Clinical features and prognostic factors related to mortality in hospitalized adult patients with COVID-19 in a public hospital in Lima, Peru

Detalhes bibliográficos
Autor(a) principal: Mejía, Fernando
Data de Publicação: 2020
Outros Autores: Medina, Carlos, Cornejo, Enrique, Morello, Enrique, Vásquez, Sergio, Alave, Jorge, Schwalb, Alvaro, Málaga, Germán
Tipo de documento: preprint
Idioma: eng
Título da fonte: SciELO Preprints
Texto Completo: https://preprints.scielo.org/index.php/scielo/preprint/view/858
Resumo: The COVID-19 pandemic has deeply affected the national health system in Peru, and despite the many strategies implemented to control the epidemic, the collapse of the sanitary system was imminent. We performed a retrospective cohort from the clinical records of adult patients with COVID-19 admitted in Hospital Cayetano Heredia (Lima, Peru), between March and June 2020. A total of 369 patient charts were included for analysis; 241 (65.31%) were male and the median age was 59 years (IQR: 49-68). Most patients (68.56%) reported at least one comorbidity; more frequently: obesity (42.55%), diabetes mellitus (21.95%), and hypertension (21.68%). The median duration of symptoms prior to hospital admission was 7 days (IQR: 5-10). Reported in-hospital mortality was 49.59%. By multiple Cox regression, oxygen saturation (SaO2) level at admission was the main predictor of patient mortality, with SaO2 levels of 84-80% and <80% had 4.44 (95%CI 2.46-8.02) and 7.74 (95%CI 4.54-13.19) times greater risk of death, respectively, when compared to patients with SaO2 >90%. Additionally, older age (>60 years old) was associated with 1.9 times greater mortality. Our study finds SaO2 at admission and older age to be independent predictors of in-hospital mortality. These findings suggest a delay in early detection of hypoxemia in the community, therefore, we propose the implementation of monitoring for hypoxemia among outpatients with COVID-19 as well as appropriate and timely oxygen therapy in admission.  
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spelling Clinical features and prognostic factors related to mortality in hospitalized adult patients with COVID-19 in a public hospital in Lima, PeruCaracterísticas clínicas y factores asociados a mortalidad en pacientes adultos hospitalizados por COVID-19 en un hospital público de Lima, Perú.Características clínicas e fatores associados à mortalidade em pacientes adultos internados pelo COVID-19 em um hospital público de Lima, Peru.SARS-CoV-2COVID-19SARS-CoV-2COVID-19SARS-CoV-2COVID-19The COVID-19 pandemic has deeply affected the national health system in Peru, and despite the many strategies implemented to control the epidemic, the collapse of the sanitary system was imminent. We performed a retrospective cohort from the clinical records of adult patients with COVID-19 admitted in Hospital Cayetano Heredia (Lima, Peru), between March and June 2020. A total of 369 patient charts were included for analysis; 241 (65.31%) were male and the median age was 59 years (IQR: 49-68). Most patients (68.56%) reported at least one comorbidity; more frequently: obesity (42.55%), diabetes mellitus (21.95%), and hypertension (21.68%). The median duration of symptoms prior to hospital admission was 7 days (IQR: 5-10). Reported in-hospital mortality was 49.59%. By multiple Cox regression, oxygen saturation (SaO2) level at admission was the main predictor of patient mortality, with SaO2 levels of 84-80% and <80% had 4.44 (95%CI 2.46-8.02) and 7.74 (95%CI 4.54-13.19) times greater risk of death, respectively, when compared to patients with SaO2 >90%. Additionally, older age (>60 years old) was associated with 1.9 times greater mortality. Our study finds SaO2 at admission and older age to be independent predictors of in-hospital mortality. These findings suggest a delay in early detection of hypoxemia in the community, therefore, we propose the implementation of monitoring for hypoxemia among outpatients with COVID-19 as well as appropriate and timely oxygen therapy in admission.   