Clinical outcomes of patients hospitalized for COVID-19 and evidence-based on the pharmacological management reduce mortality in a region of the Colombian Caribbean

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Abstract

Introduction

Despite the high volume of infections, some clinical aspects of this disease are still unknown. There are currently no studies in Colombia that describe the disease’s clinical and treatment aspects in detail.

Objective

Describe the characteristics and clinical management of a group of admitted patients with SARS-CoV-2 infection in a private clinic in Montería, Córdoba-Colombia.

Patients and methods

A descriptive observational study was carried out between May and August 2020 in 209 hospitalized patients with a confirmed diagnosis of COVID-19. Upon admittance, clinical, sociodemographic characteristics, comorbidities, and complications were analyzed. Additionally, the effect of the following medications was described: 1—antibiotics (cefepime, piperacillin, tazobactam, meropenem, vancomycin) + low molecular weight heparin (LMWH) + corticosteroids (dexamethasone–methylprednisolone) + colchicine. 2— Antibiotic + LMWH + corticosteroids. 3—LMWH + corticosteroids. 4—LMWH + corticosteroids + colchicine. 5—Other treatments (Tocilizumab).

Results

107 (51%) of the 209 patients with a confirmed diagnosis of COVID-19 passed away. The main comorbidities related to mortality of these hospitalized patients with COVID-19 were obesity and kidney disease (P < 0.05). The main complications associated with fatal outcomes in this group of patients were Acute Respiratory Distress Syndrome (ARDS) and sepsis (P < 0.05). Furthermore, it was evidenced that the colchicine combination showed a significant difference in reducing mortality in hospitalized patients compared to the other therapeutic regimens (P < 0.05).

Conclusion

A mortality rate of 51% was found attributable to several factors such as advanced age, obesity, kidney disease, and an average time in days of late consultation. The implementation of the colchicine combination could reduce the mortality rate in this disease.

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Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

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Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Fei Zhou, Ting Yu, Ronghui Du … (2020)

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

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Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

Dawei Wang, Bo Hu, Fangfang Zhu … (2020)

In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.

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Author and article information

Journal

Journal ID (nlm-ta): J Infect Public Health

Journal ID (iso-abbrev): J Infect Public Health

Title: Journal of Infection and Public Health

Publisher: The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences.

ISSN (Print): 1876-0341

ISSN (Electronic): 1876-035X

Publication date PMC-release: 6 March 2021

Publication date (Electronic): 6 March 2021

Affiliations

[a ]Infectology and Epidemiology Service, IMAT-Oncomédica, Montería, Colombia

[b ]Clinical Research Department, IMAT-Oncomédica, Montería, Colombia

[c ]Tropic Biological Research Institute, Universidad de Córdoba, Montería, Colombia

[d ]Internal Medicine Service, IMAT-Oncomédica, Montería, Colombia

Author notes

[* ]Corresponding author.

Article

Publisher Item ID: S1876-0341(21)00057-5

DOI: 10.1016/j.jiph.2021.02.013

PMC ID: 8101281

PubMed ID: 34020208

SO-VID: 5989c03f-ae5b-488e-be17-725106b0c5f9

License:

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

History

Date received : 25 December 2020

Date revision received : 20 February 2021

Date accepted : 28 February 2021

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Clinical outcomes of patients hospitalized for COVID-19 and evidence-based on the pharmacological management reduce mortality in a region of the Colombian Caribbean

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Abstract

Introduction

Objective

Patients and methods

Results

Conclusion

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Novel Coronavirus Disease COVID-19

Most cited references 40

Clinical Characteristics of Coronavirus Disease 2019 in China

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

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Cited by 10

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