Factores asociados a mortalidad en pacientes hospitalizados con COVID-19: cohorte prospectiva en un hospital de referencia nacional de Perú / Factors associated with mortality in patients hospitalized with COVID-19: a prospective cohort in a Peruvian national referral hospital

Objetivos Describir las características clínicas y evaluar los factores asociados con la mortalidad de los pacientes adultos con la nueva enfermedad causada por coronavirus 2019 (COVID-19) ingresados a un hospital de referencia nacional de Perú. Métodos Se realizó un estudio de cohorte prospectivo. Se incluyó a pacientes mayores de 18 años hospitalizados con el diagnóstico de infección por coronavirus 2 del síndrome respiratorio agudo severo (SARS-CoV-2). Se excluyó a quienes ingresaron con prueba rápida serológica positiva al ingreso, sin clínica sugestiva ni imágenes compatibles. Los datos se recolectaron a partir de la historia clínica. Resultados Se incluyó un total de 813 adultos, 544 (66,9%) tuvieron COVID-19 confirmado. La media de la edad fue de 61,2 años (desviación estándar: 15) y 575 (70,5%) fueron de sexo masculino. Las comorbilidades más frecuentes fueron hipertensión arterial (34,1%) y obesidad (25,9%). Los síntomas más frecuentes al ingreso fueron disnea (82,2%) y tos (53,9%). Un total de 114 (14%) pacientes recibieron ventilación mecánica, 38 (4,7%) ingresaron a unidad de cuidados intensivos y 377 (46,4%) fallecieron. Se asociaron a la mortalidad el requerimiento de soporte ventilatorio, el mayor compromiso pulmonar y los marcadores inflamatorios. Encontramos que por cada 10 años que aumentó la edad, el riesgo de morir se incrementó en 32% (riesgo relativo: 1,32; intervalo de confianza 95%: 1,25 a 1,38). Aquellos pacientes que requirieron ingreso a unidad de cuidados intensivos y ventilación mecánica tuvieron 1,39 (intervalo de confianza 95%: 1,13 a 1,69) y 1,97 (intervalo de confianza 95%: 1,69 a 2,29) veces el riesgo de morir, respectivamente. Conclusión La mortalidad encontrada en nuestro estudio fue alta y estuvo asociada a la edad, marcadores inflamatorios y compromiso respiratorio.

Objectives To describe and assess clinical characteristics and factors associated with mortality in adult patients with COVID-19 admitted to a national referral hospital in Peru. Methods We conducted a prospective cohort study that included hospitalized patients older than 18 years with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection diagnosis. Patients with a positive rapid serological test on admission but no respiratory symptoms nor compatible images were excluded. We collected the data from clinical records. Results A total of 813 adults were included, 544 (66.9%) with confirmed COVID-19. The mean age was 61.2 years (standard deviation: 15.0), and 575 (70.5%) were male. The most frequent comorbidities were hypertension (34.1%) and obesity (25.9%). On admission, the most frequent symptoms were dyspnea (82.2%) and cough (53.9%). A total of 114 (14.0%) patients received mechanical ventilation, 38 (4.7%) were admitted to the intensive care unit, and 377 (46.4%) died. The requirement for ventilatory support, greater lung involvement, and inflammatory markers were associated with higher mortality. It was found that for every 10-year age increase, the risk of dying increased 32% (relative risk: 1.32; 95% confidence interval: 1.25 to 1.38). Those who were admitted to the intensive care unit and and were placed on mechanical ventilation had 1.39 (95% confidence interval: 1.13 to 1.69) and 1.97 (95% confidence interval: 1.69 to 2.29) times the risk of dying compared to those who did not, respectively. Conclusion We found a high mortality rate among hospitalized patients associated with older age, higher inflammatory markers, and greater lung involvement.

Clinical and Radiological Characteristics of 2009 H1N1 Influenza Associated Pneumonia in Young Male Adults

PURPOSE: Pneumonia was an important cause of death in 2009 H1N1 influenza pandemic (pH1N1). Clinical characteristics of pH1N1 have been described well, but discriminative characteristics suggesting pH1N1 infection in pneumonia patients are not evident today. We evaluated differences between clinical and radiologic characteristics for those associated and not associated with pH1N1 influenza during the pandemic period. MATERIALS AND METHODS: We reviewed all patients with pneumonia who visited the Armed Forces Capital Hospital between July 2009 and February 2010. During this period, all pneumonia patients were tested for pH1N1 by reverse transcription-polymerase chain reaction (RT-PCR) using nasopharyngeal specimens. RESULTS: In total, 98 patients with pneumonia were enrolled. Their median age was 20 years and all patients were males. Forty-nine (50%) of patients had pH1N1 infection and the others (50%) had negative results in pH1N1 RT-PCR. Patients with pH1N1 infection complained of dyspnea more commonly (83.3% vs. 29.0%; p<0.001), had higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores [5 (range, 0-12) vs. 3 (range, 0-11); p<0.01], fewer days of prehospital illness [2 (range, 0-10) vs. 4 (range, 0-14); p=0.001], and a higher chance of bilateral infiltrates on chest X-ray (CXR) (67.3% vs. 14.3%; p<0.001) and ground-glass opacity (GGO) lesions on computed tomography (CT; 48.9% vs. 22.0%; p<0.001) than patients without pH1N1 infection. CONCLUSION: Dyspnea, bilateral infiltrates on CXR, and GGO on CT were dominant features in pH1N1-associated pneumonia. Understanding these characteristics can help selection of patients who require prompt antiviral therapy.