• José Carlos Arévalo-Lorido, Juana Carretero-Gómez, Jose Manuel Casas-Rojo, Juan Miguel Antón-Santos, José Antonio Melero-Bermejo, Maria Dolores López-Carmona, Lidia Cobos Palacios, Jaime Sanz-Cánovas, Paula Maria Pesqueira-Fontán, Andrés Alberto de la Peña-Fernández, Navas-Maria de la Sierra Alcántara, Gema Maria García-García, José David Torres Peña, Jeffrey Oskar Magallanes-Gamboa, Rosa Fernández-Madera-Martinez, Javier Fernández-Fernández, Manuel Rubio-Rivas, Guillermo Maestro-de la Calle, Eva Cervilla-Muñoz, Antonio Ramos-Martínez, Manuel Méndez-Bailón, José Manuel Ramos-Rincón, Ricardo Gómez-Huelgas, and SEMI-COVID-19 Network.
• Complejo Hospitalario Universitario de Badajoz. Badajoz, Spain.
• Curr Med Res Opin. 2022 Apr 1; 38 (4): 501-510.

BackgroundThe individual influence of a variety of comorbidities on COVID-19 patient outcomes has already been analyzed in previous works in an isolated way. We aim to determine if different associations of diseases influence the outcomes of inpatients with COVID-19.MethodsRetrospective cohort multicenter study based on clinical practice. Data were taken from the SEMI-COVID-19 Registry, which includes most consecutive patients with confirmed COVID-19 hospitalized and discharged in Spain. Two machine learning algorithms were applied in order to classify comorbidities and patients (Random Forest -RF algorithm, and Gaussian mixed model by clustering -GMM-). The primary endpoint was a composite of either, all-cause death or intensive care unit admission during the period of hospitalization. The sample was randomly divided into training and test sets to determine the most important comorbidities related to the primary endpoint, grow several clusters with these comorbidities based on discriminant analysis and GMM, and compare these clusters.ResultsA total of 16,455 inpatients (57.4% women and 42.6% men) were analyzed. According to the RF algorithm, the most important comorbidities were heart failure/atrial fibrillation (HF/AF), vascular diseases, and neurodegenerative diseases. There were six clusters: three included patients who met the primary endpoint (clusters 4, 5, and 6) and three included patients who did not (clusters 1, 2, and 3). Patients with HF/AF, vascular diseases, and neurodegenerative diseases were distributed among clusters 3, 4 and 5. Patients in cluster 5 also had kidney, liver, and acid peptic diseases as well as a chronic obstructive pulmonary disease; it was the cluster with the worst prognosis.ConclusionThe interplay of several comorbidities may affect the outcome and complications of inpatients with COVID-19.

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