Characteristics of patients who died in the Hospital Emergency Service during the SARS-CoV-2 pandemic: a retrospective cohort study in a tertiary hospital in Spain.

doi:10.21203/rs.3.rs-3228812/v1

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Characteristics of patients who died in the Hospital Emergency Service during the SARS-CoV-2 pandemic: a retrospective cohort study in a tertiary hospital in Spain.

https://doi.org/10.21203/rs.3.rs-3228812/v1

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published 25 Jan, 2024

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Objective:

The objective of this study is to analyze the characteristics of patients who died in the Hospital Emergency Department (HED) of a Spanish third-level hospital, with a special focus on those who died due to SARS-CoV-2.

Methods:

A retrospective cohort study was conducted, including all patients over 18 years old who died in the Hospital Emergency Department (HED) of a Spanish third-level hospital located in Badalona, Spain, from June 2019 to December 2020. Various sociodemographic, clinical, and diagnostic variables of the patients were analyzed to identify potential risk factors associated with mortality.

Results:

During the first wave of the COVID-19 pandemic, a total of 72 patients died in the HED, representing a 42% increase compared to the pre-pandemic period. Of the deceased patients, 11% were attributed to SARS-CoV-2. Furthermore, it was found that patients who died from SARS-CoV-2 during the first wave were significantly younger than those in the second wave, with an average age of 78.6 ± 3.1 years in the first wave and 91.8 ± 4.8 years in the second wave. No significant differences were found regarding gender or associated comorbidities.

Conclusions:

Overall, the mortality rate at the HED in relation to COVID-19 was low, and infected patients died at younger ages during the first wave compared to the second wave.

Hospital Emergency Department

Mortality

Comorbidity

SARS-CoV-2

Pandemic

Retrospective cohort

Hospital Emergency Departments (HED) serve as the primary entry point for medical care in hospitals and provide valuable insights into assessing healthcare quality. Mortality rates in HED are widely utilized indicators for measuring the quality of care provided. Several factors, including the severity of patient conditions, the increasing prevalence of terminal illnesses, the aging population with a higher burden of chronic diseases, and the subsequent rise in healthcare demands, can influence mortality rates in HED^1–5. Several studies have demonstrated that a significant proportion of patients who die in HED are elderly individuals with pre-existing functional limitations and significant comorbidities^1–2. Organizational characteristics can also influence mortality rates in HES. The increased use of HED as the first point of contact, the hospital's capacity to admit patients promptly, and the saturation of the HED itself are other aspects to be considered. Despite the multitude of influencing factors, mortality rates in HED remain useful for assessing trends and indirectly evaluating HED effectiveness in addressing medical issues and identifying underlying causes^1–2.

Although the mortality rate of patients in HED is on the rise, it is crucial to acknowledge that HED facilities are not designed to provide end-of-life care for terminally ill individuals. Rather, their primary objective is to facilitate prompt decision-making and interventions in critical scenarios. Consequently, there is growing emphasis on the quality of the setting in which deaths occur, along with the implementation of palliative care interventions and the provision of support for patients to have their family members present. It is important to highlight that hospital overcrowding affects this aspect, making it challenging to create an appropriate end-of-life environment and leading to a rise in mortality rates within HED^3,4,6.

According to the World Health Organization (WHO), cardiovascular diseases have traditionally been recognized as the leading cause of death worldwide. However, the emergence of the SARS-CoV-2 infection in 2020 significantly disrupted this prevailing trend. In Spain, there were more than 1.5 million reported cases of COVID-19 with over 20,000 deaths recorded during that year^7,8. Due to the absence of a specific vaccine and targeted treatments at the early stages of the pandemic, the symptomatic management of COVID-19 led to a high incidence of hospital admissions in the H ED and an increase in mortality rates¹⁰. To contribute to improving the quality of care and reducing mortality rates in HED during similar situations in the future, this study aims to evaluate the unique factors influencing mortality in HED during the first and second waves of the SARS-CoV-2 pandemic compared to the pre-pandemic period.

