Abrir sesión | Regístrese | ¿Olvidó su contraseña? | Contacto | English |
Email: Clave:

Medwave se preocupa por su privacidad y la seguridad de sus datos personales.
Para poder enviarle a su dirección de correo electrónico su contraseña, es necesario que ingrese su e-mail.


Estudios originales
Medwave 2020;20(10):e8066 doi: 10.5867/medwave.2020.10.8066
Pronóstico de pacientes hospitalizados por COVID-19 en un centro terciario en Chile: estudio de cohorte
Prognosis of patients with COVID-19 admitted to a tertiary center in Chile: A cohort study
Miguel Araujo, Paola Ossandón, Ana María Abarca, Ana María Menjiba, Ana María Muñoz
Referencias | Descargar PDF |
Para Descargar PDF debe Abrir sesión.
Imprimir | A(+) A(-) | Lectura fácil

Palabras clave: coronavirus infections, severe acute respiratory syndrome, prognosis, biomarkers, cohort studies, mortality

Abstract

Introduction
Since the beginning of the COVID-19 pandemic, extensive research has been done on the prognosis of patients with SARS-CoV-2 associated with age, biodemographic conditions, comorbidities, social factors, clinical parameters, inflammatory blood markers, coagulation, biochemical and blood gas parameters, among others. Few studies have addressed this problem in Latin America, so it is of interest to know how the disease plays out in this region.

Objective
The purpose of our study is to evaluate the course of COVID-19 in patients admitted to a tertiary center in Chile and to assess factors measured close to hospital admission that may be associated with death and the need for invasive mechanical ventilation.

Methods
We did a retrospective cohort study at Indisa Clinic in Santiago, Chile. We included all patients aged 15 years and older hospitalized between March 11 and July 25, 2020. Hospital mortality and severity of the cases were analyzed, and logistic regression models were applied to identify predictors of outcome variables.

Results
The sample included 785 subjects. The mean age was 59 years, 59% were men, and 61.3% had comorbidities. Forty five per cent required intensive care, and 24% invasive mechanical ventilation. The overall hospital fatality rate was 18.7%. In intensive care patients, the case fatality was 32.1%, and in those who received invasive mechanical ventilation, it was 59.4%. Independent risk factors for death included age (odds ratio 1.09; 95% confidence interval: 1.07 to 1.12), diabetes (1.68; 1.06 to 2.67), chronic lung disease (2.80; 1.48 to 5.28), increased C-reactive protein, creatinine, and ferritin. No association with sex, public health insurance, history of heart disease, oxygen saturation upon admission, or D-dimer was found. Similar factors were predictors of invasive mechanical ventilation.

Discussion
The prognosis and predictive factors in this cohort of patients hospitalized in Chile for COVID-19 were comparable to those reported in similar studies from higher-income countries. Male sex was not associated with a poor prognosis in this group of patients.


 

No English version is available for this article.

Licencia Creative Commons Esta obra de Medwave está bajo una licencia Creative Commons Atribución-NoComercial 3.0 Unported. Esta licencia permite el uso, distribución y reproducción del artículo en cualquier medio, siempre y cuando se otorgue el crédito correspondiente al autor del artículo y al medio en que se publica, en este caso, Medwave.

 

Introduction
Since the beginning of the COVID-19 pandemic, extensive research has been done on the prognosis of patients with SARS-CoV-2 associated with age, biodemographic conditions, comorbidities, social factors, clinical parameters, inflammatory blood markers, coagulation, biochemical and blood gas parameters, among others. Few studies have addressed this problem in Latin America, so it is of interest to know how the disease plays out in this region.

Objective
The purpose of our study is to evaluate the course of COVID-19 in patients admitted to a tertiary center in Chile and to assess factors measured close to hospital admission that may be associated with death and the need for invasive mechanical ventilation.

