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Radiograf&#237;a patol&#243;gica &#40;s&#237; vs&#46; no&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;73 &#40;0&#44;60&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Trombocitopenia<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a> &#40;s&#237; vs&#46; no&#41;&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan&#44; China"
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                    0 => array:2 [
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Vol. 222. Núm. 1.
Páginas 22-30 (enero 2021)
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Vol. 222. Núm. 1.
Páginas 22-30 (enero 2021)
ORIGINAL
Factores de riesgo de deterioro clínico en pacientes ingresados por COVID-19: estudio caso-control
Risk factors for clinical deterioration in patients admitted for COVID-19: A case-control study
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A. Urangaa, A. Villanuevab, I. Lafuenteb, N. Gonzálezb,c, M.J. Legarretab, U. Aguirreb,c, P.P. Españaa, J.M. Quintanab,c, S. García-Gutiérrezb,c,
Autor para correspondencia
susana.garciagutierrez@osakidetza.eus

Autor para correspondencia.
, grupo de trabajo COVID-19-Osakidetza
a Servicio de Respiratorio, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, España
b Unidad de Investigación Hospital Galdakao-Usansolo, Galdakao, Bizkaia, España
c Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Galdakao, Bizkaia, España
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Tabla 1. Diferencias por deterioro de todos los pacientes (N=297)
Tabla 2. Análisis univariables de regresión logística condicional
Tabla 3. Modelo multivariable explicativo del deterioro clínico
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Resumen
Introducción

Existe controversia sobre los mejores factores predictores de deterioro clínico en la COVID-19.

Objetivo

Identificar factores predictores de riesgo de deterioro en pacientes hospitalizados por COVID-19.

Métodos Diseño

caso-control anidado dentro de una cohorte. Ámbito: 13 centros de agudos de Osakidetza-Servicio Vasco de Salud. Participantes: se consideró casos a pacientes hospitalizados por COVID-19 con deterioro clínico, definido como la aparición de síndrome de distrés respiratorio del adulto grave, ingreso en UCI o fallecimiento. Se emparejaron 2controles por caso en función de la edad. Se recogieron variables sociodemográficas, comorbilidades, tratamientos basales, síntomas y fecha de inicio, consultas previas, así como variables clínicas, analíticas y radiológicas. Se creó un modelo explicativo del deterioro clínico mediante regresión logística condicional.

Resultados

Se incluyeron 99 casos y 198 controles. Mediante análisis de regresión logística las variables independientes asociadas con deterioro clínico fueron: saturación de O2 en Urgencias ≤ 90% (OR=16,6, IC del 95%, 4-68), radiografía de tórax patológica (OR=5,6, IC del 95%, 1,7-18,4), PCR> 100mg/dL (OR=3,62, IC del 95% 1,62-8) y trombocitopenia <150.000 plaquetas (OR=4, IC del 95%, 1,84-8,6) y, entre los antecedentes, haber padecido infarto agudo de miocardio (OR=15,7, IC del 95%, 3,29-75,09), EPOC (OR=3,05, IC del 95%, 1,43-6,5) o hipertensión arterial (OR=2,21, IC del 95%1,11-4,4). El área bajo la curva alcanzado por el modelo fue 0,86. En el análisis univariado, se asociaron con mejor evolución clínica el sexo femenino, la presencia de tos seca y dolor de garganta, pero no resultaron significativas en el análisis multivariado.

Conclusión

Las variables identificadas podrían ser de utilidad en la práctica clínica para la detección de pacientes con alto riesgo de mala evolución.

Palabras clave:
COVID-19
Factores pronósticos
Deterioro clínico
Abstract
Introduction

There is controversy regarding the best predictors of clinical deterioration in COVID-19.

Objective

This work aims to identify predictors of risk factors for deterioration in patients hospitalized due to COVID-19.

Methods Design

Nested case-control study within a cohort. Setting: 13 acute care centers of the Osakidetza-Basque Health Service. Participants: Patients hospitalized for COVID-19 with clinical deterioration—defined as onset of severe ARDS, ICU admission, or death—were considered cases. Two controls were matched to each case based on age. Sociodemographic data; comorbidities; baseline treatment; symptoms; date of onset; previous consultations; and clinical, analytical, and radiological variables were collected. An explanatory model of clinical deterioration was created by means of conditional logistic regression.

Results

A total of 99 cases and 198 controls were included. According to the logistic regression analysis, the independent variables associated with clinical deterioration were: emergency department O2 saturation ≤90% (OR 16.6; 95%CI 4-68), pathological chest X-ray (OR 5.6; 95%CI 1.7-18.4), CRP>100mg/dL (OR 3.62; 95%CI 1.62-8), thrombocytopenia with <150,000 platelets (OR 4; 95%CI 1.84-8.6); and a medical history of acute myocardial infarction (OR 15.7; 95%CI, 3.29-75.09), COPD (OR 3.05; 95%CI 1.43-6.5), or HT (OR 2.21; 95%CI 1.11-4.4). The model's AUC was 0.86. On the univariate analysis, female sex and presence of dry cough and sore throat were associated with better clinical progress, but were not found to be significant on the multivariate analysis.

Conclusion

The variables identified could be useful in clinical practice for the detection of patients at high risk of poor outcomes.

Keywords:
COVID-19
Prognostic factors
Clinical deterioration

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