A retrospective cohort study was conducted at a tertiary-level hospital located in Badalona, Spain. Spain. The study enrolled all patients aged 18 years and above who died in the Hospital Emergency Department (HED) between June 1, 2019, and December 6, 2020. The study aimed to compare and analyze three distinct time periods: the "pre-pandemic period" (June 1, 2019, to March 13, 2020), the "first wave" (March 14, 2020, to June 21, 2020), and the "second wave" (June 22, 2020, to December 6, 2020). The Emergency Minimum Basic Data Set (EMBDS) registry of the hospital was consulted for data collection purposes.

Sociodemographic factors such as age, sex, and patient origin were evaluated in this study. Various medical conditions such as arterial hypertension, diabetes mellitus, dyslipidemia, obesity, ischemic heart disease, heart failure, chronic obstructive pulmonary disease, chronic kidney disease, and neoplasms were identified and considered within the analysis. Comorbidity was defined base on the Charlson Comorbidity Index (CCI), which categorized patients into three groups: no comorbidity (0–1 points), low comorbidity (2 points), and high comorbidity (≥ 3 points). Furthermore, the study examined patients with multiple chronic conditions, specifically focusing on complex chronic patients (PCC) or those with advanced chronic disease (MACA)¹³.

The study conducted a comprehensive analysis of patient consultations within the Hospital Emergency Department (HED) over a 72-hour period and the preceding 7 days, as well as hospital admissions in the week prior. The appropriate patient location was carefully assessed, specifically referring to deaths occurring within HED boxes with a stay of less than 12 hours or in the observation unit (UO) and short-stay unit (UCE), regardless of the duration of their stay.

The study documented the cause of death using the International Classification of Diseases, 10th Revision (ICD-10)14. It also recorded the duration of hospital stay in hours until the time of death, as well as whether the deaths occurred on weekdays or weekends

Statistical Analysis

The data were analyzed using descriptive statistics, presenting categorical variables as frequencies and percentages, and continuous variables as means and standard deviations.

To assess the statistical differences between groups, chi-square tests were employed for categorical variables, while independent samples t-tests were utilized for continuous variables.

Logistic regression analysis was performed to examine the association between each variable and mortality. The results are presented as odds ratios, along with their corresponding 95% confidence intervals, either crude or adjusted for age and sex.

All analyses were conducted using Stata 16/SE (Stata Corp).

Ethical aspects

The study utilized anonymized and retrospectively collected data from the UR-CMBD (Unit of Records-CMBD). Prior to conducting the study, ethical approval was obtained from the Research Ethics Committee (CEI PI-20-180) of the center.

During the first wave, there were 72 recorded deaths, representing a 42% increase compared to the pre-pandemic period and a notable 28% rise compared to the second wave. The average age of the patients was 77 years (± 2), with a majority of males (58%). The patients stayed at the hospital for more than 25 hours. Only 42% of the patients were appropriately placed, which is a lower percentage compared to the pre-pandemic period. In 60% of the cases, the occurrence of death upon admission was expected, while this percentage increased to 72% during the second surge (Table 1).

Table 2 presents a comparison of the Charlson Comorbidity Index (CCI) and chronic pathologies among the deceased patients. It is evident that the patients who died during the initial wave exhibited a substantial burden of comorbidities. Notably, there was a decrease in the admission of patients with cognitive impairment and heart failure, juxtaposed with an upsurge in the prevalence of patients with ischemic heart disease.

Figure 1 presents a comparative assessment of comorbidities among deceased patients across distinct age cohorts during the three evaluated periods. In the first wave, a higher proportion of patients aged 60 to 74 years exhibited chronic kidney disease, while ischemic heart disease prevailed among those aged 60 to 89 years. Moreover, cognitive disorder was more prevalent among individuals aged 90 years and older. In the second wave, a notable increase was observed in patients aged 75 to 89 years with diabetes mellitus, individuals aged 60 years and above with heart failure, and individuals aged 18 to 74 years with neoplastic pathologies.

