Factors associated to death in patients hospitalized due to COVID-19

Main Article Content

Ulises Angeles-Garay http://orcid.org/0000-0002-4338-7669
José Arturo Velázquez-García http://orcid.org/0000-0003-1564-8347
Claudia Hernández-González http://orcid.org/0000-0003-4826-7516
Yesenia Velázquez-Chávez http://orcid.org/0000-0003-2573-5946
Nury Gabriela Hernández-Flores http://orcid.org/0000-0001-7927-3543
Mauricio Portilla-Aguilar http://orcid.org/0000-0003-1480-8580
Carolina Ávila-Hernández http://orcid.org/0000-0002-5197-9832
César Cruz-Uscanga http://orcid.org/0000-0002-1961-5131
Cinthia Vianey Gaona-Aguas http://orcid.org/0000-0002-4345-7567
Diana Fierro-Reyes http://orcid.org/0000-0002-9565-6832

Keywords

Mortality, Pneumonia, Treatment, COVID-19

Abstract

Background: SARS-CoV-2 virus was notified by the World Health Organization in January 2020 as a global emergency, due to its intense transmission, and clinical picture, that is aggravated in susceptible people.


Objective: To describe the factors associated with death in COVID-19 and pneumonia patients hospitalized in a thirdlevel center.


Material and methods: An undivided case-control study was carried out. It was conducted an interview to obtain general information; from the medical record were collected hospitalization data, radiological images, laboratory parameters, and treatments used. It was used descriptive statistics. Student’s t, Mann-Whitney U, and chi-squared were used to identify variables associated with death, and models of adjusted binary logistic regression to propose which variables of the patient’s history, clinical parameters and treatments explained the death.


Results: We treated 5339 patients with suspicion of COVID-19: 3117 positive (59%), 1029 hospitalized due to pneumonia, and 513 deaths (16.46%). For the analysis, 1110 patients were taken, 399 death cases were selected and 357 controls discharged due to improvement. The average age was 57.8 years; 59% were male.


Conclusions: The variables associated with mortality were: patients older than 40 years, chest radiography image > 50% involvement, intubation, lactic dehydrogenase > 500, C-reactive protein > 10, and organ failure; variables associated with improvement were: stay in the intensive care unit, use of broad spectrum parenteral antibiotics, steroids, and use of the anticoagulant enoxyheparin. Sex, diabetes, and comorbidities did not show significant association.

Abstract 297 | PDF (Spanish) Downloads 173

References

 

Wu F, Zhao S, Yu B, Chen Y, Wang W, Song Z et al. A new coronavirus associated with human respiratory disease in China. Nature. 2020;579:265-9. doi: 10.1038/s41586-020-2008-3.

 

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J et al. A Novel Coronavirus from Patients with Pneumonia in China. 2019 N Engl J Med. 2020;382:727-33. doi: 10.1056/NEJMoa2001017.

 

Huang Ch, Wang Y, Li X, Ren L, Zhao J, Hu Y. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi: 10.1016/S0140-6736(20)30183-5.

 

Xu X, Wu X, Jiang X, Xu K, Ying L, Ma Ch et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ. 2020;368:m606 doi: 10.1136/bmj.m606.

 

Chen N, Zhou M, Dong X, Qu J. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020:395:507-13. doi: 10.1016/S0140-6736(20)30211-7.

 

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, JAMA. 2020;323(11):1061-9. doi: 10.1001/jama.2020.1585.

 

Zhaoa S, Linc Q, Rand J, Musae S, Yangf G, Wangh W et al. Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak. Int J Infect Dis. 2020; 92: 214-7. doi: 10.1016/j.ijid.2020.01.050.

 

Li Q, Med M, Guan X, Wu P, Wang X, Zhou L et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia. N Engl J Med. 2000 382;1199-207. doi: 10.1056/NEJMoa2001316.

 

World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected. WHO; 13 March 2020. Disponible en https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf.

 

Kim E, Chin B, Kang Ch, Kim N, Kang Y, Choi J et al. Clinical Course and Outcomes of Patients with severe acute respiratory syndrome Coronavirus 2 infection: a Preliminary report of the first 28 patients from the Korean Cohort study of Covid-19. J Korean Med Sci. 2020;35(13):e142 doi: 10.3346/jkms.2020.35.e142.

 

Zhua Z, Luc Z, Xud T, Chene C, Yangc G, Zhaf T et al. Arbidol monotherapy is superior to lopinavir/ritonavir in treating COVID-19. J Infect. 2020;81(1):e21-e23. doi: 10.1016/j.jinf.2020.03.060.

