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Mortality and associated risk factors in patients hospitalized due to COVID-19 in a Peruvian reference hospital
Alonso Soto1,2, Dante M Quiñones-Laveriano1, Johan Azañero2,3
1Instituto de Investigaciones en Ciencias Biomédicas (INICIB), Faculty of Medicine, Universidad Ricardo Palma, Lima, Peru.
Insights
COVID-19 patients with low oxygen saturation, advanced age, and altered consciousness faced higher in-hospital mortality. Treatments like ivermectin and azithromycin showed no benefit, while corticosteroids were associated with reduced mortality.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- The COVID-19 pandemic caused significant in-hospital mortality globally.
- Identifying risk factors for mortality is crucial for effective patient management.
Purpose of the Study:
- To determine the risk factors associated with in-hospital mortality among COVID-19 patients in a Peruvian national hospital.
Main Methods:
- A retrospective cohort study analyzed medical records of 1418 COVID-19 patients hospitalized between April and August 2020.
- Cox regression models were used to identify factors associated with in-hospital mortality, including demographics, clinical characteristics, oxygen saturation, and laboratory results.
Main Results:
- The in-hospital mortality rate was 46%. Key mortality predictors included older age, history of surgery, low oxygen saturation on admission (SaO2<70%), poor general condition, altered consciousness, and elevated leukocyte levels.
- Treatments with ivermectin and azithromycin were associated with increased mortality, whereas moderate-dose corticosteroids showed a protective effect.
Conclusions:
- A high mortality rate was observed in this COVID-19 cohort.
- Low oxygen saturation, advanced age, and specific laboratory abnormalities were significant risk factors for mortality.
- Certain medications, including ivermectin and azithromycin, were linked to adverse outcomes, while corticosteroids demonstrated a survival benefit.
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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