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COVID-19 as a risk factor for long-term mortality in patients managed by the emergency medical system: A prospective,
José L Martín-Conty1,2, Begoña Polonio-López1,2, Ancor Sanz-García1,3
1Faculty of Health Sciences, Universidad de Castilla-la Mancha, Talavera de la Reina, Spain.
Insights
COVID-19 significantly increases long-term mortality risk in patients treated by emergency medical services. Previous COVID-19 infection nearly doubles mortality rates, highlighting its lasting impact on patient survival.
Area of Science:
- Emergency Medicine
- Infectious Diseases
- Public Health
Background:
- COVID-19 initially viewed as acute, now recognized for long-term consequences.
- Focus shifting to long-term health impacts beyond the acute phase.
- Understanding post-COVID-19 mortality is crucial for public health strategies.
Purpose of the Study:
- To investigate COVID-19 as an independent risk factor for long-term mortality.
- To compare mortality rates in patients with and without prior COVID-19 infection.
- To analyze factors influencing long-term survival in emergency medical services patients.
Main Methods:
- Prospective, multicenter, ambulance-based study of adult patients managed by emergency medical services (EMS).
- Data collected: sociodemographics, vital signs, pre-hospital tests, comorbidities including COVID-19 status.
- Statistical analyses: longitudinal (Cox regression) and logistic regression to assess mortality risk.
Main Results:
- 3,107 patients included (513 with prior COVID-19, 2,594 without).
- Higher mortality in COVID-19 group (31.8%) vs. non-COVID-19 group (17.9%).
- COVID-19 identified as a significant risk factor for long-term mortality (Hazard Ratio 1.33, p < 0.001).
Conclusions:
- Prior COVID-19 infection is associated with nearly double the long-term mortality rate.
- Adjusted analyses confirm COVID-19 as an independent risk factor for mortality.
- Findings underscore the critical need for long-term monitoring of COVID-19 survivors.
Introduction:
COVID-19 has initially been studied in terms of an acute-phase disease, although recently more attention has been given to the long-term consequences. In this study, we examined 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 against those who have not had the disease.
Methods:
A prospective, multicenter, ambulance-based, ongoing study was performed with adult patients with acute disease managed by EMS and transferred with high priority to the emergency department (ED) as study subjects. The study involved six advanced life support units, 38 basic life support units, and five emergency departments from Spain. Sociodemographic inputs, baseline vital signs, pre-hospital blood tests, and comorbidities, including COVID-19, were collected. The main outcome was long-term mortality, which was classified into 1-year all-cause mortality and 1-year in- and out-of-hospital mortality. To compare both the patients with COVID-19 vs. patients without COVID-19 and to compare survival vs non-survival, two main statistical analyses were performed, namely, a longitudinal analysis (Cox regression) and a logistic regression analysis.
Results:
Between 12 March 2020 and 30 September 2021, a total of 3,107 patients were included in the study, with 2,594 patients without COVID-19 and 513 patients previously suffering from COVID-19. The mortality rate was higher in patients with COVID-19 than in patients without COVID-19 (31.8 vs. 17.9%). A logistic regression showed that patients previously diagnosed with COVID-19 presented higher rates of nursing home residency, a higher number of breaths per minute, and suffering 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 an almost double mortality rate compared with the non-COVID-19 group. The final model adjusted for confusion factors suggested that COVID-19 was a risk factor for long-term mortality.
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