Methods
We did a retrospective cohort study at Indisa Clinic in Santiago, Chile. We included all patients aged 15 years and older hospitalized between March 11 and July 25, 2020. Hospital mortality and severity of the cases were analyzed, and logistic regression models were applied to identify predictors of outcome variables.

Results
The sample included 785 subjects. The mean age was 59 years, 59% were men, and 61.3% had comorbidities. Forty five per cent required intensive care, and 24% invasive mechanical ventilation. The overall hospital fatality rate was 18.7%. In intensive care patients, the case fatality was 32.1%, and in those who received invasive mechanical ventilation, it was 59.4%. Independent risk factors for death included age (odds ratio 1.09; 95% confidence interval: 1.07 to 1.12), diabetes (1.68; 1.06 to 2.67), chronic lung disease (2.80; 1.48 to 5.28), increased C-reactive protein, creatinine, and ferritin. No association with sex, public health insurance, history of heart disease, oxygen saturation upon admission, or D-dimer was found. Similar factors were predictors of invasive mechanical ventilation.

Discussion
The prognosis and predictive factors in this cohort of patients hospitalized in Chile for COVID-19 were comparable to those reported in similar studies from higher-income countries. Male sex was not associated with a poor prognosis in this group of patients.

Autores: Miguel Araujo[1], Paola Ossandón[1], Ana María Abarca[1], Ana María Menjiba[1], Ana María Muñoz[1]

Filiación:
[1] Dirección de Calidad, Clínica Indisa, Santiago, Chile

E-mail: miguel.araujo@indisa.cl

Correspondencia a:
[1] Santa María 1810, Providencia,
Santiago, Chile
7520440

Citación: Araujo M, Ossandón P, Abarca AM, Menjiba AM, Muñoz AM. Prognosis of patients with COVID-19 admitted to a tertiary center in Chile: A cohort study. Medwave 2020;20(10):e8066 doi: 10.5867/medwave.2020.10.8066

Fecha de envío: 29/8/2020

Fecha de aceptación: 3/11/2020

Fecha de publicación: 17/11/2020

Origen: No solicitado

Tipo de revisión: Con revisión por pares externa, por tres árbitros a doble ciego

Comentarios (0)

Nos complace que usted tenga interés en comentar uno de nuestros artículos. Su comentario será publicado inmediatamente. No obstante, Medwave se reserva el derecho a eliminarlo posteriormente si la dirección editorial considera que su comentario es: ofensivo en algún sentido, irrelevante, trivial, contiene errores de lenguaje, contiene arengas políticas, obedece a fines comerciales, contiene datos de alguna persona en particular, o sugiere cambios en el manejo de pacientes que no hayan sido publicados previamente en alguna revista con revisión por pares.

Aún no hay comentarios en este artículo.


Para comentar debe iniciar sesión

Medwave publica las vistas HTML y descargas PDF por artículo, junto con otras métricas de redes sociales.

Se puede producir un retraso de 48 horas en la actualización de las estadísticas.

