Outcomes of patients with COVID-19 in the intensive care unit in Mexico: A multicenter observational study
Silvio A Ñamendys-Silva, Pedro E Alvarado-Ávila, MD, FCCM Guillermo Domínguez-Cherit, MD Eduardo Rivero-Sigarroa, Luis A Sánchez-Hurtado, Alan Gutiérrez-Villaseñor, Juan P Romero-González, MD a , Heber Rodríguez-Bautista, MD Alondra García-Briones, César E Garnica-Camacho, Néstor G Cruz-Ruiz, María O González-Herrera, Francisco J García-Guillén, Manuel A Guerrero-Gutiérrez, José D Salmerón-González, Laura Romero-Gutiérrez, José L Canto-Castro, MD k , Victor H Cervantes
Heart & Lung, doi:10.1016/j.hrtlng.2020.10.013
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 laboratoryconfirmed 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 4.5À9) 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 6À14). 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, 1.02À1.08; p<0.001) and C-reactive protein levels upon ICU admission (1.008; 95% CI, 1.003À1.012; 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, 0.84À0.94; p<0.001).
Author contributions
Dr e Namendys-Silva had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: e Namendys-Silva, Dominguez-Cherit Acquisition of data: All authors Statistical analysis: e Namendys-Silva.
Drafting of the manuscript: e Namendys-Silva, Alvarado-Avila, Dominguez-Cherit, Rivero-Sigarroa Critical revision of the manuscript for important intellectual content: All authors.
Declarations of Competing Interest The authors state that there are no conflicts of interest related to this study.
Supplementary materials Supplementary material associated with this article can be found in the online version at doi:10.1016/j.hrtlng.2020.10.013.
References
Ali, Elevated level of C-reactive protein may be an early marker to predict risk for severity of COVID-19
Arentz, Yim, Klaff, Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State
Grasselli, Greco, Zanella, Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy, JAMA Intern Med,
doi:10.1001/jamainternmed.2020.3539Grasselli, Zangrillo, Zanella, Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy [published online ahead of print, JAMA
Hanley, Mcneil, The meaning and use of the area under a receiver operating characteristic (ROC) curve, Radiology
Hosmer, Taber, Lemeshow, The importance of assessing the fit of logistic regression models: a case study, Am J Public Health
Knaus, Draper, Wagner, Zimmerman, APACHE II: a severity of disease classification system, Crit Care Med
Namendys-Silva, Silva-Medina, Asquez-Barahona, Application of a modified sequential organ failure assessment score to critically ill patients, Braz J Med Biol Res
Ranieri, Rubenfeld, Acute respiratory distress syndrome: the Berlin definition, JAMA
Vincent, Moreno, Takala, The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European society of intensive care medicine, Intensive Care Med
Wang, Wu, Zhang, C-reactive protein level may predict the risk of COVID-19 aggravation, Open Forum Infect Dis,
doi:10.1093/ofid/ofaa153Xu, Yang, Yang, Clinical course and predictors of 60-day mortality in 239 critically ill patients with COVID-19: a multicenter retrospective study from Wuhan, China, Crit Care,
doi:10.1186/s13054-020-03098-9Yang, Yu, Xu, Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study [published correction appears, Lancet Respir Med,
doi:10.1016/S2213-2600(20)30079-5Zhou, Yu, Du, Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study [published correction appears, Lancet,
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'title': 'Outcomes of patients with COVID-19 in the intensive care unit in Mexico: A multicenter '
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'affiliation': []},
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'reference': [ { 'key': '10.1016/j.hrtlng.2020.10.013_bib0001',
'unstructured': 'Coronavirus Disease (COVID-19): Situation Report-147. Geneva: World '
'Health Organization '
'(https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200615-covid-19-sitrep-147.pdf?sfvrsn=2497a605_4 '
').'},
{ 'key': '10.1016/j.hrtlng.2020.10.013_bib0002',
'unstructured': 'Conferencia 15 De Junio: Comunicado Técnico Diario. Mexico: Secretaría '
'de Salud Federal '
'(https://coronavirus.gob.mx/2020/06/15/conferencia-15-de-junio/).'},
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'key': '10.1016/j.hrtlng.2020.10.013_bib0003',
'doi-asserted-by': 'crossref',
'first-page': '818',
'DOI': '10.1097/00003246-198510000-00009',
'article-title': 'APACHE II: a severity of disease classification system',
'volume': '13',
'author': 'Knaus',
'year': '1985',
'journal-title': 'Crit Care Med'},
{ 'issue': '7',
'key': '10.1016/j.hrtlng.2020.10.013_bib0004',
'doi-asserted-by': 'crossref',
'first-page': '707',
'DOI': '10.1007/BF01709751',
'article-title': 'The SOFA (Sepsis-related Organ Failure Assessment) score to describe '
'organ dysfunction/failure. On behalf of the working group on '
'sepsis-related problems of the European society of intensive care '
