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This expert consensus was technically supported with a grant provided by GSK Laboratories, Spain. Publication fees were paid by the Sociedad Espanola de Quimioterapia.

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Cabello, AlfonsoAuthor

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October 20, 2023
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Expert Consensus: Main Risk Factors for Poor Prognosis in COVID-19 and the Implications for Targeted Measures against SARS-CoV-2

Publicated to:Viruses-Basel. 15 (7): - 2023-07-01 15(7), DOI: 10.3390/v15071449

Authors: Candel, FJ; Barreiro, P; Salavert, M; Cabello, A; Fernández-Ruiz, M; Pérez-Segura, P; San Román, J; Berenguer, J; Córdoba, R; Delgado, R; España, PP; Gómez-Centurión, IA; del Castillo, JMG; Heili, SB; Martínez-Peromingo, FJ; Menéndez, R; Moreno, S; Pablos, JL; Pasquau, J; Piñana, JL; MODUS Investigators Adenda

Affiliations

Ctr Invest Biomed Red Enfermedades Infecciosas CIB, Inst Invest Sanitaria Gregorio Maranon IiSGM, Madrid 28007, Spain - Author
Hosp Clin Univ San Carlos, Clin Microbiol & Infect Dis, Transplant Coordinat, Madrid 28040, Spain - Author
Hosp Clin Univ San Carlos, Med Oncol, Madrid, Spain - Author
Hosp Clin Univ Valencia, Haematol & Haemotherapy, Valencia 46010, Spain - Author
Hosp Gen Univ Gregorio Maranon, Haematol & Haemotherapy, Madrid 28007, Spain - Author
Hosp Gen Univ La Paz, Reg Publ Hlth Lab, Infect Dis, Internal Med, Madrid 28055, Spain - Author
Hosp Univ & Politecn La Fe, Infect Dis, Internal Med, Valencia 46026, Spain - Author
Hosp Univ & Politecn La Fe, Pneumol, Valencia 46026, Spain - Author
Hosp Univ 12 De Octubre, Inst Invest Sanit Hosp 12 De Octubre imas12, Ctr Invest Biomed Red Enfermedades Infecciosas CIB, Unit Infect Dis,Inst Salud Carlos III ISCIII, Madrid 28041, Spain - Author
Hosp Univ 12 De Octubre, Inst Invest Sanitaria Hosp 12 De Octubre imas12, Clin Microbiol, Madrid 28041, Spain - Author
Hosp Univ 12 De Octubre, Inst Invest Sanitaria Hosp 12 De Octubre imas12, Rheumatol, Madrid 28041, Spain - Author
Hosp Univ Clin San Carlos, Emergency Dept, Madrid 28040, Spain - Author
Hosp Univ Fdn Jimenez Diaz, Haematol & Haemotherapy, Madrid 28040, Spain - Author
Hosp Univ Fdn Jimenez Diaz, Intermediate Resp Care Unit, Madrid 28040, Spain - Author
Hosp Univ Fdn Jimenez Diaz, Internal Med, Madrid 28040, Spain - Author
Hosp Univ Galdakao Usansolo, Pneumol, Vizcaya 48960, Spain - Author
Hosp Univ Ramon & Cajal, Infect Dis, Madrid 28034, Spain - Author
Hosp Univ Rey Juan Carlos, Geriatr, Madrid 28933, Spain - Author
Hosp Univ Virgen De LAsNieves, Infect Dis, Granada 18014, Spain - Author
Univ Rey Juan Carlos, Dept Med Special & Publ Hlth, Madrid 28922, Spain - Author
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Abstract

The clinical evolution of patients infected with the Severe Acute Respiratory Coronavirus type 2 (SARS-CoV-2) depends on the complex interplay between viral and host factors. The evolution to less aggressive but better-transmitted viral variants, and the presence of immune memory responses in a growing number of vaccinated and/or virus-exposed individuals, has caused the pandemic to slowly wane in virulence. However, there are still patients with risk factors or comorbidities that put them at risk of poor outcomes in the event of having the coronavirus infectious disease 2019 (COVID-19). Among the different treatment options for patients with COVID-19, virus-targeted measures include antiviral drugs or monoclonal antibodies that may be provided in the early days of infection. The present expert consensus is based on a review of all the literature published between 1 July 2021 and 15 February 2022 that was carried out to establish the characteristics of patients, in terms of presence of risk factors or comorbidities, that may make them candidates for receiving any of the virus-targeted measures available in order to prevent a fatal outcome, such as severe disease or death. A total of 119 studies were included from the review of the literature and 159 were from the additional independent review carried out by the panelists a posteriori. Conditions found related to strong recommendation of the use of virus-targeted measures in the first days of COVID-19 were age above 80 years, or above 65 years with another risk factor; antineoplastic chemotherapy or active malignancy; HIV infection with CD4+ cell counts < 200/mm(3); and treatment with anti-CD20 immunosuppressive drugs. There is also a strong recommendation against using the studied interventions in HIV-infected patients with a CD4+ nadir <200/mm(3) or treatment with other immunosuppressants. Indications of therapies against SARS-CoV-2, regardless of vaccination status or history of infection, may still exist for some populations, even after COVID-19 has been declared to no longer be a global health emergency by the WHO.

Keywords

covidpoor prognosisrisk factorssars-cov-2Clinical characteristicsCoronavirus disease 2019CovidHiv-infectionHuman-immunodeficiency-virusLarge cohortMonoclonal-antibodyPoor prognosisRheumatic-diseasesRisk factorsSars-cov-2Single-centerSolid-organTherapyTransplant recipients

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Viruses-Basel due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2023, it was in position , thus managing to position itself as a Q1 (Primer Cuartil), in the category Infectious Diseases.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 3.02, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions Jul 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-07-16, the following number of citations:

  • WoS: 1

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-07-16:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 31.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 31 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 3.55.
  • The number of mentions on the social network X (formerly Twitter): 5 (Altmetric).