Factors associated with increased mortality in critically ill COVID-19 patients in a Mexican public hospital: the other faces of health system oversaturation
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Abstract
BACKGROUND
The lethality rate of COVID-19 in Mexico is one of the highest worldwide, but in-hospital factors associated with this increased rate have yet to be explored. This study aims to evaluate those factors that could be associated with mortality at 28-days in critically ill COVID-19 patients in Mexico.
METHODS
This is a retrospective analysis of the patients included in the clinical trial ( NCT04381858 ) which recruited patients with severe COVID-19 with high oxygen requirement or mechanical ventilation from May to October 2020. The primary outcome, death at 28, was analyzed.
RESULTS
Between May and October 2020, 196 predominantly male patients (n=122, 62.2%) with an average of 58.1 years (± 15.5), were included in the cohort. Mortality at 28 days was 44.3 % (n= 84). Patients included in the second trimester had a greater mortality rate when compared with those recruited in the first trimester (54.1 vs 32.1, p< 0.01). On multivariate analysis, the detected protective factors were the use of fentanyl HR 0.51 (95%CI 0.31 – 0.85, p=0.01), the use of antibiotics HR 0.22 (95% CI 0.13 – 0.36, p<0.01), and a previously healthy state (no comorbidities other than obesity) HR 0.58 (95%CI 0.35 – 0.94, p =0.03); risk factors were severe kidney injury (AKIN3) HR 1.74 (95%CI 1.04 – 2.9, p=0.035), elevated D-Dimer levels HR 1.02 (95%CI 1.007 – 1.04, p=0.005), shock OR 5.8 (2.4 – 13.8, p<0.01), and recruitment in the second trimester OR 2.3 ((1.1 – 4.8, p=0.02).
CONCLUSIONS
In-hospital mortality in critically ill COVID-19 patients has increased in our center. The appropriate use of antibiotics, the type of sedation, and AKIN3 are modifiable factors directly related to this increased mortality. The increase in mortality observed in the second trimester is explained by hospital overcrowding that began in August 2020.
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SciScore for 10.1101/2021.03.04.21252084: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The original clinical trial was approved by the ethics committee of the Hospital Centenario Miguel Hidalgo on April 15 2020, with the registration number 2020-R-25. Randomization Briefly, we designed a controlled, randomized, open clinical trial that included patients with severe pneumonia secondary to SARS-CoV-2 infection, with severe respiratory failure or warranting IMV. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature …
SciScore for 10.1101/2021.03.04.21252084: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The original clinical trial was approved by the ethics committee of the Hospital Centenario Miguel Hidalgo on April 15 2020, with the registration number 2020-R-25. Randomization Briefly, we designed a controlled, randomized, open clinical trial that included patients with severe pneumonia secondary to SARS-CoV-2 infection, with severe respiratory failure or warranting IMV. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.Results from TrialIdentifier: We found the following clinical trial numbers in your paper:
Identifier Status Title NCT04381858 Completed Convalescent Plasma vs Human Immunoglobulin to Treat COVID-1… NCT04391127 Completed Hydroxychloroquine and Ivermectin for the Treatment of COVID… Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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