Mortality and associated risk factors in patients hospitalized due to COVID-19 in a Peruvian reference hospital
Alonso Soto, Dante M Quiñones-Laveriano, Johan Azañero, Rafael Chumpitaz, José Claros, Lucia Salazar, Oscar Rosales, Liz Nuñez, David Roca, Andres Alcantara
PLOS ONE, doi:10.1371/journal.pone.0264789
Objectives To determine the risk factors for in-hospital mortality in patients with COVID-19 from a Peruvian national hospital.
Methods Retrospective cohort study of medical records of patients with COVID-19 hospitalized at Hospital Nacional Hipo ´lito Unanue (HNHU) during the months of April to August 2020. The dependent variable was in-hospital mortality. Independent variables included sociodemographic and clinical characteristics, physical examination findings, oxygen saturation (SaO 2 ) at admission, treatment received during hospitalization and laboratory results at admission. A Cox regression model was used to evaluate the crude and adjusted hazard ratios for associated factors.
Results We included 1418 patients. Median age was 58 years (IQR 47-68 years) and 944 (66.6%) were male. The median length of hospitalization was 7 (4-13) days, and the mortality rate was 46%. The most frequent comorbidities were type 2 diabetes mellitus, hypertension, and obesity. In the adjusted analysis, mortality was associated with age (HR 1.02; 95%CI 1.02-1.03), history of surgery (HR 1.89;, lower oxygen saturation at admission (HR 4.08; CI95% 2.72-8.05 for SaO 2 <70% compared to SaO 2 >94%), the presence of poor general condition (HR 1.81; 95% CI 1.29-2.53), altered state of consciousness (HR 1.58;) and leukocyte levels (HR 1.01; 95%CI 1.00-1. 02). Treatment with ivermectin (HR 1.44; 95%CI 1.18-1.76) and azithromycin (HR 1.25; 95%CI 1.03-1.52) were associated with higher mortality. Treatment with corticosteroids at low to moderate doses was associated with lower mortality (HR 0.56 95%CI 0. 37-0. 86) in comparison to no steroid use.
Supporting information
S1 Data. (DTA)
Author Contributions Conceptualization: Alonso Soto, Dante M. Quiñones-Laveriano, Johan Azañero, Rafael Chumpitaz, Jose ´Claros, Lucia Salazar, Andres Alcantara. Data curation: Alonso Soto, Dante M. Quiñones-Laveriano, Rafael Chumpitaz, Jose ´Claros, Lucia Salazar, Oscar Rosales, Liz Nuñez, David Roca, Andres Alcantara. Formal analysis: Alonso Soto, Dante M. Quiñones-Laveriano, Johan Azañero. Investigation: Alonso Soto, Dante M. Quiñones-Laveriano, Johan Azañero, Rafael Chumpitaz, Jose ´Claros, Lucia Salazar, Oscar Rosales, Liz Nuñez, David Roca, Andres Alcantara. Methodology: Alonso Soto, Dante M. Quiñones-Laveriano. Software: Alonso Soto. Supervision: Alonso Soto. Validation: Alonso Soto. Visualization: Alonso Soto. Writing -original draft: Alonso Soto, Dante M. Quiñones-Laveriano. Writing -review & editing: Alonso Soto, Dante M. Quiñones-Laveriano, Johan Azañero, Rafael Chumpitaz, Jose ´Claros, Lucia Salazar, Oscar Rosales, Liz Nuñez, David Roca, Andres Alcantara.
