• G Maestro de la Calle, A García Reyne, J Lora-Tamayo, A Muiño Miguez, F Arnalich-Fernandez, J L Beato Pérez, J A Vargas Núñez, M A Caudevilla Martínez, N Alcalá Rivera, E Orviz Garcia, B Sánchez Moreno, S J Freire Castro, N Rhyman, P M Pesqueira Fontan, L Piles, J F López Caleya, M E Fraile Villarejo, N Jiménez-García, R Boixeda, A González Noya, A Gracia Gutiérrez, J Á Martín Oterino, R Gómez Huelgas, J M Antón Santos, C Lumbreras Bermejo, and en nombre de la red SEMI-COVID-19.
• Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España.
• Rev Clin Esp. 2023 May 1; 223 (5): 281297281-297.

BackgroundCOVID-19 shows different clinical and pathophysiological stages over time. Theeffect of days elapsed from the onset of symptoms (DEOS) to hospitalization on COVID-19prognostic factors remains uncertain. We analyzed the impact on mortality of DEOS to hospital-ization and how other independent prognostic factors perform when taking this time elapsedinto account.MethodsThis retrospective, nationwide cohort study, included patients with confirmed COVID-19 from February 20th and May 6th, 2020. The data was collected in a standardized online datacapture registry. Univariate and multivariate COX-regression were performed in the generalcohort and the final multivariate model was subjected to a sensitivity analysis in an earlypresenting (EP; < 5 DEOS) and late presenting (LP; ≥5 DEOS) group.Results7915 COVID-19 patients were included in the analysis, 2324 in the EP and 5591 in theLP group. DEOS to hospitalization was an independent prognostic factor of in-hospital mortalityin the multivariate Cox regression model along with other 9 variables. Each DEOS incrementaccounted for a 4.3% mortality risk reduction (HR 0.957; 95% CI 0.93---0.98). Regarding variationsin other mortality predictors in the sensitivity analysis, the Charlson Comorbidity Index onlyremained significant in the EP group while D-dimer only remained significant in the LP group.ConclusionWhen caring for COVID-19 patients, DEOS to hospitalization should be consideredas their need for early hospitalization confers a higher risk of mortality. Different prognosticfactors vary over time and should be studied within a fixed timeframe of the disease.© 2023 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

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