  1. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-1062. | CrossRef | PubMed |
  2. Chen R, Liang W, Jiang M, Guan W, Zhan C, Wang T, et al. Risk Factors of Fatal Outcome in Hospitalized Subjects With Coronavirus Disease 2019 From a Nationwide Analysis in China. Chest. 2020 Jul;158(1):97-105. | CrossRef | PubMed |
  3. Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ. 2020 May 22;369:m1985. | CrossRef | PubMed |
  4. Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G, et al. Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy. JAMA Intern Med. 2020 Oct 1;180(10):1345-1355. | CrossRef | PubMed |
  5. Petrilli CM, Jones SA, Yang J, Rajagopalan H, O'Donnell L, Chernyak Y, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020 May 22;369:m1966. | CrossRef | PubMed |
  6. Robbins-Juarez SY, Qian L, King KL, Stevens JS, Husain SA, Radhakrishnan J, et al. Outcomes for Patients With COVID-19 and Acute Kidney Injury: A Systematic Review and Meta-Analysis. Kidney Int Rep. 2020 Jun 25;5(8):1149-1160. | CrossRef | PubMed |
  7. Parohan M, Yaghoubi S, Seraji A, Javanbakht MH, Sarraf P, Djalali M. Risk factors for mortality in patients with Coronavirus disease 2019 (COVID-19) infection: a systematic review and meta-analysis of observational studies. Aging Male. 2020 Jun 8:1-9. | CrossRef | PubMed |
  8. Henry BM, de Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med. 2020 Jun 25;58(7):1021-1028. | CrossRef | PubMed |
  9. Huang I, Pranata R, Lim MA, Oehadian A, Alisjahbana B. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta- analysis. Ther Adv Respir Dis. 2020 Jan-Dec;14:1753466620937175. | CrossRef | PubMed |
  10. Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HHX, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect. 2020 Jul;81(1):e6-e12. | CrossRef | PubMed |
  11. Liang W, Liang H, Ou L, Chen B, Chen A, Li C, et al. Development and Validation of a Clinical Risk Score to Predict the Occurrence of Critical Illness in Hospitalized Patients With COVID-19. JAMA Intern Med. 2020 Aug 1;180(8):1081-1089. | CrossRef | PubMed |
  12. McRae MP, Simmons GW, Christodoulides NJ, Lu Z, Kang SK, Fenyo D, et al. Clinical decision support tool and rapid point-of-care platform for determining disease severity in patients with COVID-19. Lab Chip. 2020 Jun 21;20(12):2075-2085. | CrossRef | PubMed |
  13. Shen B, Yi X, Sun Y, Bi X, Du J, Zhang C, et al. Proteomic and Metabolomic Characterization of COVID-19 Patient Sera. Cell. 2020 Jul 9;182(1):59-72.e15. | CrossRef | PubMed |
  14. Galbadage T, Peterson BM, Awada J, Buck AS, Ramirez DA, Wilson J, Gunasekera RS. Systematic Review and Meta-Analysis of Sex-Specific COVID-19 Clinical Outcomes. Front Med (Lausanne). 2020 Jun 23;7:348. | CrossRef | PubMed |
  15. Tamara A, Tahapary DL. Obesity as a predictor for a poor prognosis of COVID-19: A systematic review. Diabetes Metab Syndr. 2020 Jul-Aug;14(4):655-659. | CrossRef | PubMed |
  16. Benites-Goñi H, Vargas-Carrillo E, Peña-Monge E, Taype-Rondan A, Arróspide-Mormontoy D, Castillo-Córdova M, et al. Clinical characteristics, management and mortality of patients hospitalized with COVID-19 in a reference hospital in Lima, Peru. 2020. | Link |
  17. Nunes B, Souza ASd, Nogueira J, Andrade F, Thumé E, Teixeira D, et al. Envelhecimento, multimorbidade e risco para COVID-19 grave: ELSI-Brasil . 2020. | Link |
  18. Marín-Sánchez A. Características clínicas básicas en los primeros 100 casos fatales de COVID-19 en Colombia [Basic clinical characteristics in the first 100 fatal cases of COVID-19 in Colombia]. Rev Panam Salud Publica. 2020 Jul 31;44:e87. Spanish. | CrossRef | PubMed |
  19. Sociedad Chilena de Radiología. Capítulo de Tórax toma como modelo propuesta elaborada por la RSNA, STR y la ACR en informes Covid19, para sugerir formato de informe. 2020. [On line] | Link |
  20. Bao C, Tao X, Cui W, Yi B, Pan T, Young KH, et al. SARS-CoV-2 induced thrombocytopenia as an important biomarker significantly correlated with abnormal coagulation function, increased intravascular blood clot risk and mortality in COVID-19 patients. Exp Hematol Oncol. 2020 Jul 17;9:16. | CrossRef | PubMed |
  21. Amgalan A, Othman M. Hemostatic laboratory derangements in COVID-19 with a focus on platelet count. Platelets. 2020 Aug 17;31(6):740-745. | CrossRef | PubMed |
  22. Yang X, Yang Q, Wang Y, Wu Y, Xu J, Yu Y, et al. Thrombocytopenia and its association with mortality in patients with COVID-19. J Thromb Haemost. 2020 Jun;18(6):1469-1472. | CrossRef | PubMed |
  23. Vargas-Vargas M, Cortés-Rojo C. Ferritin levels and COVID-19. Rev Panam Salud Publica. 2020 Jun 1;44:e72. | CrossRef | PubMed |
  24. Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996 Dec;49(12):1373-9. | CrossRef | PubMed |
  25. Potempa LA, Rajab IM, Hart PC, Bordon J, Fernandez-Botran R. Insights into the Use of C-Reactive Protein as a Diagnostic Index of Disease Severity in COVID-19 Infections. Am J Trop Med Hyg. 2020 Aug;103(2):561-563. | CrossRef | PubMed |
  26. Altman DG, Lausen B, Sauerbrei W, Schumacher M. Dangers of using "optimal" cutpoints in the evaluation of prognostic factors. J Natl Cancer Inst. 1994 Jun 1;86(11):829-35. | CrossRef | PubMed |
  27. Austin PC, Brunner LJ. Inflation of the type I error rate when a continuous confounding variable is categorized in logistic regression analyses. Stat Med. 2004 Apr 15;23(7):1159-78. | CrossRef | PubMed |
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-1062. | CrossRef | PubMed |

