Abstract
Background: As of June 15, 2020, a cumulative total of 7,823,289 confirmed cases of COVID-19 have been reported across 216 countries and territories worldwide. However, there is little information on the clinical characteristics and outcomes of critically ill patients with severe COVID-19 who were admitted to intensive care units (ICUs) in Latin America. The present study evaluated the clinical characteristics and outcomes of critically ill patients with severe COVID-19 who were admitted to ICUs in Mexico.
Methods: This was a multicenter observational study that included 164 critically ill patients with laboratory-confirmed COVID-19 who were admitted to 10 ICUs in Mexico, from April 1 to April 30, 2020. Demographic data, comorbid conditions, clinical presentation, treatment, and outcomes were collected and analyzed. The date of final follow-up was June 4, 2020.
Results: A total of 164 patients with severe COVID-19 were included in this study. The mean age of patients was 57.3 years (SD 13.7), 114 (69.5%) were men, and 6.0% were healthcare workers. Comorbid conditions were common in patients with critical COVID-19: 38.4% of patients had hypertension and 32.3% had diabetes. Compared to survivors, nonsurvivors were older and more likely to have diabetes, hypertension or other conditions. Patients presented to the hospital a median of 7 days (IQR 4.5-9) after symptom onset. The most common presenting symptoms were shortness of breath, fever, dry cough, and myalgias. One hundred percent of patients received invasive mechanical ventilation for a median time of 11 days (IQR 6-14). A total of 139 of 164 patients (89.4%) received vasopressors, and 24 patients (14.6%) received renal replacement therapy during hospitalization. Eighty-five (51.8%) patients died at or before 30 days, with a median survival of 25 days. Age (OR, 1.05; 95% CI, 1.02-1.08; p<0.001) and C-reactive protein levels upon ICU admission (1.008; 95% CI, 1.003-1.012; p<0.001) were associated with a higher risk of in-hospital death. ICU length of stay was associated with reduced in-hospital mortality risk (OR, 0.89; 95% CI, 0.84-0.94; p<0.001).
Conclusions: This observational study of critically ill patients with laboratory-confirmed COVID-19 who were admitted to the ICU in Mexico demonstrated that age and C-reactive protein level upon ICU admission were associated with in-hospital mortality, and the overall hospital mortality rate was high.
Trial registration: ClinicalTrials.gov, NCT04336345 .
Keywords: COVID-19; Coronavirus; Intensive care unit; Mexico; Outcomes; SARS-CoV-2 infection.
【저자키워드】 COVID-19, coronavirus, SARS-COV-2 infection, intensive care unit, outcomes, Mexico, 【초록키워드】 Treatment, severe COVID-19, Hospitalization, Clinical characteristics, SARS-COV-2 infection, hospital, C-reactive protein, risk, diabetes, outcome, hypertension, ICU, survival, Survivors, Latin America, healthcare, Fever, Patient, ICU admission, age, Follow-up, demographic, information, Care, Critical, in-hospital mortality, renal replacement therapy, Invasive mechanical ventilation, myalgias, presenting symptom, In-hospital death, Shortness of breath, Critically ill patient, confirmed case, symptom onset, Older, higher risk, 95% CI, median time, dry cough, ICUs, vasopressors, Final, comorbid conditions, cumulative, laboratory-confirmed, hospital mortality rate, men, country, multicenter observational study, analyzed, collected, reported, evaluated, reduced, median, condition, demonstrated, conditions, admitted to ICU, IQR, nonsurvivor, patients died, 【제목키워드】 intensive care, multicenter observational study, patients with COVID-19,