Highlights Most of the patients with critical COVID-19 admitted to the 10 ICUs in Mexico were men over 57 years of age with hypertension and diabetes, and 6% were health-care workers. Patients with hypertension and diabetes had significantly decreased survival, but neither of these comorbidities were an independent factor associated with mortality Patients with critical COVID-19 who died in the hospital exhibit significantly higher C-reactive protein concentrations than survivors in our study

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The awake prone position (AP) strategy for patients with acute respiratory distress syndrome (ARDS) is a safe, simple, and cost-effective technique used to improve hypoxemia. We aimed to evaluate intubation and mortality risk in patients with coronavirus disease (COVID-19) who underwent AP during hospitalisation.In this retrospective, multicentre observational study conducted between May 1 and June 12, 2020 in 27 hospitals in Mexico and Ecuador, non-intubated patients with COVID-19 managed with AP or supine positioning were included to evaluate intubation and mortality risk through logistic regression models; multivariable and centre adjustment, propensity score analyses, and E-values were calculated to limit confounding. This study was registered at https://clinicaltrials.gov/ct2/show/NCT04407468827 non-intubated patients with COVID-19 in the AP (n=505) and supine (n=322) groups were included for analysis. Less patients in the AP group required endotracheal intubation (23.6% versus 40.4%) or died (20% versus 37.9%). AP was a protective factor for intubation even after multivariable adjustment (OR=0.39, 95%CI: 0.28–0.56, p<0.0001, E-value=2.01), which prevailed after propensity score analysis (OR=0.32, 95%CI: 0.21–0.49, p<0.0001, E-value=2.21), and mortality (adjusted OR=0.38, 95%CI: 0.25–0.57, p<0.0001, E-value=1.98). The main variables associated with intubation amongst AP patients were increasing age, lower baseline SpO2/FiO2, and management with a non-rebreather mask.AP in hospitalised non-intubated patients with COVID-19 is associated with a lower risk of intubation and mortality.

PurposeThe awake prone position (PP) strategy for patients with acute respiratory distress syndrome (ARDS) is a safe, simple, and cost-effective technique used to improve hypoxemia. We aimed to evaluate the relationship between awake PP (AP) and endotracheal intubation in patients with coronavirus disease (COVID-19).MethodsIn this retrospective, multicentre observational study conducted between 1 May and 12 June 2020 in 27 hospitals in Mexico and Ecuador, non-intubated patients with COVID-19 managed with AP or awake supine positioning (AS) were included to evaluate intubation and mortality risk in AP patients through logistic regression models; multivariable adjustment, propensity score analyses, and E-values were calculated to limit confounding. A CART model with cross-validation was also built. This study was registered at https://clinicaltrials.gov/ct2/show/NCT04407468Results827 non-intubated patients with COVID-19 in the AP (n=505) and AS (n=322) groups were included for analysis. Less patients in the AP group required endotracheal intubation (23.6% vs 40.4%) or died (20% vs 37.9%). AP was a protective factor for intubation even after multivariable adjustment (OR=0.39, 95%CI:0.28-0.56, p<0.0001, E-value=2.01), which prevailed after propensity score analysis (OR=0.32, 95%CI:0.21-0.49, p<0.0001, E-value=2.21), and mortality (adjusted OR=0.38, 95%CI:0.25-0.57, p<0.0001, E-value=1.98). The main variables associated with PP failure in AP patients were age, lower SpO2/FiO2, and management with a non-rebreather mask. In the CART model, only two variables were used: SpO2/FiO2 (F 97.7, p<0.001) and PP (X2 50.5, p<0.001), with an overall percentage of 75.2%.ConclusionPP in awake hospitalised patients with COVID-19 is associated with a lower risk of intubation and mortality.

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Objective: Determine whether the levels of glycated hemoglobin (HbA1c) measured on admission to the intensive care unit (ICU) are associated with mortality in patients with severe SARS-CoV-2 pneumonia with invasive mechanical ventilation. Design: Cohort study, retrospective, observational. A single center. Place: ICU of a second-level care hospital. Patients: Severe SARS-CoV-2 pneumonia confirmed with IMV since admission to the ICU. Interventions: none. Results: A total of 56 patients with severe pneumonia, confirmed with SARS-CoV-2, all with IMV. The group with HbA1c <6.5% included 32 (57.14%) patients and the group with HbA1c ≥6.5% included 24 (42.86%) patients and the mortality rate in ICU was 43.8% and 70.8%, respectively, with p = 0.04. Predictors of mortality at 28 days in ICU were DHL >500 U/L, OR 3.65 (95% CI 1.18-11.29), HbA1c ≥6.5%, OR 3.12 (95% CI 1.01-9.6), SAH, OR 3.12 (95% CI 1.01-9.5), use of vasopressor, OR 0.2 (95% CI 0.05-0.73), diabetes was not statistically significant. Conclusion:The 28-day probability of survival in patients with severe SARS-CoV-2 pneumonia with IMV in the ICU is lower when the HbA1c level is ≥6.5% on admission.

Objective:The objective of this study was to assess the association and interaction of laboratory parameters, Simplified Acute Physiology Score II (SAPSII), Modified Shock Index (MSI), and Mannheim Peritonitis Index (MPI) with in-hospital mortality. Material and methods:We conducted a single-center case-control study. Adult patients with abdominal sepsis were included from May 2015 to May 2020. Baseline characteristics, laboratory parameters, SAPSII, MSI, and MPI scores at admission were collected. A principal component (PC) analysis was applied to evaluate variable interactions. In-hospital mortality risk was determined through logistic regression models. Results: One hundred and twenty-seven patients were identified, 60 of which were included for analyses. Non-survivors (48.4%) had a higher frequency of hypertension, lactate and MPI, and lower BE and alactic BE levels. Eight PCs were obtained, PC1 being a linear combination of pH,