In-hospital mortality from severe COVID-19 in a tertiary care center in Mexico City; causes of death, risk factors and the impact of hospital saturation

Autor: Alfonso Gulias Herrero, Alejandra Martínez-Valenzuela, José Luis Cárdenas-Fragoso, Karla María Tamez-Flores, Antonio Olivas-Martinez, Víctor Hugo Tovar-Méndez, Oscar Arturo Lozano-Cruz, Thierry Hernández-Gilsoul, Arturo Galindo-Fraga, Bernardo A Martinez-Guerra, Edgar Ortiz-Brizuela, Carla M Roman-Montes, Carla Medrano-Borromeo, Eric Ochoa-Hein, María F González-Lara, Alfredo Ponce-de-León, José Sifuentes-Osornio, David Kershenobich-Stalnikowitz, José Víctor Jiménez
Jazyk: angličtina
Rok vydání: 2021
Předmět:
RNA viruses
Male
Viral Diseases
Pulmonology
Coronaviruses
Epidemiology
Physiology
030204 cardiovascular system & hematology
Overweight
Severity of Illness Index
Body Mass Index
law.invention
Tertiary Care Centers
Medical Conditions
0302 clinical medicine
law
Risk Factors
Cause of Death
Medicine and Health Sciences
030212 general & internal medicine
Hospital Mortality
Prospective Studies
Prospective cohort study
Pathology and laboratory medicine
Cause of death
Bed Occupancy
Respiratory Distress Syndrome
Multidisciplinary
Mortality rate
Overcrowding
Medical microbiology
Middle Aged
Intensive care unit
Shock
Septic
Hospitals
Intensive Care Units
Infectious Diseases
Physiological Parameters
Viruses
Medicine
Female
SARS CoV 2
Pathogens
medicine.symptom
Research Article
medicine.medical_specialty
SARS coronavirus
Death Rates
Science
Microbiology
03 medical and health sciences
Population Metrics
Severity of illness
medicine
Humans
Obesity
Mexico
Aged
Population Biology
Biology and life sciences
Septic shock
business.industry
SARS-CoV-2
Body Weight
Organisms
Viral pathogens
COVID-19
Covid 19
Pneumonia
medicine.disease
Respiration
Artificial
Microbial pathogens
Morbid Obesity
Health Care
Health Care Facilities
Medical Risk Factors
Emergency medicine
business
Zdroj: PLoS ONE, Vol 16, Iss 2, p e0245772 (2021)
PLoS ONE
ISSN: 1932-6203
Popis: Background As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has remained in Latin America, Mexico has become the third country with the highest death rate worldwide. Data regarding in-hospital mortality and its risk factors, as well as the impact of hospital overcrowding in Latin America has not been thoroughly explored. Methods and findings In this prospective cohort study, we enrolled consecutive adult patients hospitalized with severe confirmed COVID-19 pneumonia at a SARS-CoV-2 referral center in Mexico City from February 26th, 2020, to June 5th, 2020. A total of 800 patients were admitted with confirmed diagnosis, mean age was 51.9 ± 13.9 years, 61% were males, 85% were either obese or overweight, 30% had hypertension and 26% type 2 diabetes. From those 800, 559 recovered (69.9%) and 241 died (30.1%). Among survivors, 101 (18%) received invasive mechanical ventilation (IMV) and 458 (82%) were managed outside the intensive care unit (ICU); mortality in the ICU was 49%. From the non-survivors, 45.6% (n = 110) did not receive full support due to lack of ICU bed availability. Within this subgroup the main cause of death was acute respiratory distress syndrome (ARDS) in 95% of the cases, whereas among the non-survivors who received full (n = 105) support the main cause of death was septic shock (45%) followed by ARDS (29%). The main risk factors associated with in-hospital death were male sex (RR 2.05, 95% CI 1.34–3.12), obesity (RR 1.62, 95% CI 1.14–2.32)—in particular morbid obesity (RR 3.38, 95%CI 1.63–7.00)—and oxygen saturation < 80% on admission (RR 4.8, 95%CI 3.26–7.31). Conclusions In this study we found similar in-hospital and ICU mortality, as well as risk factors for mortality, compared to previous reports. However, 45% of the patients who did not survive justified admission to ICU but did not receive IMV / ICU care due to the unavailability of ICU beds. Furthermore, mortality rate over time was mainly due to the availability of ICU beds, indirectly suggesting that overcrowding was one of the main factors that contributed to hospital mortality.
Databáze: OpenAIRE
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