Outcomes of patients with COVID-19 in the intensive care unit in Mexico: A multicenter observational study
Silvio A Ñamendys-Silva, Pedro E Alvarado-Ávila, Guillermo Domínguez-Cherit, Eduardo Rivero-Sigarroa, Luis A Sánchez-Hurtado, Alan Gutiérrez-Villaseñor, Juan P Romero-González, Heber Rodríguez-Bautista, Alondra García-Briones, César E Garnica-Camacho, Néstor G Cruz-Ruiz, María O González-Herrera, Francisco J García-Guillén, Manuel A Guerrero-Gutiérrez, José D Salmerón-González, Laura Romero-Gutiérrez, José L Canto-Castro, Victor H Cervantes, Mexico COVID-19 Critical Care Collaborative Group, Silvio A Ñamendys-Silva, Pedro E Alvarado-Ávila, Guillermo Domínguez-Cherit, Eduardo Rivero-Sigarroa, Luis A Sánchez-Hurtado, Alan Gutiérrez-Villaseñor, Juan P Romero-González, Heber Rodríguez-Bautista, Alondra García-Briones, César E Garnica-Camacho, Néstor G Cruz-Ruiz, María O González-Herrera, Francisco J García-Guillén, Manuel A Guerrero-Gutiérrez, José D Salmerón-González, Laura Romero-Gutiérrez, José L Canto-Castro, Victor H Cervantes, Mexico COVID-19 Critical Care Collaborative Group
Abstract
Background: As of June 15, 2020, a cumulative total of 7,823,289 confirmed cases of COVID-19 have been reported across 216 countries and territories worldwide. However, there is little information on the clinical characteristics and outcomes of critically ill patients with severe COVID-19 who were admitted to intensive care units (ICUs) in Latin America. The present study evaluated the clinical characteristics and outcomes of critically ill patients with severe COVID-19 who were admitted to ICUs in Mexico.
Methods: This was a multicenter observational study that included 164 critically ill patients with laboratory-confirmed COVID-19 who were admitted to 10 ICUs in Mexico, from April 1 to April 30, 2020. Demographic data, comorbid conditions, clinical presentation, treatment, and outcomes were collected and analyzed. The date of final follow-up was June 4, 2020.
Results: A total of 164 patients with severe COVID-19 were included in this study. The mean age of patients was 57.3 years (SD 13.7), 114 (69.5%) were men, and 6.0% were healthcare workers. Comorbid conditions were common in patients with critical COVID-19: 38.4% of patients had hypertension and 32.3% had diabetes. Compared to survivors, nonsurvivors were older and more likely to have diabetes, hypertension or other conditions. Patients presented to the hospital a median of 7 days (IQR 4.5-9) after symptom onset. The most common presenting symptoms were shortness of breath, fever, dry cough, and myalgias. One hundred percent of patients received invasive mechanical ventilation for a median time of 11 days (IQR 6-14). A total of 139 of 164 patients (89.4%) received vasopressors, and 24 patients (14.6%) received renal replacement therapy during hospitalization. Eighty-five (51.8%) patients died at or before 30 days, with a median survival of 25 days. Age (OR, 1.05; 95% CI, 1.02-1.08; p<0.001) and C-reactive protein levels upon ICU admission (1.008; 95% CI, 1.003-1.012; p<0.001) were associated with a higher risk of in-hospital death. ICU length of stay was associated with reduced in-hospital mortality risk (OR, 0.89; 95% CI, 0.84-0.94; p<0.001).
Conclusions: This observational study of critically ill patients with laboratory-confirmed COVID-19 who were admitted to the ICU in Mexico demonstrated that age and C-reactive protein level upon ICU admission were associated with in-hospital mortality, and the overall hospital mortality rate was high.
Trial registration: ClinicalTrials.gov, NCT04336345.
Keywords: COVID-19; Coronavirus; Intensive care unit; Mexico; Outcomes; SARS-CoV-2 infection.
Conflict of interest statement
Declarations of Competing Interest The authors state that there are no conflicts of interest related to this study.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Source: PubMed