Mortality in adults with COVID-19: experience of the Intensive Care Unit of a Third Level Hospital in Paraguay
DOI:
https://doi.org/10.52379/mcs.v7i1.272Keywords:
COVID-19, mortality, mechanical ventilation, bacterial infection, hemodialysisAbstract
Introduction: Several factors may influence mortality in patients hospitalized with COVID-19. Objective: This research aimed to determine mortality and associated factors in adults with COVID-19 hospitalized in the intensive care unit of a Third Level Hospital in Paraguay. Methodology: Observational, descriptive of cross-association, cross-sectional, and retrospective study. We included medical records of adult patients, of both sexes, who had a confirmed diagnosis (by antigen and/or PCR test) of SARS-CoV-2 infection and who were hospitalized in the intensive care unit of a Third Level General Hospital in Paraguay. Results: We included 116 patients, 54% of whom were male. The mean age was 57 ± 12.9 years. Of participants, 51% had hypertension and 29% diabetes mellitus. Mechanical ventilation was required in 85% of the patients. Of ventilated patients, 75% had a fatal outcome. A statistically significant association was found between the presence of bacterial infections and hemodialysis requirement and fatal outcome (p=0.0074 and p=0.00011, respectively). The mean age of the deceased patients was 59.5 years, while the group of patients discharged from the intensive care unit had a mean age of 54.2 years. The difference between these ages in relation to death was significant, with a p<0.05. Discussion: Overall mortality due to COVID-19 was more than 6 per 10 patients, being higher in those patients with ventilation. Those patients who presented bacterial superinfection or required hemodialysis during hospitalization had a worse outcome compared to patients who did not present this type of complications.
Downloads
References
Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020 May 26;323(20):2052-2059. https://doi.org/10.1001/jama.2020.6775. Erratum in: JAMA. 2020 26;323(20):2098.
Baradaran A, Ebrahimzadeh MH, Baradaran A, Kachooei AR. Prevalence of Comorbidities in COVID-19 Patients: A Systematic Review and Meta-Analysis. Arch Bone Jt Surg. 2020 Apr;8(Suppl 1):247-255. https://doi.org/10.22038/abjs.2020.47754.2346
Patel U, Malik P, Usman MS, Mehta D, Sharma A, Malik FA, et al. Age-Adjusted Risk Factors Associated with Mortality and Mechanical Ventilation Utilization Amongst COVID-19 Hospitalizations-a Systematic Review and Meta-Analysis. SN Compr Clin Med. 2020;2(10):1740-1749. https://doi.org10.1007/s42399-020-00476-w
COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators. Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med. 2021;47(1):60-73. https://doi.org/10.1007/s00134-020-06294-x
Singer AJ, Morley EJ, Meyers K, Fernandes R, Rowe AL, Viccellio P, et al. Cohort of Four Thousand Four Hundred Four Persons Under Investigation for COVID-19 in a New York Hospital and Predictors of ICU Care and Ventilation. Ann Emerg Med. 2020;76(4):394-404. https://doi.org/10.1016/j.annemergmed.2020.05.011
Cheng S, Zhao Y, Wang F, Chen Y, Kaminga AC, Xu H. Comorbidities' potential impacts on severe and non-severe patients with COVID-19: A systematic review and meta-analysis. Medicine (Baltimore). 2021;100(12):e24971. https://doi.org/10.1097/MD.0000000000024971
Honardoost M, Janani L, Aghili R, Emami Z, Khamseh ME. The Association between Presence of Comorbidities and COVID-19 Severity: A Systematic Review and Meta-Analysis. Cerebrovasc Dis. 2021;50(2):132-140. https://doi.org/10.1159/000513288
Ouyang L, Yu M, Zhu Y, Gong J. Respiratory supports of COVID-19 patients in intensive care unit: A systematic review. Heliyon. 2021;7(4):e06813. https://doi.org/10.1016/j.heliyon.2021.e06813
Chang R, Elhusseiny KM, Yeh YC, Sun WZ. COVID-19 ICU and mechanical ventilation patient characteristics and outcomes-A systematic review and meta-analysis. PLoS One. 2021;16(2):e0246318. https://doi.org/10.1371/journal.pone.0246318
