tetano
Editor, Senior Moderator
Heart Lung
. 2020 Oct 21;S0147-9563(20)30412-X.
doi: 10.1016/j.hrtlng.2020.10.013. Online ahead of print.
Outcomes of patients with COVID-19 in the intensive care unit in Mexico: A multicenter observational study
Silvio A ?amendys-Silva[SUP] 1 [/SUP], Pedro E Alvarado-?vila[SUP] 2 [/SUP], Guillermo Dom?nguez-Cherit[SUP] 3 [/SUP], Eduardo Rivero-Sigarroa[SUP] 2 [/SUP], Luis A S?nchez-Hurtado[SUP] 4 [/SUP], Alan Guti?rrez-Villase?or[SUP] 5 [/SUP], Juan P Romero-Gonz?lez[SUP] 5 [/SUP], Heber Rodr?guez-Bautista[SUP] 2 [/SUP], Alondra Garc?a-Briones[SUP] 5 [/SUP], C?sar E Garnica-Camacho[SUP] 6 [/SUP], N?stor G Cruz-Ruiz[SUP] 7 [/SUP], Mar?a O Gonz?lez-Herrera[SUP] 8 [/SUP], Francisco J Garc?a-Guill?n[SUP] 9 [/SUP], Manuel A Guerrero-Guti?rrez[SUP] 9 [/SUP], Jos? D Salmer?n-Gonz?lez[SUP] 10 [/SUP], Laura Romero-Guti?rrez[SUP] 4 [/SUP], Jos? L Canto-Castro[SUP] 11 [/SUP], Victor H Cervantes[SUP] 12 [/SUP], Mexico COVID-19 Critical Care Collaborative Group
Affiliations
Abstract
Background: As of June 15, 2020, a cumulative total of 7,823,289 confirmed cases of COVID-19 have been reported across 216 countries and territories worldwide. However, there is little information on the clinical characteristics and outcomes of critically ill patients with severe COVID-19 who were admitted to intensive care units (ICUs) in Latin America. The present study evaluated the clinical characteristics and outcomes of critically ill patients with severe COVID-19 who were admitted to ICUs in Mexico.
Methods: This was a multicenter observational study that included 164 critically ill patients with laboratory-confirmed COVID-19 who were admitted to 10 ICUs in Mexico, from April 1 to April 30, 2020. Demographic data, comorbid conditions, clinical presentation, treatment, and outcomes were collected and analyzed. The date of final follow-up was June 4, 2020.
Results: A total of 164 patients with severe COVID-19 were included in this study. The mean age of patients was 57.3 years (SD 13.7), 114 (69.5%) were men, and 6.0% were healthcare workers. Comorbid conditions were common in patients with critical COVID-19: 38.4% of patients had hypertension and 32.3% had diabetes. Compared to survivors, nonsurvivors were older and more likely to have diabetes, hypertension or other conditions. Patients presented to the hospital a median of 7 days (IQR 4.5-9) after symptom onset. The most common presenting symptoms were shortness of breath, fever, dry cough, and myalgias. One hundred percent of patients received invasive mechanical ventilation for a median time of 11 days (IQR 6-14). A total of 139 of 164 patients (89.4%) received vasopressors, and 24 patients (14.6%) received renal replacement therapy during hospitalization. Eighty-five (51.8%) patients died at or before 30 days, with a median survival of 25 days. Age (OR, 1.05; 95% CI, 1.02-1.08; p<0.001) and C-reactive protein levels upon ICU admission (1.008; 95% CI, 1.003-1.012; p<0.001) were associated with a higher risk of in-hospital death. ICU length of stay was associated with reduced in-hospital mortality risk (OR, 0.89; 95% CI, 0.84-0.94; p<0.001).
Conclusions: This observational study of critically ill patients with laboratory-confirmed COVID-19 who were admitted to the ICU in Mexico demonstrated that age and C-reactive protein level upon ICU admission were associated with in-hospital mortality, and the overall hospital mortality rate was high.
Trial registration: ClinicalTrials.gov, NCT04336345.
Keywords: COVID-19; Coronavirus; Intensive care unit; Mexico; Outcomes; SARS-CoV-2 infection.
