Factors Associated with COVID-19 Death in a High-Altitude Peruvian Setting during the First 14 Months of the Pandemic: A Retrospective Multicenter Cohort Study in Hospitalized Patients

Abstract

Risk factors for COVID-19 death in high-altitude populations have been scarcely described. This study aimed to describe risk factors for COVID-19 death in three referral hospitals located at 3399 m in Cusco, Peru, during the first 14 months of the pandemic. A retrospective multicenter cohort study was conducted. A random sample of ~50% (1225/2674) of adult hospitalized patients who died between 1 March 2020 and 30 June 2021 was identified. Of those, 977 individuals met the definition of death by COVID-19. Demographic characteristics, intensive care unit (ICU) admission, invasive respiratory support (IRS), disease severity, comorbidities, and clinical manifestation at hospital admission were assessed as risk factors using Cox proportional-hazard models. In multivariable models adjusted by age, sex, and pandemic periods, critical disease (vs. moderate) was associated with a greater risk of death (aHR: 1.27; 95%CI: 1.14–1.142), whereas ICU admission (aHR: 0.39; 95%CI: 0.27–0.56), IRS (aHR: 0.37; 95%CI: 0.26–0.54), the ratio of oxygen saturation (ROX) index ≥ 5.3 (aHR: 0.87; 95%CI: 0.80–0.94), and the ratio of SatO2/FiO2 ≥ 122.6 (aHR: 0.96; 95%CI: 0.93–0.98) were associated with a lower risk of death. The risk factors described here may be useful in assisting decision making and resource allocation.

O2 Saturation Predicted the ICU Stay of COVID-19 Patients in a Hospital at Altitude: A Low-Cost Tool for Post-Pandemic

“…For their part, the PO 2 S values we reported in our study (74.9%) were closer to an investigation where patients hospitalized for COVID-19 at altitude with a PO 2 S of 75-79% and ≤75% had 2.92 (1.99, 4.3) and 2.79 (1.89, 4.11) (both p < 0.001) higher risk of ICU admission or death, respectively, compared to patients with PO 2 S ≥ 85% [3]. Somehow, the literature confirmed these postulates by stating that patients with COVID-19 hospitalized in ICU at high altitudes (3339 MASL) with higher oxygen respiratory rates had lower odds of mortality [17]. Patients hospitalized at low altitudes with a PO 2 S ≤ 90% were 47 times more likely to die due to COVID-19 than those with a PO 2 S > 90% (p < 0.001) [18].…”

Hiperglicemia al ingreso hospitalario como predictor de mala evolución en pacientes hospitalizados por COVID-19

“…Además, a mayores altitudes, la presión (32) parcial de oxígeno en el aire disminuye, lo que puede comprometer aún más la capacidad de oxigenación en pacientes con COVID-19, especialmente aquellos con comorbilidades respiratorias o cardiovasculares preexistentes . La siopatología de la adaptación a la (33) altitud también puede in uir en la respuesta in amatoria y en la coagulación sanguínea, factores críticos en el curso clínico de COVID-19.…”