 

Kim J, Kim E, Kwon H, Jung Ch, Kim K, Choe J et al. Lopinavir-ritonavir versus hydroxychloroquine for viral clearance and clinical improvement in patients with mild to moderate coronavirus disease 2019. Korean J Intern Med. 2020;224:1-11 doi: 10.3904/kjim.2020.224.

 

Boulware D, Pullen M, Bangdiwala A, Pastick K, Lofgren S, Okafor E et al. A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19. N Engl J Med. 2020;383(6):517-25. doi: 10.1056/NEJMoa2016638.

 

Rosenberg E, Dufort E, Udo T, Wilberschied L, Kumar J, Tesoriero J et al. Association of Treatment with Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State. JAMA. 2020;323(24):2493-502. doi: 10.1001/jama.2020.8630.

 

Mady A, Aletreby W, Abdulrahman B, Lhmdi M, Alfateh M, Alqahtani M et al. Tocilizumab in the treatment of rapidly evolving COVID-19 pneumonia and multifaceted critical illness: A retrospective case series. Ann Med Surg. 2020;60:417-24. doi: 10.1016/j.amsu.2020.10.061.

 

Toniatia P, Piva S, Catta M, Garrafa E, Regola E, Castelli F, et al. Tocilizumab for the treatment of severe COVID-19 pneumonia with hyperinflammatory syndrome and acute respiratory failure: A single center study of 100 patients in Brescia, Italy. Autoimmun Rev. 2020;19(7):102568. doi: 10.1016/j.autrev.2020.102568.

 

Escobedo-de la Peña J, Rascón-Pacheco A, Ascencio-Montiel I, González-Figueroa E, Fernández-Gárate J, Medina-Gómez O et al. Hypertension, Diabetes and Obesity, Major Risk Factors for Death in Patients With COVID-19 in Mexico. Arch Med Res. 2021;52(4):443-9. doi: 10.1016/j.arcmed.2020.12.002.

 

Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk Factors Associated with Acute Respiratory Distress Syndrome and Death in Patients with Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-43. doi: 10.1001/jamainternmed.2020.0994.

 

Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L., Mailhe M, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: Results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020;56:105949. doi: 10.1016/j.ijantimicag.2020.105949.

 

Colson P, Rolain JM, Lagier JC, Brouqui P, Raoult D. Chloroquine and hydroxychloroquine as available weapons to fight COVID-19. Int J Antimicrob Agents. 2020;55:105932. doi: 10.1016/j.ijantimicag.2020.105932.

 

Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020;30:269-71. doi: 10.1038/s41422-020-0282-0.

 

Bray M, Rayner C, Noël F, Jans D, Wagstaff K. Ivermectin and COVID-19: A report in Antiviral Research, widespread interest, an FDA warning, two letters to the editor and the authors' responses. Antivir Res. 2020:178. doi: 10.1016/j.antiviral.2020.104805.

 

Caly L, Druce JD, Catton MG, Jans DA, Wagstaff K. The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antivir Res. 2020;178:104787. doi: 10.1016/j.antiviral.2020.104787.

 

Xu X, Han M, Li T, Sun W, Wang D, Fu B, et al. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci. 2020;117:10970-5. doi: 10.1073/pnas.2005615117.

 

Luo P, Liu Y, Qiu L, Liu X, Liu D, Li J. Tocilizumab treatment in COVID-19: A single center experience. J Med Virol. 2020;92:814-8. doi: 10.1002/jmv.25801.

 

Bloch E, Shoham S, Casadeval A, Sachais BS, Shaz B, Winters J, et al. Deployment of convalescent plasma for the prevention and treatment of COVID-19. J Clin Invest. 2020;130:2757-65. doi: 10.1172/JCI138745.

 

Zhang B, Liu S, Tan T, Huang W, Dong Y, Chen L et al. Treatment with convalescent plasma for critically ill patients with SARS-CoV-2 infection. Chest. 2020;158:e9-13. doi: 10.1016/j.chest.2020.03.039.

 

Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G et al. A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe COVID-19. N Engl J Med. 2020;382(19):1787-99. doi: 10.1056/NEJMoa2001282.

 

Chinese Clinical Guidance for COVID-19 Pneumonia Diagnosis and Treatment (7th edition). Updated: March 16, 2020. Disponible en http://kjfy.meeting.so/msite/news/show/cn/3337.html.