La pandemia por COVID-19 ha representado un duro golpe al sistema sanitario peruano, y las estrategias implementadas para el control de la epidemia han sido insuficientes en el contexto de colapso del sistema de salud. Se realizó una cohorte retrospectiva a partir de la revisión de las historias clínicas de pacientes adultos hospitalizados por COVID-19, entre marzo y junio de 2020, en el Hospital Cayetano Heredia, Lima- Perú. Se analizó 369 historias clínicas, 241 (65.31%) pacientes eran del sexo masculino y la mediana de edad era de 59 años (RIC: 49-68). El 68.56% presentaba al menos una comorbilidad, siendo las más frecuentes obesidad (42.55%), diabetes mellitus (21.95%) e hipertensión arterial (21.68%). La mediana de duración de síntomas previo al ingreso hospitalario fue de 7 días (RIC: 5-10). La mortalidad intrahospitalaria encontrada fue del 49.59%. En el análisis multivariado, la saturación de oxígeno al ingreso al hospital fue el principal factor predictor de mortalidad. Se observó un marcado incremento de mortalidad; encontrándose que la SatO2 de 84-80% y <80% tuvieron 4.44 (IC95% 2.46-8.02) y 7.74 (IC95% 4.54- 13.19) veces mayor riesgo de muerte, respectivamente, en comparación con pacientes con SatO2 basal >90%. Adicionalmente, la edad mayor a 60 años se asocia a 1.90 veces mayor mortalidad. Nuestro estudio muestra que la edad mayor a 60 años y el nivel de hipoxemia presente al momento de la admisión al hospital son factores asociados de forma independiente a la mortalidad intrahospitalaria. Los hallazgos sugieren una demora en detección de hipoxemia en la comunidad, por lo que se propone reforzar el sistema de monitoreo e identificación temprana de hipoxemia en pacientes con COVID-19, asociada a un soporte oxigenatorio en el momento oportuno. A pandemia do COVID-19 representou um duro golpe no sistema de saúde peruano, e as estratégias implementadas para controlar a epidemia foram insuficientes no contexto do colapso do sistema de saúde. Foi realizada uma coorte retrospectiva com base na revisão dos prontuários de pacientes adultos internados pelo COVID-19, entre março e junho de 2020, no Hospital Cayetano Heredia, Lima-Peru. Foram analisados ​​369 prontuários, 241 (65,31%) pacientes eram do sexo masculino e a idade média foi de 59 anos (RIC: 49-68). 68,56% apresentavam pelo menos uma comorbidade, sendo as mais frequentes obesidade (42,55%), diabetes mellitus (21,95%) e hipertensão (21,68%). A duração mediana dos sintomas antes da internação foi de 7 dias (RIC: 5-10). A mortalidade hospitalar encontrada foi de 49,59%. Na análise multivariada, a saturação de oxigênio na admissão hospitalar foi o principal preditor de mortalidade. Um aumento acentuado na mortalidade foi observado; constatando que SatO2 de 84-80% e <80% tinha 4,44 (IC95% 2,46-8,02) e 7,74 (IC95% 4,54-13,19) vezes maior risco de morte, respectivamente, em comparação com pacientes com SatO2 basal> 90%. Além disso, a idade acima de 60 anos está associada a uma mortalidade 1,90 vezes maior. Nosso estudo mostra que a idade superior a 60 anos e o nível de hipoxemia presente no momento da admissão no hospital são fatores independentemente associados à mortalidade hospitalar. Os resultados sugerem um atraso na detecção de hipoxemia na comunidade, motivo pelo qual se propõe fortalecer o sistema de monitoramento e identificação precoce de hipoxemia em pacientes com COVID-19, associados ao suporte à oxigenação no momento apropriado.SciELO PreprintsSciELO PreprintsSciELO Preprints2020-06-29info:eu-repo/semantics/preprintinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://preprints.scielo.org/index.php/scielo/preprint/view/85810.1590/SciELOPreprints.858enghttps://preprints.scielo.org/index.php/scielo/article/view/858/1187Copyright (c) 2020 Fernando Mejía, Carlos Medina, Enrique Cornejo, Enrique Morello, Sergio Vásquez, Jorge Alave, Alvaro Schwalb, Germán Málagahttps://creativecommons.org/licenses/by/4.0info:eu-repo/semantics/openAccessMejía, FernandoMedina, CarlosCornejo, EnriqueMorello, EnriqueVásquez, SergioAlave, JorgeSchwalb, AlvaroMálaga, Germánreponame:SciELO Preprintsinstname:SciELOinstacron:SCI2020-06-27T13:31:36Zoai:ops.preprints.scielo.org:preprint/858Servidor de preprintshttps://preprints.scielo.org/index.php/scieloONGhttps://preprints.scielo.org/index.php/scielo/oaiscielo.submission@scielo.orgopendoar:2020-06-27T13:31:36SciELO Preprints - SciELOfalse
dc.title.none.fl_str_mv Clinical features and prognostic factors related to mortality in hospitalized adult patients with COVID-19 in a public hospital in Lima, Peru
Características clínicas y factores asociados a mortalidad en pacientes adultos hospitalizados por COVID-19 en un hospital público de Lima, Perú.
