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

{ 'institution': [{'name': 'medRxiv'}], 'indexed': {'date-parts': [[2022, 4, 1]], 'date-time': '2022-04-01T22:20:44Z', 'timestamp': 1648851644320}, 'posted': {'date-parts': [[2021, 3, 8]]}, 'group-title': 'Infectious Diseases (except HIV/AIDS)', 'reference-count': 32, 'publisher': 'Cold Spring Harbor Laboratory', 'content-domain': {'domain': [], 'crossmark-restriction': False}, 'accepted': {'date-parts': [[2021, 3, 8]]}, 'abstract': '<jats:title>ABSTRACT</jats:title><jats:sec><jats:title>BACKGROUND</jats:title><jats:p>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.</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. 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