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Objective. To describe the epidemiological, clinical, laboratory, and radiological characteristics, medical treatment, and outcomes of a case series of severe spontaneous hematoma in COVID-19. Material and Methods. This retrospective study included patients hospitalized for COVID-19 who were diagnosed with severe spontaneous bleeding complications by following a standardized treatment protocol that included computed tomography angiography (CTA) from 1 March 2020 to 28 February 2022. The main outcomes were embolization and all-cause mortality. Baseline variables were analyzed for their association with mortality using bivariable logistic regression, and results were expressed as odds ratios (OR) and 95% confidence intervals (CI). Results. In total, 2450 adults were hospitalized for COVID-19 in our center during the study period. 20 patients presented severe and spontaneous intramuscular bleeding (8.1 per 1000 COVID-19 admission vs. 0.47 per 1000 non-COVID-19 admissions, p < 0.001); their median age was 68.5 years (interquartile range (IQR) 63, 80), they had high comorbidity (median Charlson comorbidity index 4.5), and 95% were receiving high doses of heparin. The median interval from COVID-19 symptoms to bleeding was 17 days (IQR 13, 24), and 70% reported cough as a previous symptom. Hypovolemic shock, hypotension, and abdominal pain were the most frequent symptoms of the hematoma. All presented decreased hemoglobin, and 95% required transfusion. Intramuscular hematoma occurred most frequently in the rectus sheath, iliopsoas compartment, and femoral-iliac compartment. All patients underwent embolization; mortality was 45%. We did not identify risk factors associated with an increased risk of death. Conclusion. Although severe bleeding is an uncommon complication of COVID-19, its prevalence is higher than in inpatients without COVID-19, it usually needs embolization, and it is associated with high mortality. [ABSTRACT FROM AUTHOR]

Background: The prevalence of multimorbidity and the number of chronic pathologies increases with age, and hospitalization rates are higher in very elderly patients. Aims: To identify predictors of mortality in patients aged 90 years or more at 6 and 12 months after admission to the internal medicine ward. Materials and methods: Prospective cohort study in patients aged 90 years or older whowere admitted to the internal medicine ward of Alicante General University Hospital from November 2018 to March 2019. We collected data for patient scores on the Barthel, Lawton-Brody, and Short Portable Mental Status Questionnaire; a nutritional questionnaire; the Charlson index; PALIAR and PROFUND prognostic indexes; and mortality at 6 and 12 months. Results: In the bivariate analysis adjusted for gender and comorbidity, malnutrition was associated with mortality at 6 and 12 months (odds ratio [OR] 5.17, 95% confidence interval [CI] 1.30, 20.50; OR 7.78, 95% CI 1.47, 40.9, respectively), as were moderate-severe cognitive impairment (6 months: OR 12.0, 95% CI 2.79, 52.0; 12 months: OR 10.73, 95% CI 2.40, 47.8) and high-risk scores on the PALIAR (6 months: OR 9.18, 95% CI 1.99, 42.27; 12 months: OR 11.7, 95% CI 2.62, 51.60) and PROFUND (6 months: OR 10.7, 95% CI 1.68, 68.80; 12 months: OR 20.9, 95% CI 3.15, 139.0) prognostic indexes. The Barthel index was associated with mortality only at 6 months (OR 6.16; 95% CI 1.69, 22.4). Conclusions: In nonagenarian inpatients, a worse score on the comprehensive assessment and a higher score on prognostic indexes were associated with increased risk of mortality at 6 and 12 months. [ABSTRACT FROM AUTHOR]

Objectives: Frailty can be used as a predictor of adverse outcomes in people with coronavirus disease 2019 (COVID‐19). The aim of the study was to analyse the prognostic value of two different frailty scores in patients hospitalised for COVID‐19. Material and Methods: This retrospective cohort study included adult (≥18 years) inpatients with COVID‐19 and took place from 3 March to 2 May 2020. Patients were categorised by Clinical Frailty Score (CFS) and Hospital Frailty Risk Score (HFRS). The primary outcome was in‐hospital mortality, and secondary outcomes were tocilizumab treatment, length of hospital stay, admission in intensive care unit (ICU) and need for invasive mechanical ventilation. Results were analysed by multivariable logistic regression and expressed as odds ratios (ORs), adjusting for age, sex, kidney function and comorbidity. Results: Of the 290 included patients, 54 were frail according to the CFS (≥5 points; prevalence 18.6%, 95% confidence interval [CI]: 14.4‐23.7) vs 65 by HFRS (≥5 points; prevalence: 22.4%, 95% CI 17.8‐27.7). Prevalence of frailty increased with age according to both measures: 50‐64 years, CFS 1.9% vs HFRS 12.3%; 65‐79 years, CFS 31.5% vs HFRS 40.0%; and ≥80 years, CFS 66.7% vs HFRS 40.0% (P <.001). CFS‐defined frailty was independently associated with risk of death (OR 3.67, 95% CI 1.49‐9.04) and less treatment with tocilizumab (OR 0.28, 95% CI 0.08‐0.93). HFRS‐defined frailty was independently associated with length of hospital stay over 10 days (OR 2.89, 95% CI 1.53‐5.44), ICU admission (OR 4.18, 95% CI 1.84‐9.52) and invasive mechanical ventilation (OR 5.93, 95% CI 2.33‐15.10). Conclusion: In the spring 2020 wave of the COVID‐19 pandemic in Spain, CFS‐defined frailty was an independent predictor for death, while frailty as measured by the HFRS was associated with length of hospital stay over 10 days, ICU admission and use of invasive mechanical ventilation. [ABSTRACT FROM AUTHOR]

Background and Objectives : The aim of the following cross-sectional study is to determine the association between human leukocyte antigen (HLA) alleles and outcomes in patients presenting to the emergency department (ED) with SARS-CoV-2 infection. Methods and Materials : Genotyping was made using the Axiom Human Genotyping SARS-CoV-2 Research Array. Statistical analysis was made with Fisher's exact test and multivariable logistic regression, adjusted for sex, age and clinical variables. Results : Of 190 patients, 11.1% were discharged from the ED; 57.9% were admitted to the COVID-19 ward, without intensive care unit (ICU) admission; 15.3% survived an ICU admission; and 15.8% died. After multivariable analysis, two HLA alleles protected against hospital admission (HLA-C*05:01, adjusted odds ratio [aOR] 0.2, 95% confidence interval [CI] 0.055-0.731; and HLA-DQB1*02:02, aOR 0.046, CI 0.002-0.871) and one was associated with higher risk for ICU admission or death (HLA-DQA1*05:01, aOR 2.517, CI 1.086-5.833). Conclusions : In this population, HLA-C*05:01 and HLA-DQB1*02:02 are associated with a protective effect against hospital admission and HLA-DQA1*05:01 is associated with higher risk of ICU admission or death in the multivariable analysis. This may help stratify risk in COVID-19 patients.