When comparing comorbidities based on gender (Fig. 2), it was observed that men experienced premature mortality compared to women across all three studied periods. Both males and females exhibited a significant burden of comorbidities, with noteworthy prevalence of cardiovascular diseases and chronic obstructive pulmonary disease among males, while cognitive impairment was more prominent among females.

Table 3 presents a comparative analysis of the ranking of the 12 primary causes of death according to the ICD-10 classification system during the three examined periods. The table discerns by age, sex, and time from admission to death. In the pre-pandemic period, severe sepsis and non-traumatic intracerebral hemorrhage occupied the first and second positions, respectively. However, in the second wave, their rankings shifted to first and third place, respectively. However, during the first wave, they were pushed to the 3rd and 5th positions. Significantly, during the first wave, COVID-19 emerged as the leading cause of death, surpassing all others in the ranking. It was followed by cardiac arrest. In the second wave, COVID-19 dropped to the 6th position in the ranking.

Table 4 presents a comparative analysis of deceased patients during the first and second waves, categorized based on the presence or absence of a COVID-19 diagnosis. In the first wave, patients who succumbed to COVID-19 were found to be significantly younger, with an average age of 78 years (± 3), compared to those who died during the second wave, with an average age of 92 years (± 5). Moreover, among patients who did not contract COVID-19 during the first wave, there was a remarkable 20% lower prevalence of cognitive impairment compared to the second wave. Additionally, there was a notable 14% decrease in cases of heart failure compared to the second wave. Conversely, there was an 11% increase in cases of ischemic heart disease during the first wave when compared to the second wave. Importantly, a lower percentage of expected deaths was noted among patients without COVID-19 during the first wave, accounting for 53% of cases, in comparison to the 70% observed during the second wave.

Supplementary Table 1 presents an analysis of the characteristics of deceased patients at the HED, focusing on the risk of death from COVID-19 in comparison to other causes. It was observed that patients coming from residential care facilities had twice the risk of death from COVID-19 compared to other causes (OR = 2.58, 95% CI: 1.03–6.49). This risk was further elevated during the first wave, with an odds ratio of 6.00 (95% CI: 1.40-25.64). Regarding comorbidities, individuals with neoplasms exhibited a reduced risk of mortality from COVID-19 (OR = 0.13, 95% CI: 0.02–0.97). However, during the first wave, patients with dementia faced a sevenfold higher risk of death from COVID-19 compared to other causes (OR = 7.05, 95% CI: 1.55–32.14).

This study analyzes the mortality rate in a Hospital Emergency Department (HED) during the COVID-19 pandemic. The analysis reveals a significant surge in the mortality rate during the first wave, with rates of 0.164 in the pre-pandemic period, 0.432 during the first wave, and 0.267 during the second wave. In comparison, previous studies cited in the literature reported pre-pandemic mortality rates ranging from 0.10–0.40%. These observed differences can be attributed to various factors and are justified by the diversity in the structure and functioning of Hospital Emergency Departments, as well as the diversity in patient profiles in terms of type and severity of conditions^{1–2, 15–17}.

In our research, we conducted an investigation to examine the potential impact of the day of the week on mortality rates at the HED, but no significant differences were found. However, it is noteworthy to mention the study conducted by Aylin et al., which reported compelling and concerning data. Their research indicated a noteworthy 10% increase in the adjusted probability of mortality for all emergency admissions occurring during weekends⁸.

During the first wave, we observed that the average length of stay from the patient's arrival until their decease was slightly higher, exceeding 25 hours. These findings are consistent with the research conducted by Vázquez-García et al., revealing that 47.9% of deaths occurred between 4 and 24 hours after hospital admission, while 40.7% occurred within the first 4 hours³. Similarly, Richardson et al. reported that 47.4% of the deaths happened within 4 to 24 hours after hospital admission⁴. In contrast, Parra et al. found a higher average time in the total sample, with 666 minutes for patients with pre-existing terminal illnesses and 597 minutes for patients with acute pathology⁵. These findings suggest that patients with significant comorbidities tend to die after spending more hours at the HED compared to those whose deaths result from acute or critical causes.

