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Heart Lung . Outcomes of patients with COVID-19 in the intensive care unit in Mexico: A multicenter observational study

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  • Heart Lung . Outcomes of patients with COVID-19 in the intensive care unit in Mexico: A multicenter observational study


    Heart Lung


    . 2020 Oct 21;S0147-9563(20)30412-X.
    doi: 10.1016/j.hrtlng.2020.10.013. Online ahead of print.
    Outcomes of patients with COVID-19 in the intensive care unit in Mexico: A multicenter observational study


    Silvio A ?amendys-Silva 1 , Pedro E Alvarado-?vila 2 , Guillermo Dom?nguez-Cherit 3 , Eduardo Rivero-Sigarroa 2 , Luis A S?nchez-Hurtado 4 , Alan Guti?rrez-Villase?or 5 , Juan P Romero-Gonz?lez 5 , Heber Rodr?guez-Bautista 2 , Alondra Garc?a-Briones 5 , C?sar E Garnica-Camacho 6 , N?stor G Cruz-Ruiz 7 , Mar?a O Gonz?lez-Herrera 8 , Francisco J Garc?a-Guill?n 9 , Manuel A Guerrero-Guti?rrez 9 , Jos? D Salmer?n-Gonz?lez 10 , Laura Romero-Guti?rrez 4 , Jos? L Canto-Castro 11 , Victor H Cervantes 12 , Mexico COVID-19 Critical Care Collaborative Group



    Affiliations

    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.

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