'medicine',
'volume': '22',
'author': 'Vincent',
'year': '1996',
'journal-title': 'Intensive Care Med.'},
{ 'issue': '2',
'key': '10.1016/j.hrtlng.2020.10.013_bib0005',
'doi-asserted-by': 'crossref',
'first-page': '186',
'DOI': '10.1590/1414-431X20122308',
'article-title': 'Application of a modified sequential organ failure assessment score to '
'critically ill patients',
'volume': '46',
'author': 'Namendys-Silva',
'year': '2013',
'journal-title': 'Braz J Med Biol Res'},
{ 'issue': '23',
'key': '10.1016/j.hrtlng.2020.10.013_bib0006',
'first-page': '2526',
'article-title': 'Acute respiratory distress syndrome: the Berlin definition',
'volume': '307',
'author': 'Definition Task Force',
'year': '2012',
'journal-title': 'JAMA'},
{ 'key': '10.1016/j.hrtlng.2020.10.013_bib0007',
'doi-asserted-by': 'crossref',
'unstructured': 'Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. Vital '
'surveillances: the epidemiological characteristics of an outbreak of '
'2019 novel coronavirus diseases (COVID-19) China, 2020. China CDC '
'Weekly. Accessed August 24, 2020. '
'http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51',
'DOI': '10.46234/ccdcw2020.032'},
{ 'issue': '1',
'key': '10.1016/j.hrtlng.2020.10.013_bib0008',
'doi-asserted-by': 'crossref',
'first-page': '29',
'DOI': '10.1148/radiology.143.1.7063747',
'article-title': 'The meaning and use of the area under a receiver operating '
'characteristic (ROC) curve',
'volume': '143',
'author': 'Hanley',
'year': '1982',
'journal-title': 'Radiology'},
{ 'issue': '12',
'key': '10.1016/j.hrtlng.2020.10.013_bib0009',
'doi-asserted-by': 'crossref',
'first-page': '1630',
'DOI': '10.2105/AJPH.81.12.1630',
'article-title': 'The importance of assessing the fit of logistic regression models: a '
'case study',
'volume': '81',
'author': 'Hosmer',
'year': '1991',
'journal-title': 'Am J Public Health'},
{ 'issue': '16',
'key': '10.1016/j.hrtlng.2020.10.013_bib0010',
'doi-asserted-by': 'crossref',
'first-page': '1574',
'DOI': '10.1001/jama.2020.5394',
'article-title': 'Baseline characteristics and outcomes of 1591 patients infected with '
'SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy [published '
'online ahead of print, 2020 Apr 6]',
'volume': '323',
'author': 'Grasselli',
'year': '2020',
'journal-title': 'JAMA'},
{ 'key': '10.1016/j.hrtlng.2020.10.013_bib0011',
'article-title': 'Factors Associated With Death in Critically Ill Patients With '
'Coronavirus Disease 2019 in the US',
'volume': '15',
'author': 'Gupta',
'year': '2020',
'journal-title': 'JAMA Intern Med'},
{ 'issue': '1',
'key': '10.1016/j.hrtlng.2020.10.013_bib0012',
'doi-asserted-by': 'crossref',
'first-page': '394',
'DOI': '10.1186/s13054-020-03098-9',
'article-title': 'Clinical course and predictors of 60-day mortality in 239 critically '
'ill patients with COVID-19: a multicenter retrospective study from '
'Wuhan, China',
'volume': '24',
'author': 'Xu',
'year': '2020',
'journal-title': 'Crit Care'},
{ 'key': '10.1016/j.hrtlng.2020.10.013_bib0013',
'doi-asserted-by': 'crossref',
'DOI': '10.1001/jamainternmed.2020.3539',
'article-title': 'Risk factors associated with mortality among patients with COVID-19 in '
'intensive care units in Lombardy, Italy',
'author': 'Grasselli',
'year': '2020',
'journal-title': 'JAMA Intern Med'},
{ 'key': '10.1016/j.hrtlng.2020.10.013_bib0014',
'doi-asserted-by': 'crossref',
'first-page': '754',
'DOI': '10.3389/fimmu.2018.00754',
'article-title': 'Role of C-reactive protein at sites of inflammation and infection',
'volume': '9',
'author': 'Sproston',
'year': '2018',
'journal-title': 'Front Immunol'},
{ 'key': '10.1016/j.hrtlng.2020.10.013_bib0015',
'article-title': 'Elevated level of C-reactive protein may be an early marker to predict '
'risk for severity of COVID-19 [published online ahead of print, 2020 '
'May 30]',
'author': 'Ali',
'year': '2020',
'journal-title': 'J Med Virol'},
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'key': '10.1016/j.hrtlng.2020.10.013_bib0016',
'doi-asserted-by': 'crossref',
'DOI': '10.1093/ofid/ofaa153',
'article-title': 'C-reactive protein level may predict the risk of COVID-19 aggravation',
'volume': '7',
'author': 'Wang',
'year': '2020',
'journal-title': 'Open Forum Infect Dis'},
{ 'issue': '5',
'key': '10.1016/j.hrtlng.2020.10.013_bib0017',
'doi-asserted-by': 'crossref',
'first-page': '475',
'DOI': '10.1016/S2213-2600(20)30079-5',
'article-title': 'Clinical course and outcomes of critically ill patients with SARS-CoV-2 '
'pneumonia in Wuhan, China: a single-centered, retrospective, '
'observational study [published correction appears in Lancet Respir Med',
'volume': '8',
'author': 'Yang',
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'article-title': 'Characteristics and Outcomes of 21 Critically Ill Patients With '
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'19]',
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'year': '2020',
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