Concerning the suitability of patient placement at the time of death, a reasonably positive proportion was noted in terms of percentages, considering the challenging circumstances of the pandemic and the burden on hospital capacity. Previous investigations have also reported comparable percentages of appropriate patient placement in observation areas at the time of death, varying between 35.3% and 51.5%^{3, 6–7}.

Regarding gender differences, our study revealed a consistent pattern of females experiencing mortality at more advanced ages compared to males, and this trend was observed across all three analyzed periods. These findings are consistent with data from the Instituto Nacional de Estadística from Spain, which reported a life expectancy at birth of 79.6 years for men and 85.1 years for women in 2020¹⁸. These differences may be attributed to disparities in lifestyle between genders.

The average age of deceased patients in the various periods was similar, but there was a significant increase in the number of deaths among the elderly population across all three periods, consistent with findings from prior research^1–2. It is pertinent to highlight that the National Institute of Statistics in Catalonia reported a life expectancy at birth of 82.3 years in 2020¹⁸. This observed variability in age might be linked to the substantial comorbidity and severity of patients' conditions.

Upon analyzing the relationship between age groups and comorbidities assessed using the Charlson Comorbidity Index (CCI), we observed a direct and proportional correlation between age and comorbidity burden across all three studied periods. The mean CCI score was consistently higher than 6 points, with no significant differences observed between periods. This suggests that the patients who passed away in our HED carried a substantial load of chronic diseases. Such multipathology may have been the primary reason for their hospital admission, either due to the deterioration of pre-existing conditions or the occurrence of an acute event that triggered an immediate fatal outcome due to their limited baseline health status. These findings are consistent to the ones obtained by Vázquez-García et al.⁶

During the second wave of COVID-19, we observed a rise in the proportion of deceased patients with pre-existing conditions such as diabetes mellitus, heart failure, and neoplastic diseases. This trend might be linked to reduced medical monitoring and care for these patients during the initial wave of the pandemic. This trend might be linked to reduced medical monitoring and care for these patients during the initial wave of the pandemic. These results are supported by the findings presented in the SESPAS 2022 report²⁹.

Patients who died with a diagnosis of COVID-19 during the first wave were significantly younger than those who died during the second wave. These findings indicates that as individuals age increase, there is a 20% increased risk of COVID-19-related mortality in the HED compared to other causes of death. These findings are reinforced by studies conducted by Zhang¹⁹ and Maria Dorrucci²¹. The higher mortality rate among younger patients during the first wave could be attributed to factors such as limited knowledge about the disease, lack of treatment options, and absence of vaccination at that time.

Our findings did not demonstrate statistically significant differences in the sex of deceased COVID-19 patients. These findings differ from multiple publications, such as those by Zhang and Pérez-López, which have shown higher mortality rates among males affected by COVID-19 ^19–20. However, it is important to acknowledge that our sample size of deceased COVID-19 patients was relatively small, which could have limited our capacity to detect significant differences between genders.

Institutionalized patients with dementia who are affected by COVID-19 are at a heightened risk of mortality. This finding is corroborated by multiple studies ^26–27 and meta-analyses²⁸. The pandemic has further accentuated the vulnerability of dementia patients, as evidenced by increased morbidity and mortality stemming from the disruption of their social support systems and restricted access to secondary healthcare services due to confinement and social distancing measures.

Patients with oncological conditions presented a lower risk of mortality from COVID-19 compared to patients without neoplastic diseases. However, the literature on mortality in patients with neoplasms presents a wide array of results, with varying findings reported in different studies^23–25. Some studies provide data on overall mortality, while others (including this analysis) focus on outcomes within a 30-day timeframe. Moreover, the majority of studies address mortality across all causes, with only a limited number including specific mortality related to COVID-19, which holds significance for individuals with cancer. Additionally, it is essential to recognize that the impact of the COVID-19 pandemic and the constraints on healthcare systems have not been uniform across different regions worldwide.