. 2020 Oct 21;S0147-9563(20)30412-X.
doi: 10.1016/j.hrtlng.2020.10.013. Online ahead of print.
Outcomes of patients with COVID-19 in the intensive care unit in Mexico: A multicenter observational study
Silvio A ?amendys-Silva[SUP] 1 [/SUP], Pedro E Alvarado-?vila[SUP] 2 [/SUP], Guillermo Dom?nguez-Cherit[SUP] 3 [/SUP], Eduardo Rivero-Sigarroa[SUP] 2 [/SUP], Luis A S?nchez-Hurtado[SUP] 4 [/SUP], Alan Guti?rrez-Villase?or[SUP] 5 [/SUP], Juan P Romero-Gonz?lez[SUP] 5 [/SUP], Heber Rodr?guez-Bautista[SUP] 2 [/SUP], Alondra Garc?a-Briones[SUP] 5 [/SUP], C?sar E Garnica-Camacho[SUP] 6 [/SUP], N?stor G Cruz-Ruiz[SUP] 7 [/SUP], Mar?a O Gonz?lez-Herrera[SUP] 8 [/SUP], Francisco J Garc?a-Guill?n[SUP] 9 [/SUP], Manuel A Guerrero-Guti?rrez[SUP] 9 [/SUP], Jos? D Salmer?n-Gonz?lez[SUP] 10 [/SUP], Laura Romero-Guti?rrez[SUP] 4 [/SUP], Jos? L Canto-Castro[SUP] 11 [/SUP], Victor H Cervantes[SUP] 12 [/SUP], Mexico COVID-19 Critical Care Collaborative Group
Affiliations
- PMID: 33138974
- DOI: 10.1016/j.hrtlng.2020.10.013
Abstract
Background: As of June 15, 2020, a cumulative total of 7,823,289 confirmed cases of COVID-19 have been reported across 216 countries and territories worldwide. However, there is little information on the clinical characteristics and outcomes of critically ill patients with severe COVID-19 who were admitted to intensive care units (ICUs) in Latin America. The present study evaluated the clinical characteristics and outcomes of critically ill patients with severe COVID-19 who were admitted to ICUs in Mexico.
Methods: This was a multicenter observational study that included 164 critically ill patients with laboratory-confirmed COVID-19 who were admitted to 10 ICUs in Mexico, from April 1 to April 30, 2020. Demographic data, comorbid conditions, clinical presentation, treatment, and outcomes were collected and analyzed. The date of final follow-up was June 4, 2020.
Results: A total of 164 patients with severe COVID-19 were included in this study. The mean age of patients was 57.3 years (SD 13.7), 114 (69.5%) were men, and 6.0% were healthcare workers. Comorbid conditions were common in patients with critical COVID-19: 38.4% of patients had hypertension and 32.3% had diabetes. Compared to survivors, nonsurvivors were older and more likely to have diabetes, hypertension or other conditions. Patients presented to the hospital a median of 7 days (IQR 4.5-9) after symptom onset. The most common presenting symptoms were shortness of breath, fever, dry cough, and myalgias. One hundred percent of patients received invasive mechanical ventilation for a median time of 11 days (IQR 6-14). A total of 139 of 164 patients (89.4%) received vasopressors, and 24 patients (14.6%) received renal replacement therapy during hospitalization. Eighty-five (51.8%) patients died at or before 30 days, with a median survival of 25 days. Age (OR, 1.05; 95% CI, 1.02-1.08; p<0.001) and C-reactive protein levels upon ICU admission (1.008; 95% CI, 1.003-1.012; p<0.001) were associated with a higher risk of in-hospital death. ICU length of stay was associated with reduced in-hospital mortality risk (OR, 0.89; 95% CI, 0.84-0.94; p<0.001).
Conclusions: This observational study of critically ill patients with laboratory-confirmed COVID-19 who were admitted to the ICU in Mexico demonstrated that age and C-reactive protein level upon ICU admission were associated with in-hospital mortality, and the overall hospital mortality rate was high.
Trial registration: ClinicalTrials.gov, NCT04336345.
Keywords: COVID-19; Coronavirus; Intensive care unit; Mexico; Outcomes; SARS-CoV-2 infection.