Factores asociados a la muerte por COVID-19 en pacientes admitidos en un hospital público en Tacna, Perú

Hueda-Zavaleta, Miguel; Copaja-Corzo, Cesar; Bardales-Silva, Fabrizzio; Flores-Palacios, Rodrigo; Barreto-Rocchetti, Luis; Benítes-Zapata, Vicente A.

doi:10.17843/rpmesp.2021.382.7158

Cited by 27 publications

(47 citation statements)

References 16 publications

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“…Our cohort showed a high mortality rate (46%) like other Peruvian hospital cohorts [ 5 – 8 , 10 , 11 ] which reported a mortality between 33% and 50%. Peru is the third country in Latin America with the highest mortality beneath Brazil and Mexico [ 12 ].…”

Section: Discussionsupporting

confidence: 57%

“…Within the group of hospitalized patients, mortality can be close to 50% [ 7 ], which can be even higher in older patients, those with comorbidities or with a lower oxygen saturation (SaO 2 ) at admission [ 5 , 6 ]. Among laboratory markers, C-reactive protein (CRP), procalcitonin, lactate dehydrogenase (LDH) and platelets, among others, could predict a serious clinical deterioration in these patients [ 8 – 10 ]. However, predictors of mortality are heterogeneous among different countries.…”

Section: Introductionmentioning

confidence: 99%

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Mortality and associated risk factors in patients hospitalized due to COVID-19 in a Peruvian reference hospital

et al. 2022

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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 Hipólito 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 (SaO2) 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; 95%CI 1.31–2.74), lower oxygen saturation at admission (HR 4.08; CI95% 2.72–8.05 for SaO2<70% compared to SaO2>94%), the presence of poor general condition (HR 1.81; 95% CI 1.29–2.53), altered state of consciousness (HR 1.58; 95%CI 1.18–2.11) 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. Conclusion A high mortality was found in our cohort. Low oxygen saturation at admission, age, and the presence of hematological and biochemical alterations were associated with higher mortality. The use of hydroxychloroquine, ivermectin or azithromycin was not useful and was probably associated with unfavorable outcomes. The use of corticosteroids at moderate doses was associated with lower mortality.

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Section: Discussionsupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Mortality and associated risk factors in patients hospitalized due to COVID-19 in a Peruvian reference hospital

et al. 2022

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“…This difference is particularly relevant due to the high rate of carbapenem resistance of A. baumannii and Pseudomonas aeruginosa in this cohort, which was 96% and 100%. This high proportion of multidrug-resistant microorganisms could be due to the almost universal consumption of antibiotics in our cohort (99%), well above that described by other authors (64-72%) [22][23][24], and to the deviation from adequate infection prevention and control practices, probably related to the collapse of the Peruvian health system [20].…”

Section: Discussionsupporting

confidence: 85%

“…The mortality found in this study (33%) is similar to that reported for ICU patients in other hospitals [12,[18][19][20]. Although most of these reports are from high-income countries, patients with critical COVID-19 in our hospital were governed by constantly updated protocols as new evidence appeared, which probably impacted mortality.…”

Section: Discussionsupporting

confidence: 82%

Antibiotic Use and Fatal Outcomes among Critically Ill Patients with COVID-19 in Tacna, Peru

et al. 2021

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Overuse of antibiotics during the Coronavirus Disease 2019 (COVID-19) pandemic could increase the selection of extensively resistant bacteria (XDR). However, it is unknown what impact they could have on the evolution of patients, particularly critically ill patients. This study aimed to evaluate the characteristics and impact of ICU-acquired infections in patients with COVID-19. A retrospective cohort study was conducted, evaluating all patients with critical COVID-19 admitted to the intensive care unit (ICU) of a hospital in Southern Peru from 28 March 2020 to 1 March 2021. Of the 124 patients evaluated, 50 (40.32%) developed a healthcare-associated infection (HAI), which occurred at a median of 8 days (IQR 6–17) after ICU admission. The proportion of patients with HAI that required ceftriaxone was significantly higher; the same was true for the use of dexamethasone. Forty bacteria isolations (80%) were classified as XDR to antibiotics, with the most common organisms being Acinetobacter baumannii (54%) and Pseudomonas aeruginosa (22%); 33% (41/124) died at the ICU during the follow-up. In the adjusted analysis, healthcare-associated infection was associated with an increased risk of mortality (aHR= 2.7; 95% CI: 1.33–5.60) and of developing acute renal failure (aRR = 3.1; 95% CI: 1.42–6.72). The incidence of healthcare infection mainly by XDR pathogens is high in critically ill patients with COVID-19 and is associated with an increased risk of complications or death.

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“…On the other hand, the possible benefit of NTZ has been argued in several studies [44,45] and more recently, the combined use of NTZ, ivermectin, ribavirin, and zinc supplement effectively cleared the SARS-COV2 from the nasopharynx in a shorter time than symptomatic therapy [46]. There are studies with contradictory information on colchicine, some encouraging its use [47,48] and others leaving a doubt on its effectiveness [49,50].…”

Section: Discussionmentioning

confidence: 99%

Rural treatment of COVID-19 patients with pirfenidone, nitazoxanide and colchicine. Case series

Esquivel

Calderón

Carrillo

et al. 2022

Monaldi Arch Chest Dis

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Combined treatments against SARS-CoV-2 are emerging and some have taken into account the post-COVID-19 fibrosis. The aim of this survey was to report the experience of treating COVID-19 patients with pirfenidone, nitazoxanide (NTZ) and colchicine. It was a case series report of COVID-19 patients treated from December 2020 to March 2021, in a rural health center located in the State of Mexico, Mexico. 23 patients were included (mean age 44.5 ± 17.1 years), 12 women (mean age 45.9 ± 17.9 years) and 11 men (mean age 43 ± 16.9 years) with four deaths (17.39%). The evolution time was of 17.3 ± 6.7 days being the main symptoms fever (82.6%), myalgia (69.6%) and cough (65.2%). The main comorbidities were overweight/obesity 18 (78.26%), type 2 diabetes mellitus (T2DM) 4 (17.39%), Chronic obstructive pulmonary disease (COPD) 5 (21.73%) and systemic hypertension 2 (8.69%). Two patients were intubated and both died; in these cases, they refused to take NTZ until after three days the medical doctor had prescribed it for the first time. It can be concluded that implementing a mixed treatment with pirfenidone, NTZ and colchicine could improve the survival rate in ambulatory patients of low socioeconomic status.

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Factores asociados a la muerte por COVID-19 en pacientes admitidos en un hospital público en Tacna, Perú

Cited by 27 publications

References 16 publications

Mortality and associated risk factors in patients hospitalized due to COVID-19 in a Peruvian reference hospital

Mortality and associated risk factors in patients hospitalized due to COVID-19 in a Peruvian reference hospital

Antibiotic Use and Fatal Outcomes among Critically Ill Patients with COVID-19 in Tacna, Peru

Rural treatment of COVID-19 patients with pirfenidone, nitazoxanide and colchicine. Case series

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