Chen R, Liang W, Jiang M, Guan W, Zhan C, Wang T, et al. Risk Factors of Fatal Outcome in Hospitalized Subjects With Coronavirus Disease 2019 From a Nationwide Analysis in China. Chest. 2020 Jul;158(1):97-105. | CrossRef | PubMed |

Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ. 2020 May 22;369:m1985. | CrossRef | PubMed |

Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G, et al. Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy. JAMA Intern Med. 2020 Oct 1;180(10):1345-1355. | CrossRef | PubMed |

Petrilli CM, Jones SA, Yang J, Rajagopalan H, O'Donnell L, Chernyak Y, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020 May 22;369:m1966. | CrossRef | PubMed |

Robbins-Juarez SY, Qian L, King KL, Stevens JS, Husain SA, Radhakrishnan J, et al. Outcomes for Patients With COVID-19 and Acute Kidney Injury: A Systematic Review and Meta-Analysis. Kidney Int Rep. 2020 Jun 25;5(8):1149-1160. | CrossRef | PubMed |

Parohan M, Yaghoubi S, Seraji A, Javanbakht MH, Sarraf P, Djalali M. Risk factors for mortality in patients with Coronavirus disease 2019 (COVID-19) infection: a systematic review and meta-analysis of observational studies. Aging Male. 2020 Jun 8:1-9. | CrossRef | PubMed |

Henry BM, de Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med. 2020 Jun 25;58(7):1021-1028. | CrossRef | PubMed |

Huang I, Pranata R, Lim MA, Oehadian A, Alisjahbana B. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta- analysis. Ther Adv Respir Dis. 2020 Jan-Dec;14:1753466620937175. | CrossRef | PubMed |

Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HHX, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect. 2020 Jul;81(1):e6-e12. | CrossRef | PubMed |

Liang W, Liang H, Ou L, Chen B, Chen A, Li C, et al. Development and Validation of a Clinical Risk Score to Predict the Occurrence of Critical Illness in Hospitalized Patients With COVID-19. JAMA Intern Med. 2020 Aug 1;180(8):1081-1089. | CrossRef | PubMed |

McRae MP, Simmons GW, Christodoulides NJ, Lu Z, Kang SK, Fenyo D, et al. Clinical decision support tool and rapid point-of-care platform for determining disease severity in patients with COVID-19. Lab Chip. 2020 Jun 21;20(12):2075-2085. | CrossRef | PubMed |