Características clínicas e fatores associados à mortalidade em pacientes adultos internados pelo COVID-19 em um hospital público de Lima, Peru.
title Clinical features and prognostic factors related to mortality in hospitalized adult patients with COVID-19 in a public hospital in Lima, Peru
spellingShingle Clinical features and prognostic factors related to mortality in hospitalized adult patients with COVID-19 in a public hospital in Lima, Peru
Mejía, Fernando
SARS-CoV-2
COVID-19
SARS-CoV-2
COVID-19
SARS-CoV-2
COVID-19
title_short Clinical features and prognostic factors related to mortality in hospitalized adult patients with COVID-19 in a public hospital in Lima, Peru
title_full Clinical features and prognostic factors related to mortality in hospitalized adult patients with COVID-19 in a public hospital in Lima, Peru
title_fullStr Clinical features and prognostic factors related to mortality in hospitalized adult patients with COVID-19 in a public hospital in Lima, Peru
title_full_unstemmed Clinical features and prognostic factors related to mortality in hospitalized adult patients with COVID-19 in a public hospital in Lima, Peru
title_sort Clinical features and prognostic factors related to mortality in hospitalized adult patients with COVID-19 in a public hospital in Lima, Peru
author Mejía, Fernando
author_facet Mejía, Fernando
Medina, Carlos
Cornejo, Enrique
Morello, Enrique
Vásquez, Sergio
Alave, Jorge
Schwalb, Alvaro
Málaga, Germán
author_role author
author2 Medina, Carlos
Cornejo, Enrique
Morello, Enrique
Vásquez, Sergio
Alave, Jorge
Schwalb, Alvaro
Málaga, Germán
author2_role author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Mejía, Fernando
Medina, Carlos
Cornejo, Enrique
Morello, Enrique
Vásquez, Sergio
Alave, Jorge
Schwalb, Alvaro
Málaga, Germán
dc.subject.por.fl_str_mv SARS-CoV-2
COVID-19
SARS-CoV-2
COVID-19
SARS-CoV-2
COVID-19
topic SARS-CoV-2
COVID-19
SARS-CoV-2
COVID-19
SARS-CoV-2
COVID-19
description The COVID-19 pandemic has deeply affected the national health system in Peru, and despite the many strategies implemented to control the epidemic, the collapse of the sanitary system was imminent. We performed a retrospective cohort from the clinical records of adult patients with COVID-19 admitted in Hospital Cayetano Heredia (Lima, Peru), between March and June 2020. A total of 369 patient charts were included for analysis; 241 (65.31%) were male and the median age was 59 years (IQR: 49-68). Most patients (68.56%) reported at least one comorbidity; more frequently: obesity (42.55%), diabetes mellitus (21.95%), and hypertension (21.68%). The median duration of symptoms prior to hospital admission was 7 days (IQR: 5-10). Reported in-hospital mortality was 49.59%. By multiple Cox regression, oxygen saturation (SaO2) level at admission was the main predictor of patient mortality, with SaO2 levels of 84-80% and <80% had 4.44 (95%CI 2.46-8.02) and 7.74 (95%CI 4.54-13.19) times greater risk of death, respectively, when compared to patients with SaO2 >90%. Additionally, older age (>60 years old) was associated with 1.9 times greater mortality. Our study finds SaO2 at admission and older age to be independent predictors of in-hospital mortality. These findings suggest a delay in early detection of hypoxemia in the community, therefore, we propose the implementation of monitoring for hypoxemia among outpatients with COVID-19 as well as appropriate and timely oxygen therapy in admission.  
publishDate 2020
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