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Factors associated with increased mortality in critically ill COVID-19 patients in a Mexican public hospital: the other faces of health system oversaturation

Mar 2021  
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Mortality 19% Improvement Relative Risk Ivermectin for COVID-19  Guzman et al.  LATE TREATMENT Is late treatment with ivermectin beneficial for COVID-19? Retrospective study in Mexico Lower mortality with ivermectin (not stat. sig., p=0.35) c19ivm.org Guzman et al., medRxiv, March 2021 Favorsivermectin Favorscontrol 0 0.5 1 1.5 2+
Ivermectin for COVID-19
4th treatment shown to reduce risk in August 2020
 
*, now with p < 0.00000000001 from 104 studies, recognized in 22 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 75 treatments. c19ivm.org
Retrospective 196 critically ill patients in Mexico. Patients overlap with the existing RCT by Beltran-Gonzalez (NCT04391127 (history)). This preprint shows a larger treated population and greater (non-statistically significant) improvement with ivermectin, RR 0.81 [0.53-1.24].
risk of death, 19.0% lower, HR 0.81, p = 0.35.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Guzman et al., 8 Mar 2021, retrospective, Mexico, preprint, 11 authors, trial NCT04391127 (history).
This PaperIvermectinAll
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 .
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This study aims to evaluate ' 'those factors that could be associated with mortality at 28-days in critically ill COVID-19 ' 'patients in Mexico.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>This ' 'is a retrospective analysis of the patients included in the clinical trial (<jats:ext-link ' 'xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="clintrialgov" ' 'xlink:href="NCT04381858">NCT04381858</jats:ext-link>) 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.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>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 <jats:italic>vs</jats:italic> 32.1, p&lt; 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 antibiotics HR 0.22 (95% CI 0.13 – 0.36, p&lt;0.01), ' 'and a previously healthy state (no comorbidities other than obesity) HR 0.58 (95%CI 0.35 – ' '0.94, p =0.03); risk factors were severe kidney injury (AKIN3) HR 1.74 (95%CI 1.04 – 2.9, ' 'p=0.035), elevated D-Dimer levels HR 1.02 (95%CI 1.007 – 1.04, p=0.005), shock OR 5.8 (2.4 – ' '13.8, p&lt;0.01), and recruitment in the second trimester OR 2.3 ((1.1 – 4.8, ' 'p=0.02).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>In-hospital ' 'mortality in critically ill COVID-19 patients has increased in our center. The appropriate ' 'use of antibiotics, the type of sedation, and AKIN3 are modifiable factors directly related ' 'to this increased mortality. The increase in mortality observed in the second trimester is ' 'explained by hospital overcrowding that began in August 2020.</jats:p></jats:sec>', 'DOI': '10.1101/2021.03.04.21252084', 'type': 'posted-content', 'created': {'date-parts': [[2021, 3, 8]], 'date-time': '2021-03-08T14:15:11Z', 'timestamp': 1615212911000}, 'source': 'Crossref', 'is-referenced-by-count': 1, 'title': 'Factors associated with increased mortality in critically ill COVID-19 patients in a Mexican ' 'public hospital: the other faces of health system oversaturation', 'prefix': '10.1101', 'author': [ {'given': 'Mariana Jocelyn Macías', 'family': 'Guzmán', 'sequence': 'first', 'affiliation': []}, { 'given': 'Alejandro', 'family': 'Castillo-Gonzalez', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Jose Lenin Beltran', 'family': 'Gonzalez', 'sequence': 'additional', 'affiliation': []}, {'given': 'Mario González', 'family': 'Gámez', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Emanuel Antonio Mendoza', 'family': 'Enciso', 'sequence': 'additional', 'affiliation': []}, {'given': 'Itzel Ovalle', 'family': 'Robles', 'sequence': 'additional', 'affiliation': []}, {'given': 'Andrea Lucia García', 'family': 'Díaz', 'sequence': 'additional', 'affiliation': []}, { 'given': 'César Mauricio Gutiérrez', 'family': 'Peña', 'sequence': 'additional', 'affiliation': []}, {'given': 'Lucila Martinez', 'family': 'Medina', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Victor Antonio Monroy', 'family': 'Colin', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Arreola Guerra', 'family': 'Jose Manuel', 'sequence': 'additional', 'affiliation': []}], 'member': '246', 'reference': [ { 'key': '2021030909551226000_2021.03.04.21252084v1.1', 'unstructured': 'World Health Organization. Director-General’s remarks at the media ' 'briefing on 2019-nCoV on 11 February 2020. ' 'http://www.who.int/dg/speeches/detail/who-director-general-s-remarks-at-the-media-briefing-on-2019-ncov-on-11-february-2020 ' '(Accessed on january 24, 2021)'}, { 'key': '2021030909551226000_2021.03.04.21252084v1.2', 'doi-asserted-by': 'publisher', 'DOI': '10.1001/jama.2020.2648'}, { 'key': '2021030909551226000_2021.03.04.21252084v1.3', 'doi-asserted-by': 'crossref', 'first-page': '54', 'DOI': '10.1164/rccm.202006-2405OC', 'article-title': 'Case Fatality Rates for Patients with COVID-19 Requiring Invasive ' 'Mechanical Ventilation. A Meta-analysis', 'volume': '203', 'year': '2021', 'journal-title': 'Am J Respir Crit Care Med'}, { 'key': '2021030909551226000_2021.03.04.21252084v1.4', 'unstructured': 'La Secretaria de Salud. Información referente a casos COVID-19 en ' 'México. Gobierno de México: La Secretaría de Salud; 2020 [accessed 2020 ' 'Jul 1]. 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' 'Efficacy and safety of Ivermectin and Hydroxychloroquine in patients ' 'with severe COVID-19. 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Late treatment
is less effective
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