Patients who died in our facility during the pre-pandemic period succumbed mainly due to infectious diseases and cerebrovascular pathologies. However, during the first wave of the COVID-19 pandemic, COVID-19 became the leading cause of death, surpassing these previously predominant diagnoses. According to the World Health Organization (WHO) and other studies conducted in developed countries, the principal causes of mortality encompass cardiovascular diseases, dementia, cerebrovascular pathologies, and cancer^1,3,10. Yuan's study also highlighted sepsis as the leading cause of death, followed by cardiovascular and cerebrovascular pathologies22. This difference, compared to the majority of studies, is likely attributable to the substantial number of elderly patients with multiple comorbidities in our population.

The current study possesses several strengths, including its exhaustive analysis of multiple variables pertaining to mortality in the HED, encompassing sociodemographic factors, comorbidities, and patient location. It relies on reliable medical records and conducts a comparison across different periods, enabling the identification of potential changes in risk factors and mortality during distinct phases of the SARS-CoV-2 pandemic. However, certain limitations arise from its retrospective design, which may constrain the availability and quality of collected data, and the possible existence of selection biases and unaccounted confounding factors in the analysis. Despite these limitations, the obtained results contribute significantly to enhancing healthcare quality by providing relevant information for the implementation of effective strategies and preventive measures in similar circumstances in the future.

The deceased patients in our HED have a notably higher mean age and elevated comorbity rates, leading to more complex healthcare management. Consequently, there is a growing necessity to implement sociosanitary policies and chronic and palliative care strategies in response to the progressive aging of the population. Implementing such policies and strategies could potentially reduce mortality rates among these patient subgroups in the HED.

During the first wave of the SARS-CoV-2 pandemic, the mortality rate in the HED for COVID-19 was relatively low. However, the infected patients who died were younger compared to those who died during the second wave. This divergence could be attributed to the limited knowledge of the disease, its progression, and the absence of targeted treatment and preventive measures at that early stage. Additionally, there was an increase in unexpected deaths and longer hospital stays during the first wave as compared to the second wave. These data highlight the evolving nature fo the pandemic and the complexity of hospital management as more knowledge we have. This highlights the importance of ongoing research and data analysis to continuously improve patient care and treatment strategies.

Funding:

There is no funding or financial support in relation to the present study.

Ethical responsabilities

All authors have confirmed the maintenance of confidentiality and respect for patients' rights in the authorship responsibilities document, publication agreement, and rights transfer to Internal and Emergency Medicine.