Shen B, Yi X, Sun Y, Bi X, Du J, Zhang C, et al. Proteomic and Metabolomic Characterization of COVID-19 Patient Sera. Cell. 2020 Jul 9;182(1):59-72.e15. | CrossRef | PubMed |

Galbadage T, Peterson BM, Awada J, Buck AS, Ramirez DA, Wilson J, Gunasekera RS. Systematic Review and Meta-Analysis of Sex-Specific COVID-19 Clinical Outcomes. Front Med (Lausanne). 2020 Jun 23;7:348. | CrossRef | PubMed |

Tamara A, Tahapary DL. Obesity as a predictor for a poor prognosis of COVID-19: A systematic review. Diabetes Metab Syndr. 2020 Jul-Aug;14(4):655-659. | CrossRef | PubMed |

Benites-Goñi H, Vargas-Carrillo E, Peña-Monge E, Taype-Rondan A, Arróspide-Mormontoy D, Castillo-Córdova M, et al. Clinical characteristics, management and mortality of patients hospitalized with COVID-19 in a reference hospital in Lima, Peru. 2020. | Link |

Nunes B, Souza ASd, Nogueira J, Andrade F, Thumé E, Teixeira D, et al. Envelhecimento, multimorbidade e risco para COVID-19 grave: ELSI-Brasil . 2020. | Link |

Marín-Sánchez A. Características clínicas básicas en los primeros 100 casos fatales de COVID-19 en Colombia [Basic clinical characteristics in the first 100 fatal cases of COVID-19 in Colombia]. Rev Panam Salud Publica. 2020 Jul 31;44:e87. Spanish. | CrossRef | PubMed |

Sociedad Chilena de Radiología. Capítulo de Tórax toma como modelo propuesta elaborada por la RSNA, STR y la ACR en informes Covid19, para sugerir formato de informe. 2020. [On line] | Link |

Bao C, Tao X, Cui W, Yi B, Pan T, Young KH, et al. SARS-CoV-2 induced thrombocytopenia as an important biomarker significantly correlated with abnormal coagulation function, increased intravascular blood clot risk and mortality in COVID-19 patients. Exp Hematol Oncol. 2020 Jul 17;9:16. | CrossRef | PubMed |

Amgalan A, Othman M. Hemostatic laboratory derangements in COVID-19 with a focus on platelet count. Platelets. 2020 Aug 17;31(6):740-745. | CrossRef | PubMed |

Yang X, Yang Q, Wang Y, Wu Y, Xu J, Yu Y, et al. Thrombocytopenia and its association with mortality in patients with COVID-19. J Thromb Haemost. 2020 Jun;18(6):1469-1472. | CrossRef | PubMed |

Vargas-Vargas M, Cortés-Rojo C. Ferritin levels and COVID-19. Rev Panam Salud Publica. 2020 Jun 1;44:e72. | CrossRef | PubMed |

Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996 Dec;49(12):1373-9. | CrossRef | PubMed |

Potempa LA, Rajab IM, Hart PC, Bordon J, Fernandez-Botran R. Insights into the Use of C-Reactive Protein as a Diagnostic Index of Disease Severity in COVID-19 Infections. Am J Trop Med Hyg. 2020 Aug;103(2):561-563. | CrossRef | PubMed |

Altman DG, Lausen B, Sauerbrei W, Schumacher M. Dangers of using "optimal" cutpoints in the evaluation of prognostic factors. J Natl Cancer Inst. 1994 Jun 1;86(11):829-35. | CrossRef | PubMed |

Austin PC, Brunner LJ. Inflation of the type I error rate when a continuous confounding variable is categorized in logistic regression analyses. Stat Med. 2004 Apr 15;23(7):1159-78. | CrossRef | PubMed |