Mortality and associated risk factors in patients hospitalized due to COVID-19 in a Peruvian reference hospital
Alonso Soto, Dante M Quiñones-Laveriano, Johan Azañero, Rafael Chumpitaz, José Claros, Lucia Salazar, Oscar Rosales, Liz Nuñez, David Roca, Andres Alcantara
PLOS ONE, doi:10.1371/journal.pone.0264789
Objectives To determine the risk factors for in-hospital mortality in patients with COVID-19 from a Peruvian national hospital.
Methods Retrospective cohort study of medical records of patients with COVID-19 hospitalized at Hospital Nacional Hipo ´lito Unanue (HNHU) during the months of April to August 2020. The dependent variable was in-hospital mortality. Independent variables included sociodemographic and clinical characteristics, physical examination findings, oxygen saturation (SaO 2 ) at admission, treatment received during hospitalization and laboratory results at admission. A Cox regression model was used to evaluate the crude and adjusted hazard ratios for associated factors.
Results We included 1418 patients. Median age was 58 years (IQR 47-68 years) and 944 (66.6%) were male. The median length of hospitalization was 7 (4-13) days, and the mortality rate was 46%. The most frequent comorbidities were type 2 diabetes mellitus, hypertension, and obesity. In the adjusted analysis, mortality was associated with age (HR 1.02; 95%CI 1.02-1.03), history of surgery (HR 1.89;, lower oxygen saturation at admission (HR 4.08; CI95% 2.72-8.05 for SaO 2 <70% compared to SaO 2 >94%), the presence of poor general condition (HR 1.81; 95% CI 1.29-2.53), altered state of consciousness (HR 1.58;) and leukocyte levels (HR 1.01; 95%CI 1.00-1. 02). Treatment with ivermectin (HR 1.44; 95%CI 1.18-1.76) and azithromycin (HR 1.25; 95%CI 1.03-1.52) were associated with higher mortality. Treatment with corticosteroids at low to moderate doses was associated with lower mortality (HR 0.56 95%CI 0. 37-0. 86) in comparison to no steroid use.
Supporting information
S1 Data. (DTA)
Author Contributions Conceptualization: Alonso Soto, Dante M. Quiñones-Laveriano, Johan Azañero, Rafael Chumpitaz, Jose ´Claros, Lucia Salazar, Andres Alcantara. Data curation: Alonso Soto, Dante M. Quiñones-Laveriano, Rafael Chumpitaz, Jose ´Claros, Lucia Salazar, Oscar Rosales, Liz Nuñez, David Roca, Andres Alcantara. Formal analysis: Alonso Soto, Dante M. Quiñones-Laveriano, Johan Azañero. Investigation: Alonso Soto, Dante M. Quiñones-Laveriano, Johan Azañero, Rafael Chumpitaz, Jose ´Claros, Lucia Salazar, Oscar Rosales, Liz Nuñez, David Roca, Andres Alcantara. Methodology: Alonso Soto, Dante M. Quiñones-Laveriano. Software: Alonso Soto. Supervision: Alonso Soto. Validation: Alonso Soto. Visualization: Alonso Soto. Writing -original draft: Alonso Soto, Dante M. Quiñones-Laveriano. Writing -review & editing: Alonso Soto, Dante M. Quiñones-Laveriano, Johan Azañero, Rafael Chumpitaz, Jose ´Claros, Lucia Salazar, Oscar Rosales, Liz Nuñez, David Roca, Andres Alcantara.
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'abstract': '<jats:sec id="sec001">\n'
'<jats:title>Objectives</jats:title>\n'
'<jats:p>To determine the risk factors for in-hospital mortality in patients with COVID-19 '
'from a Peruvian national hospital.</jats:p>\n'
'</jats:sec>\n'
'<jats:sec id="sec002">\n'
'<jats:title>Methods</jats:title>\n'
'<jats:p>Retrospective cohort study of medical records of patients with COVID-19 hospitalized '
'at Hospital Nacional Hipólito Unanue (HNHU) during the months of April to August 2020. The '
'dependent variable was in-hospital mortality. Independent variables included sociodemographic '
'and clinical characteristics, physical examination findings, oxygen saturation '
'(SaO<jats:sub>2</jats:sub>) at admission, treatment received during hospitalization and '
'laboratory results at admission. A Cox regression model was used to evaluate the crude and '
'adjusted hazard ratios for associated factors.</jats:p>\n'
'</jats:sec>\n'
'<jats:sec id="sec003">\n'
'<jats:title>Results</jats:title>\n'
'<jats:p>We included 1418 patients. Median age was 58 years (IQR 47–68 years) and 944 (66.6%) '
'were male. The median length of hospitalization was 7 (4–13) days, and the mortality rate was '
'46%. The most frequent comorbidities were type 2 diabetes mellitus, hypertension, and '
'obesity. In the adjusted analysis, mortality was associated with age (HR 1.02; 95%CI '
'1.02–1.03), history of surgery (HR 1.89; 95%CI 1.31–2.74), lower oxygen saturation at '
'admission (HR 4.08; CI95% 2.72–8.05 for SaO<jats:sub>2</jats:sub><70% compared to '
'SaO<jats:sub>2</jats:sub>>94%), the presence of poor general condition (HR 1.81; 95% CI '
'1.29–2.53), altered state of consciousness (HR 1.58; 95%CI 1.18–2.11) and leukocyte levels '
'(HR 1.01; 95%CI 1.00–1. 02). Treatment with ivermectin (HR 1.44; 95%CI 1.18–1.76) and '
'azithromycin (HR 1.25; 95%CI 1.03–1.52) were associated with higher mortality. Treatment with '
'corticosteroids at low to moderate doses was associated with lower mortality (HR 0.56 95%CI '
'0. 37–0. 86) in comparison to no steroid use.</jats:p>\n'
'</jats:sec>\n'
'<jats:sec id="sec004">\n'
'<jats:title>Conclusion</jats:title>\n'
'<jats:p>A high mortality was found in our cohort. Low oxygen saturation at admission, age, '
'and the presence of hematological and biochemical alterations were associated with higher '
'mortality. The use of hydroxychloroquine, ivermectin or azithromycin was not useful and was '
'probably associated with unfavorable outcomes. The use of corticosteroids at moderate doses '
'was associated with lower mortality.</jats:p>\n'
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