Rodríguez Maroto O, Llorente Álvarez S, Casanueva Gutierrez M, Álvarez Álvarez B, Menéndez Somoano P, Riva Miranda G. Mortalidad en un Servicio de Urgencias Hospitalarias. Características clínico epidemiológicas. Emergencias. 2004;16:17-22
Stefanovski, P. H., Vladimir Radkov, R., Lyubomir Ilkov, T., Pencho Tonchev, T., Yoana Mladenova, T., Vihar Manchev, K., & Radko Nikolov, R. (2017). Analysis of mortality in the emergency department at a university hospital in Pleven. Journal of International Medical Research, 45(5), 1553–1561. https://doi.org/10.1177/0300060517707901
Vázquez-García D, Rica-Escuín M, Germán-Bes C, Caballero-Navarro AL. Características epidemiológicas de los pacientes fallecidos en los servicios de urgencias hospitalarias del sistema aragonés de salud y su relación con el índice comorbilidad. Emergencias. 2020; 32;162-168.
Richardson PG, Greenslade J, Isoardi J, Davey M, Gillett M, Tucker A, et al. End-of-life issues: Withdrawal and withholding of life-sustaining healthcare in the emergency department: A comparison between emergency physicians and emergency registrars: A sub-study. EMA - Emerg Med Australas. 2016;28:684-90.
Parra-Caballero P, Curbelo-García JJ, Gullón-Ojesto A, Ruiz-Giménez Arrieta N, Suárez-Fernández C, Del Arco-Galán C. Mortalidad precoz en un hospital terciario: Análisis de la calidad asistencial. Emergencias. 2011;23:430-6.
Le Conte P, Riochet D, Batard E, Volteau C, Giraudeau B, Arnaudet I, et al. Death in emergency departments: A multicenter cross-sectio- nal survey with analysis of withholding and withdrawing life su- pport. Intensive Care Med. 2010;36:765-72.
VanTricht M, Riochet D, Batard E, Martinage A, Montassier E, Potel G, et al. Palliative care for patients who died in emergency depart- ments : analysis of a multicentre cross-sectional survey. Emerg Med J. 2012;29:795-7.
Aylin, P., Yunus, A., Bottle, A., Majeed, A., & Bell, D. (2010). Weekend mortality for emergency admissions. A large, multicentre study. Quality and Safety in Health Care, 19(3), 213–217. doi.org/10.1136/qshc.2008.028639
Informe no 59. Situación de COVID-19 en España. Casos diagnosticados a partir 10 de mayo. https://www.isciii.es/QueHacemos/Servicios/VigilanciaSaludPublicaRENAVE/EnfermedadesTransmisibles/Paginas/Informes_Previos_COVID-19_2020.aspx
Las 10 principales causas de defunción. https://www.who.int/es/news-room/fact-sheets/detail/the-top-10-causes-of-death
Srivastava N, Baxi P, Ratho RK, Saxena SK. Global Trends in Epidemiology of Coronavirus Disease 2019 (COVID-19). S.K. Saxena (ed), Coronavirus Disease 2019 (COVID-19) Medical Virology: from Pathogenesis to Disease Control. 2020, 9-21.
COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. https://www.COVID19treatmentguidelines.nih.gov/overview/overview-of-COVID-19/
Bases para un modelo catalán de atención a las personas con necesidades complejas. Conceptualización e introducción a los elementos operativos. Versión 6.0 del 27 de marzo de 2017. https://scientiasalut.gencat.cat/bitstream/handle/11351/3305/bases_modelo_catalan_atencion_personas_necesidades_complejas_2017_cas.pdf?sequence=5
Clasificación Internacional de Enfermedades 10.ª revisión, modificación clínica. Edición Española. https://eciemaps.mscbs.gob.es/ecieMaps/browser/index_10_mc.html.
Miró O, De Dios A, Antonio MT, Sánchez M, Borrás A, Millá J. Estudio de la mortalidad en un servicio de urgencias hospitalario: incidencias, causas y consecuencias. Med Clin (Barc.) 1999;112:690-2.
Sahuquillo Llamas JC, Tudela Hita P, Segura Egea A, Estrada Cuxarto O. Análisis de la mortalidad en el Servicio de Urgencias de un Hospital General. Emergencias. 2000;12(extra):377.
Rodríguez Maroto O, Llorente Álvarez S, Casanueva Gutierrez M, Álvarez Álvarez B, Menéndez Somoano P, De La Riva Miranda G. Mortalidad en un Servicio de Urgencias Hospitalarias. Características clínico epidemiológicas. Emergencias 2004;16:17-22