References
Aggarwal, Cheruiyot, Aggarwal, Association of cardiovascular diseases with coronavirus disease 2019 (COVID-19) severity: a meta-analysis, Current Problems in,
doi:10.1016/j.cpcardiol.2020.100617Bae, So, Impact of cardiovascular disease and risk factors on fatal outcomes in patients with COVID-19 according to age: systematic review and meta-analysis, Heart,
doi:10.1136/heartjnl-2020-317901Bahl, Van Baalen, Ortiz, Chen, Todd et al., Early predictors of in-hospital mortality in patients with COVID-19 in a large American cohort, Intern Emerg Med,
doi:10.1007/s11739-020-02509-7Barbosa, Galvão, ´jo De Souza, Gomes, De Almeida Medeiros et al., Incidence of and mortality from COVID-19 in the older Brazilian population and its relationship with contextual indicators: an ecological study, Rev Bras Geriatr E Gerontol,
doi:10.1590/1981-22562020023.200171Bo, Hong-Qui, Yi, A model to predict the risk of mortality in severely ill COVID-19 patients, Computational and structural biotechnology journal,
doi:10.1016/j.csbj.2021.03.012Burton, Fort, Seoane, Hospitalization and Mortality among Black Patients and White Patients with Covid-19, N Engl J Med,
doi:10.1056/NEJMsa2011686Cifuentes, Rodriguez-Villamizar, Rojas-Botero, Alvarez-Moreno, ´ndez-Niño, Socioeconomic inequalities associated with mortality for COVID-19 in Colombia: a cohort nationwide study, J Epidemiol Community Health,
doi:10.1136/jech-2020-216275Corona, Pizzocaro, Vena, Rastrelli, Semeraro et al., Diabetes is most important cause for mortality in COVID-19 hospitalized patients: Systematic review and meta-analysis, Rev Endocr Metab Disord,
doi:10.1007/s11154-021-09630-8Dana, Bannay, Bourst, obesity and mortality in critically ill COVID-19 patients with respiratory failure, Int J Obesity,
doi:10.1038/s41366-021-00872-9Danwang, Endomba, Nkeck, Wouna, Robert et al., A meta-analysis of potential biomarkers associated with severity of coronavirus disease 2019 (COVID-19), Biomark Res,
doi:10.1186/s40364-020-00217-0De, Minsa: Casos confirmados por coronavirus COVID-19 ascienden a 1 804 915 en el Peru ´
Diende ´re, Sondo, Oue ´draogo Ar, Dahourou, Cisse et al., Predictors of severe hypoxemia among COVID-19 patients in Burkina Faso (West Africa): Findings from hospital based cross-sectional study, Int J Infect Dis,
doi:10.1016/j.ijid.2021.04.007Dı ´az-Ve ´lez, Urrunaga-Pastor, Romero-Cerda ´n, Risk factor for mortality in hospitalized patients with COVID-19 from three hospitals in Peru: a retrospective cohort study [Version 1; peer review: 2 approved, F1000Research,
doi:10.12688/f1000research.51474.1Escobedo-De La Peña, Rasco ´n-Pacheco, De, ´lez-Figueroa, Ferna ´n-Dez-Ga ´rate et al., Hypertension, Diabetes and Obesity, Major Risk Factors for Death in Patients with COVID-19 in Mexico, Arch Med Res,
doi:10.1016/j.arcmed.2020.12.002Go ´mez, Nf, Lobo, Cremades, Tejerina et al., Potenciales biomarcadores predictores de mortalidad en pacientes COVID-19 en el Servicio de Urgencias, Rev Esp Quimioter,
doi:10.37201/req/060.2020Grasselli, Greco, Zanella, Albano, Antonelli et al., Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy, JAMA Intern Med,
doi:10.1001/jamainternmed.2020.3539Hu, Liu, Jiang, Early predicction of mortality risk amog patients qith severe COVID-19, using machine learning,
doi:10.1093/ije/dyaa171Hueda-Zavaleta, Copaja-Corzo, Bardales-Silva, Flores-Palacios, Barreto-Rocchetti et al., Factores asociados a la muerte por COVID-19 en pacientes admitidos en un hospital pu ´blico en Tacna, Peru ´, Rev Peru Med Exp Salud Publica,
doi:10.17843/rpmesp.2021.382.7158Karampela, Chrysanthopoulou, Christodoulatos, Dalamaga, Is there an obesity paradox in critical illness? Epidemiologic and metabolic considerations, Obes Rep,
doi:10.1007/s13679-020-00394-xKrinley, Fisher, The diabetes paradox: diabetes is not independently associated with mortality in critical III patients, Hospital practice,
