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

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Abstract

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.

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Most cited references 50

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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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Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study

Xiaobo Yang, Yuan Yu, Jiqian Xu … (2020)

Summary Background An ongoing outbreak of pneumonia associated with the severe acute respiratory coronavirus 2 (SARS-CoV-2) started in December, 2019, in Wuhan, China. Information about critically ill patients with SARS-CoV-2 infection is scarce. We aimed to describe the clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia. Methods In this single-centered, retrospective, observational study, we enrolled 52 critically ill adult patients with SARS-CoV-2 pneumonia who were admitted to the intensive care unit (ICU) of Wuhan Jin Yin-tan hospital (Wuhan, China) between late December, 2019, and Jan 26, 2020. Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes were all collected. Data were compared between survivors and non-survivors. The primary outcome was 28-day mortality, as of Feb 9, 2020. Secondary outcomes included incidence of SARS-CoV-2-related acute respiratory distress syndrome (ARDS) and the proportion of patients requiring mechanical ventilation. Findings Of 710 patients with SARS-CoV-2 pneumonia, 52 critically ill adult patients were included. The mean age of the 52 patients was 59·7 (SD 13·3) years, 35 (67%) were men, 21 (40%) had chronic illness, 51 (98%) had fever. 32 (61·5%) patients had died at 28 days, and the median duration from admission to the intensive care unit (ICU) to death was 7 (IQR 3–11) days for non-survivors. Compared with survivors, non-survivors were older (64·6 years [11·2] vs 51·9 years [12·9]), more likely to develop ARDS (26 [81%] patients vs 9 [45%] patients), and more likely to receive mechanical ventilation (30 [94%] patients vs 7 [35%] patients), either invasively or non-invasively. Most patients had organ function damage, including 35 (67%) with ARDS, 15 (29%) with acute kidney injury, 12 (23%) with cardiac injury, 15 (29%) with liver dysfunction, and one (2%) with pneumothorax. 37 (71%) patients required mechanical ventilation. Hospital-acquired infection occurred in seven (13·5%) patients. Interpretation The mortality of critically ill patients with SARS-CoV-2 pneumonia is considerable. The survival time of the non-survivors is likely to be within 1–2 weeks after ICU admission. Older patients (>65 years) with comorbidities and ARDS are at increased risk of death. The severity of SARS-CoV-2 pneumonia poses great strain on critical care resources in hospitals, especially if they are not adequately staffed or resourced. Funding None.

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Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report

Mark Peters (2020)

Abstract Background Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death. Methods In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Here, we report the preliminary results of this comparison. Results A total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usual care. Overall, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; P<0.001). The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients were receiving at the time of randomization. In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.91 to 1.55). Conclusions In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support. (Funded by the Medical Research Council and National Institute for Health Research and others; RECOVERY ClinicalTrials.gov number, NCT04381936; ISRCTN number, 50189673.)

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Author and article information

Contributors

Antonio Olivas-Martínez:

ORCID: https://orcid.org/0000-0003-2779-0068

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing

José Luis Cárdenas-Fragoso: Role: ConceptualizationRole: Data curationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing

José Víctor Jiménez: Role: ConceptualizationRole: Data curationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing

Oscar Arturo Lozano-Cruz: Role: ConceptualizationRole: Data curationRole: Writing – review & editing

Edgar Ortiz-Brizuela: Role: ConceptualizationRole: Data curationRole: MethodologyRole: Writing – review & editing

Víctor Hugo Tovar-Méndez: Role: Data curationRole: Writing – review & editing

Carla Medrano-Borromeo: Role: Data curationRole: Writing – review & editing

Alejandra Martínez-Valenzuela: Role: Data curationRole: Writing – review & editing

Carla Marina Román-Montes:

ORCID: https://orcid.org/0000-0002-2509-618X

Role: Data curationRole: Writing – review & editing

Bernardo Martínez-Guerra:

ORCID: https://orcid.org/0000-0002-5191-2179

Role: Data curationRole: Writing – review & editing

María Fernanda González-Lara: Role: Writing – review & editing

Thierry Hernandez-Gilsoul:

ORCID: https://orcid.org/0000-0002-9389-9945

Role: Writing – review & editing

Alfonso Gulias Herrero: Role: Writing – review & editing

Karla María Tamez-Flores: Role: Writing – review & editing

Eric Ochoa-Hein: Role: Writing – review & editing

Alfredo Ponce-de-León: Role: Writing – review & editing

Arturo Galindo-Fraga:

ORCID: https://orcid.org/0000-0002-2818-1160

Role: Writing – review & editing

David Kershenobich-Stalnikowitz: Role: ConceptualizationRole: Writing – review & editing

José Sifuentes-Osornio:

ORCID: https://orcid.org/0000-0003-3067-2687

Role: ConceptualizationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – review & editing

Chiara Lazzeri: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS One

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 3 February 2021

Publication date Collection: 2021

Publication date PMC-release: 3 February 2021

Volume: 16

Issue: 2

Electronic Location Identifier: e0245772

Affiliations

[1 ] Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

[2 ] Department of Biostatistics, University of Washington, Seattle, WA, United States of America

[3 ] Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

[4 ] Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

[5 ] Department of Epidemiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

[6 ] General Director´s Office, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

Azienda Ospedaliero Universitaria Careggi, ITALY

Author notes

Competing Interests: The authors have declared that no competing interests exist.

‡ EO-B and VHT-M also contributed equally to this work.

* E-mail: sifuentesosornio@ 123456gmail.com

Author information

Antonio Olivas-Martínez https://orcid.org/0000-0003-2779-0068

Carla Marina Román-Montes https://orcid.org/0000-0002-2509-618X

Bernardo Martínez-Guerra https://orcid.org/0000-0002-5191-2179

Thierry Hernandez-Gilsoul https://orcid.org/0000-0002-9389-9945

Arturo Galindo-Fraga https://orcid.org/0000-0002-2818-1160

José Sifuentes-Osornio https://orcid.org/0000-0003-3067-2687

Article

Publisher ID: PONE-D-20-28321

DOI: 10.1371/journal.pone.0245772

PMC ID: 7857625

PubMed ID: 33534813

SO-VID: b2b7faf6-7c53-4831-883b-2dcb5c04aab0

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 18 September 2020

Date accepted : 7 January 2021

Page count

Figures: 2, Tables: 5, Pages: 17

Funding

The author(s) received no specific funding for this work.

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Data Availability All relevant data are within the manuscript and its Supporting Information files.

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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

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Abstract

Background

Methods and findings

Conclusions

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Novel Coronavirus Disease COVID-19

Most cited references 50

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

Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study

Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report

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