Factors associated with increased mortality in critically ill COVID-19 patients in a Mexican public hospital: the other faces of health system oversaturation
Mariana Jocelyn Macías Guzmán, Alejandro Castillo-Gonzalez, Jose Lenin Beltran Gonzalez, Mario González Gámez, Emanuel Antonio Mendoza Enciso, MD Itzel Ovalle Robles, Andrea Lucia García Díaz, César Mauricio Gutiérrez Peña, Lucila Martinez Medina, Victor Antonio Monroy Colin, Arreola Guerra Jose Manuel
doi:10.1101/2021.03.04.21252084
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 .
References
Ammar, Sacha, Welch, Sedation, Analgesia, and Paralysis in COVID-19 Patients in the Setting of Drug Shortages, J Intensive Care Med
Balas, Weinhouse, Denehy, Chanques, Rochwerg et al., Interpreting and implementing the 2018 pain, agitation/sedation, delirium, immobility, and sleep disruption clinical practice guideline, Crit Care Med
Caulier, Delannoy, Meybeck, Georges, Thiopental as substitute therapy for critically ill patients with COVID-19 requiring mechanical ventilation and prolonged sedation
Chen, Shao, Hsu, Wu, Hung et al., Incidence of acute kidney injury in COVID-19 infection: a systematic review and meta-analysis, Crit Care
Conti, Arcangeli, Antonelli, Cavaliere, Costa et al., Sedation with sufentanil in patients receiving pressure support ventilation has no efects on respiration: a pilot study, Can J Anaesth
Devlin, Skrobik, Gélinas, Executive Summary: Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU, Crit Care Med
Ferrer, Martin-Loeches, Phillips, Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program, Crit Care Med
François, Laterre, Luyt, Chastre, The challenge of ventilator-associated pneumonia diagnosis in COVID-19 patients, Crit Care
Gabarre, Dumas, Dupont, Darmon, Azoulay et al., Acute kidney injury in critically ill patients with COVID-19, Intensive Care Med
Joannidis, Druml, Forni, Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017 : Expert opinion of the Working
Li, Xu, Yu, Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan, J Allergy Clin Immunol
Lim, Subramaniam, Reddy, Case Fatality Rates for Patients with COVID-19 Requiring Invasive Mechanical Ventilation. A Meta-analysis, Am J Respir Crit Care Med
Nisula, Kaukonen, Vaara, Korhonen, Poukkanen et al., Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study, Intensive Care Med
Ostermann, Chang, Acute kidney injury in the intensive care unit according to RIFLE, Crit Care Med
Rawson, Moore, Zhu, Bacterial and Fungal Coinfection in Individuals With Coronavirus: A Rapid Review To Support COVID-19 Antimicrobial Prescribing, Clin Infect Dis
Shao, Li, Liu, Tian, Luo et al., Acute kidney injury is associated with severe infection and fatality in patients with COVID-19: A systematic review and meta-analysis of 40 studies and 24,527 patients, Pharmacol Res
Wu, Mcgoogan, Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72Y314 Cases From the Chinese Center for Disease Control and Prevention, JAMA
Zhu, Wang, Du, Xi, Could remifentanil reduce duration of mechanical ventilation in comparison with other opioids for mechanically ventilated patients? A systematic review and meta-analysis, Crit Care
Ñamendys-Silva, Case fatality ratio of COVID-19 patients requiring invasive mechanical ventilation in Mexico: an analysis of nationwide data, Crit Care