King CS, Sahjwani D, Brown AW, Feroz S, Cameron P, Osborn E, et al. Outcomes of mechanically ventilated patients with COVID-19 associated respiratory failure. PLoS One. 2020;15(11):e0242651. https://doi.org/10.1371/journal.pone.0242651
Guo L, Wang W, Zhao N, Guo L, Chi C, Hou W, Wu A, Tong H, Wang Y, Wang C, Li E. Mechanical ventilation strategies for intensive care unit patients without acute lung injury or acute respiratory distress syndrome: a systematic review and network meta-analysis. Crit Care. 2016;20(1):226. https://doi.org/10.1186/s13054-016-1396-0
Wilson JG, Matthay MA. Mechanical ventilation in acute hypoxemic respiratory failure: a review of new strategies for the practicing hospitalist. J Hosp Med. 2014;9(7):469-75. https://doi.org/10.1002/jhm.2192
Grasselli G, Cattaneo E, Florio G, Ippolito M, Zanella A, Cortegiani A, et al. Mechanical ventilation parameters in critically ill COVID-19 patients: a scoping review. Crit Care. 2021;25(1):115. https://doi.org/10.1186/s13054-021-03536-2
Lim ZJ, Subramaniam A, Ponnapa Reddy M, Blecher G, Kadam U, Afroz A, et al. Case Fatality Rates for Patients with COVID-19 Requiring Invasive Mechanical Ventilation. A Meta-analysis. Am J Respir Crit Care Med. 2021;203(1):54-66. https://doi.org/10.1164/rccm.202006-2405OC
Ñamendys-Silva, S.A. Case fatality ratio of COVID-19 patients requiring invasive mechanical ventilation in Mexico: an analysis of nationwide data. Crit Care 2021;25(68). https://doi.org/10.1186/s13054-021-03485-w
Plotnikow GA, Matesa A, Nadur JM, Alonso M, Nuñez I I, Vergara G, Alfageme MJ, Vitale A, Gil M, Kinzler V, Melia M, Pugliese F, Donnianni M, Pochettino J, Brozzi I, Scapellato JL; Grupo Argentino Telegram nCoV19. Characteristics and outcomes of patients infected with nCoV19 requiring invasive mechanical ventilation in Argentina. Rev Bras Ter Intensiva. 2020;32(3):348-353. https://doi.org/10.5935/0103-507X.20200062
Tan E, Song J, Deane AM, Plummer MP. Global Impact of Coronavirus Disease 2019 Infection Requiring Admission to the ICU: A Systematic Review and Meta-analysis. Chest. 2021;159(2):524-536. https://doi.org/10.1016/j.chest.2020.10.014
Roedl K, Jarczak D, Thasler L, Bachmann M, Schulte F, Bein B, et al. Mechanical ventilation and mortality among 223 critically ill patients with coronavirus disease 2019: A multicentric study in Germany. Aust Crit Care. 2021;34(2):167-175. https://doi.org/10.1016/j.aucc.2020.10.009
Nicholson CJ, Wooster L, Sigurslid HH, Li RH, Jiang W, Tian W, et al. Estimating risk of mechanical ventilation and in-hospital mortality among adult COVID-19 patients admitted to Mass General Brigham: The VICE and DICE scores. EClinicalMedicine. 2021;33:100765. https://doi.org/10.1016/j.eclinm.2021.100765
Sirvent JM, Baro A, Morales M, Sebastian P, Saiz X. Predictive biomarkers of mortality in critically ill patients with COVID-19. Med Intensiva (Engl Ed). 2020;46(2):94–6. English, Spanish. https://doi.org/10.1016/j.medin.2020.09.010
Torales J, Cuenca-Torres O, Barrios L, Armoa-Garcia L, Estigarribia G, Sanabria G, et al. An evaluation of the safety and immunogenicity of MVC-COV1901: Results of an interim analysis of a phase III, parallel group, randomized, double-blind, active-controlled immunobridging study in Paraguay. Vaccine. 2023;41(1):109-118. https://doi.org/10.1016/j.vaccine.2022.10.030
Park SH, Hong SH, Kim K, Lee SW, Yon DK, Jung SJ, et al. Non-Pharmaceutical Interventions Reduce the Incidence, and Mortality of COVID-19: A Study based on the Survey from the International COVID-19 Research Network (ICRN). J Med Virol. 2022. https://doi.org/10.1002/jmv.28354. Epub ahead of print.
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Paola Pusineri Escobar, Manuel González Gómez, Iván Barrios, Julio Torales
This work is licensed under a Creative Commons Attribution 4.0 International License.