doi:10.3810/hp.2012.04.967Lelapi, Licastro, Provenzano, Cardiovascular disease as a biomarker for an increased risk of COVID-19 infection and related poor prognosis, Biomark Med,
doi:10.2217/bmm-2020-0201Marcolino, Ziegelmann, Souza-Silva, Clinical characteristics and outcomes of patients hospitalized with COVID-19 in Brazil: Results from the Brazilian COVID-19 registry, International Journal of infectious diseases,
doi:10.1016/j.ijid.2021.01.019Mehraeen, Karimi, Barzegary, Vahedi, Afsahi et al., Predictors of mortality in patients with COVID-19-a systematic review, Eur J Integr Med,
doi:10.1016/j.eujim.2020.101226Mejı ´a, Medina, Cornejo, Morello, Va ´squez S, Alave, Oxygen saturation as a predictor of mortality in hospitalized adult patients with COVID-19 in a public hospital in Lima, Peru, PLOS ONE,
doi:10.1371/journal.pone.0244171Navarrete-Mejı ´a, Soto, Velasco-Guerrero, Loro-Chero, Diabetes mellitus e hipertensio ´n arterial como factor de riesgo de mortalidad en pacientes con Covid-19, Rev Cuerpo Me ´d Hosp Nac Almanzor Aguinaga Asenjo,
doi:10.35434/rcmhnaaa.2020.134.766Neyra-Leo ´n, Huancahuari-Nuñez, ´az-Monge, Pinto, The impact of COVID-19 in the healthcare workforce in Peru, J Public Health Policy,
doi:10.1057/s41271-020-00259-6Okereke, Ukor, Adebisi, Ogunkola, Iyagbaye et al., Impact of COVID-19 on access to healthcare in low-and middle-income countries: Current evidence and future recommendations, Int J Health Plann Manage,
doi:10.1002/hpm.3067Olivas-Martı ´nez, Ca ´rdenas-Fragoso, ´nez, In-hospital mortality from severe COVID-19 in a tertiary center in Mexico City; causes of death, risk factors and impact of hospital saturation, PLOS ONE,
doi:10.1371/journal.pone.0245772Opal, Girard, Ely, The Immunopathogenesis of sepsis in elderly patients, Clin Infect Dis,
doi:10.1086/432007Poly, Mdm, Yang, Lin, Jian et al., Obesity and Mortality Among Patients Diagnosed With COVID-19: A Systematic Review and Meta-Analysis, Front Med,
doi:10.3389/fmed.2021.620044Rodrı ´guez-Zu ´ñiga, Quintana-Aquehua, Dı ´az-Lajo, Charaja-Coata, Becerra-Bonilla et al., Factores de riesgo asociados a mortalidad en pacientes adultos con neumonı ´a por SARS-CoV-2 en un hospital pu ´blico de Lima, Peru ´, Acta Me ´dica Peru,
doi:10.35663/amp.2020.374.1676Singh, Majumdar, Singh, Misra, Role of corticosteroid in the management of COVID-19: A systemic review and a Clinician's perspective, Diabetes Metab Syndr Clin Res Rev,
doi:10.1016/j.dsx.2020.06.054Soto, Cuando la vehemencia supera la evidencia: el caso del uso de hidroxicloroquina para el tratamiento del COVID-19, Acta Me ´dica Peru,
doi:10.35663/amp.2020.371.914Soto, El uso de drogas sin efecto demostrado como estrategia terape ´utica en COVID-19 en el Peru ´, Acta Me ´dica Peru,
doi:10.35663/amp.2020.373.1548Soto-Becerra, Culquichico ´n, Hurtado-Roca, Araujo-Castillo, Real-world effectiveness of hydroxychloroquine, azithromycin, and ivermectin among hospitalized COVID-19 patients: results of a target trial emulation using observational data from a nationwide healthcare system in Peru
Vences, Pareja-Ramos, Otero, Veramendi-Espinoza, Vega-Villafana et al., Factores asociados a mortalidad en pacientes hospitalizados con COVID-19: cohorte prospectiva en un hospital de referencia nacional de Peru ´, Medwave,
doi:10.5867/medwave.2021.06.8231Vial, Peters, Pe ´rez I, COVID-19 in South America: clinical epidemiological characteristics amog 381 patients during the early phase of the pandemic in Santiago, Chile, BMC infct Dis,
doi:10.1186/s12879-020-05665-5Yupari-Azabache, Bardales-Aguirre, Rodriguez-Azabache, Barros-Sevillano, ´guez-Diaz, Factores de riesgo de mortalidad por COVID-19 en pacientes hospitalizados: Un modelo de regresio ´n logı ´stica, Rev Fac Med Humana,
doi:10.25176/rfmh.v21i1.3264Zhou, Yu, Du, Fan, Liu et al., Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, The Lancet,
doi:10.1016/S0140-6736%2820%2930566-3