Instituto Nacional de Estadística. https://www.ine.es/ss/Satellite?L=es_ES&c=INESeccion_C&cid=1259944484459&p=1254735110672&pagename=ProductosYServicios%2FPYSLayout&param1=PYSDetalleFichaIndicador&param3=1259947308577
Zhang JJ, Dong X, Liu GH, Gao YD. Risk and Protective Factors for COVID-19 Morbidity, Severity, and Mortality. Clin Rev Allergy Immunol. 2023 Feb;64(1):90-107. doi: 10.1007/s12016-022-08921-5. Epub 2022 Jan 19. PMID: 35044620; PMCID: PMC8767775.
Pérez López FR, Tajada M, Savirón Cornudella R, Sanchez-Prieto M, Chedrauie P, Teráng E. Coronavirus disease 2019 and gender-related mortality in European countries: A meta-analysis. Maturitas. 2020 Nov; 141:59-62.
Dorrucci M, Minelli G, Boros S, Manno V, Prati S, Battaglini M, Corsetti G, Andrianou X, Riccardo F, Fabiani M, Vescio MF, Spuri M, Urdiales AM, Martina DM, Onder G, Pezzotti P, Bella A. Excess Mortality in Italy During the COVID-19 Pandemic: Assessing the Differences Between the First and the Second Wave, Year 2020. Front Public Health. 2021 Jul 16;9:669209. doi: 10.3389/fpubh.2021.669209. PMID: 34336767; PMCID: PMC8322580.
Yuan, X.-L., Du, X.-Y., & Ding, N. (2022). A retrospective analysis of mortality in a Beijing hospital Emergency Department. Annali Italiani Di Chirurgia, 93, 453–456.
Chavez-MacGregor M, Lei X, Zhao H, Scheet P, Giordano SH. Evaluation of COVID-19 Mortality and Adverse Outcomes in US Patients With or Without Cancer. JAMA Oncol. 2022 Jan 1;8(1):69-78. doi: 10.1001/jamaoncol.2021.5148. PMID: 34709356; PMCID: PMC8554684.
Naimi A, Yashmi I, Jebeleh R, Imani Mofrad M, Azimian Abhar S, Jannesar Y, Heidary M, Pakzad R. Comorbidities and mortality rate in COVID-19 patients with hematological malignancies: A systematic review and meta-analysis. J Clin Lab Anal. 2022 May;36(5):e24387. doi: 10.1002/jcla.24387. Epub 2022 Apr 6. PMID: 35385130; PMCID: PMC9102765.
Aboueshia M, Hussein MH, Attia AS, Swinford A, Miller P, Omar M, Toraih EA, Saba N, Safah H, Duchesne J, Kandil E. Cancer and COVID-19: analysis of patient outcomes. Future Oncol. 2021 Sep;17(26):3499-3510. doi: 10.2217/fon-2021-0121. Epub 2021 Jul 15. PMID: 34263660; PMCID: PMC8284249.
Kyoung DS, Lee J, Nam H, Park MH. Dementia and COVID-19 Mortality in South Korea. Dement Neurocogn Disord. 2021 Jul;20(3):38-40. doi: 10.12779/dnd.2021.20.3.38. Epub 2021 May 31. PMID: 34354756; PMCID: PMC8326307.
Wang Q, Davis PB, Gurney ME, Xu R. COVID-19 and dementia: Analyses of risk, disparity, and outcomes from electronic health records in the US. Alzheimers Dement. 2021 Aug;17(8):1297-1306. doi: 10.1002/alz.12296. Epub 2021 Feb 9. PMID: 33559975; PMCID: PMC8014535.
Dadras O, SeyedAlinaghi S, Karimi A, Shamsabadi A, Qaderi K, Ramezani M, Mirghaderi SP, Mahdiabadi S, Vahedi F, Saeidi S, Shojaei A, Mehrtak M, Azar SA, Mehraeen E, Voltarelli FA. COVID-19 mortality and its predictors in the elderly: A systematic review. Health Sci Rep. 2022 May 23;5(3):e657. doi: 10.1002/hsr2.657. Erratum in: Health Sci Rep. 2022 Jul 21;5(4):e723. PMID: 35620541; PMCID: PMC9125886
Torres-Cantero AM, Álvarez León EE, Morán-Sánchez I, San Lázaro Campillo I, Bernal Morell E, Hernández Pereña M, Martínez-Morata I. El impacto de la pandemia de COVID-19 sobre la salud. Informe SESPAS 2022 [Health impact of COVID pandemic. SESPAS Report 2022]. Gac Sanit. 2022;36 Suppl 1:S4-S12. Spanish. doi: 10.1016/j.gaceta.2022.02.008. PMID: 35781147; PMCID: PMC9244867.

Tables 1 to 4 are available in the Supplementary Files section.

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Characteristics of patients who died in the Hospital Emergency Service during the SARS-CoV-2 pandemic: a retrospective cohort study in a tertiary hospital in Spain.

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