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

Abstract

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.

Risk Factors Associated with Mortality in Hospitalized Patients with COVID-19 during the Omicron Wave in Brazil

“…It was found that the risk factor of being elderly (40–59, 60–79 or 80+ years old) increases the possibility of death compared to hospitalized adults under 40 years of age. This finding is in line with those reported in other studies conducted for different countries [ 14 , 38 , 39 , 40 ], and it can be interpreted due to the influence of immunosenescence (immune aging), which negatively contributes to a low immune response to vaccination of the elderly. Notice that this immunological fact is not unique to anti-COVID-19 vaccines, occurring with influenza, pneumonia, tetanus, and hepatitis B vaccines as well [ 41 ].…”

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

“…The risk of death for hospitalized patients with or without diabetes or chronic lung disease was comparable. These findings differ from those reported elsewhere, where it is suggested that these conditions have an impact on mortality [ 15 , 55 , 56 , 57 ]. However, the lack of association observed here could be explained by the “diabetes/obesity paradox” and by the physiological readjustment during the critical stage of the disease [ 58 ].…”

“…Numerous investigations have evaluated factors associated with COVID-19 death in hospitalized patients; most of them have been conducted over a short period, and only a few of them have been conducted in Peru [ 10 , 11 , 12 , 13 , 14 , 15 ]. Of the studies carried out in Peru, one included information from three healthcare centers [ 12 ] and another described factors associated with ICU admission among hospitalized patients in a high-altitude setting [ 10 ].…”

Zonulin, a marker of gut permeability, is associated with mortality in a cohort of hospitalised peruvian COVID-19 patients

“…In addition, a lower Sa/FiO 2 ratio and a decreased lymphocyte count were associated with death by COVID-19 ( Henry et al., 2020 ; Huang and Pranata, 2020 ; Booth et al., 2021 ; Pons et al., 2021 ; Gopalan et al., 2022 ; Soto et al., 2022 ). It should be noted that lymphopenia might occur due to consequent apoptosis of activated CD4+T cells by SARS-CoV-2 ( Shen et al., 2022 ), thereby inducing immune suppression.…”