Comparison of the clinical characteristics and mortality in ARDS due to COVID-19 versus ARDS due to Influenza A-H1N1pdm09 (preprint)

Importance Infection with the SARS-Cov-2 and Influenza A-H1N1 viruses is responsible for the first pandemics of the 21st century. Both of these viruses can cause severe pneumonia and acute respiratory distress syndrome (ARDS). The clinical differences and mortality associated with these two pandemic pneumonias in patients with ARDS are not well established Objective To compare case-fatality between ARDS-Covid-19 and ARDS-Influenza A (H1N1), adjusting for known prognostic risk factors. Design, Setting and Participants One hundred forty-seven patients with COVID-19 were compared with 94 with Influenza A-H1N1, all of these were admitted to the intensive care unit of the Referral Center for Respiratory Diseases and COVID-19 in Mexico City and fulfilled the criteria of ARDS. Results Patients arrived at the hospital after 9 days of symptoms. Influenza patients had more obesity, more use of Norepinephrine, and higher levels of lactic dehydrogenase and glucose, and fewer platelets and lower PaO 2 /FIO 2 . Crude mortality was higher in COVID than in influenza (39% vs. 22%; p = 0.005). In a Cox proportional hazard model, patients with a diagnosis of COVID-19 had a hazard ratio (HR) = 3.7; 95% Confidence Interval [CI] = 1.9-7.4, adjusted for age, gender, sequential organ failure assessment (SOFA) score, ventilatory ratio, and prone ventilation. In the fully adjusted model, the ventilatory ratio and the absence of prone-position ventilation were also predictors of mortality. CONCLUSION COVID-19 patients treated in an intensive care unit (ICU) had a 3.7 times higher risk of death than similar patients with Influenza A-H1N1, after adjusting for SOFA score and other relevant risk factors for mortality. Question Is the mortality of ARDS associated with Covid-19 greater than that of ARDS associated to influenza H1N1? Findings In a Cox proportional hazard model, patients with a diagnosis of COVID-19 had a hazard ratio (HR) = 3.7; 95% Confidence Interval [CI] = 1.9-7.4, adjusted for age, gender, sequential organ failure assessment (SOFA) score. Meaning COVID-19 patients treated in an intensive care unit (ICU) had a 3.7 times higher risk of death than similar patients with Influenza A-H1N1

HYDROXYCHLOROQUINE FOR THE TREATMENT OF SEVERE RESPIRATORY INFECTION BY COVID-19: A RANDOMIZED CONTROLLED TRIAL (preprint)

The novel coronavirus pandemic (COVID 19) represents a major public health problem due to its rapid spread and its ability to generate severe pneumonia. Thus, it is essential to find a treatment that reduces mortality. Our objective was to estimate whether treatment with 400 mg/day of Hydroxychloroquine for 10 days reduces in-hospital mortality in subjects with severe respiratory disease due to COVID 19 compared with placebo. Material and methods: A double-blind, randomized, placebo-controlled trial to evaluate the safety and efficacy of Hydroxychloroquine for the treatment of severe disease by COVID 19 through an intention-to-treat analysis. Eligible for the study were adults aged more than 18 years with COVID-19 confirmed by RT-PCR and lung injury requiring hospitalization with or without mechanical ventilation. Primary outcome was 30-day mortality. Secondary outcomes: days of mechanical ventilation, days of hospitalization and cumulative incidence of serious adverse events. Results: A total of 214 patients with COVID 19 were recruited, randomized and analyzed. They were hypoxemic with a mean SpO2 of 65%{+/-}20, tachycardic (pulse rate 108{+/-}17 min 1) and tachypneic (32{+/-}10 min 1); 162 were under mechanical ventilation at randomization. Thirty-day mortality was similar in both groups (38% in Hydroxychloroquine vs. 41% in placebo, hazard ratio [HR] 0.88, 95% Confidence Interval [95%CI] 0.51 1.53). In the surviving participants, no significant difference was found in secondary outcomes. Conclusion: No beneficial effect or significant harm could be demonstrated in our randomized controlled trial including 214 patients, using relatively low doses of Hydroxychloroquine compared with placebo in hospitalized patients with severe COVID 19.

Clinical Risk Factors for Mortality Among Critically ill Mexican Patients With COVID-19 (preprint)

BackgroundLittle literature exists about the experience with critically ill COVID-19 patients from Latin America, despite this is the current epicenter of the pandemic. Here, we aimed to describe the clinical characteristics and risk factors for mortality in mechanically-ventilated COVID-19 patients from Mexico.  MethodsClinical data from sixty-seven consecutive, mechanically-ventilated COVID-19 patients were analyzed. Patients were grouped according to their clinical outcome (survival vs. death). Clinical risk factors for mortality were identified by machine-learning algorithms and traditional regression analyses. ResultsThe median age of study participants was 42 years and 65% were men. The most common comorbidity observed in our study was obesity (49.2%). Fever was the most frequent symptom of illness (88%), followed by dyspnea (84%), and cough (62%). Multilobe ground-glass opacities were observed in 76% of patients by thoracic CT scan. Fifty-two percent of study participants were ventilated in prone position, and 59% required cardiovascular support with norepinephrine. Furthermore, 49% of participants had a coinfection with a second pathogen. Two-thirds of COVID-19 patients developed acute kidney injury (AKIN). Thirty deaths occurred during the study (44.7%). Levels of uric acid, creatinine, bilirubin, and SOFA score, were significantly higher among deceased patients, whereas survivors showed higher PaO2/FiO2 values at admission. AKIN, uric acid, LDH, and a longitudinal increase in ventilatory ratio were associated with mortality. Baseline PaO2/FiO2 values and a longitudinal recovery of lymphocytes were protective factors against mortality.ConclusionsOur study provides reference data about the clinical phenotype and risk factors for COVID-19-assocaited mortality among mechanically-ventilated Mexican patients.

Clinical characteristics and outcomes of patients with COVID-19 and ARDS admitted to a third level health institution in Mexico City (preprint)

Abstract Background: In December 2019, the first cases of severe pneumonia associated with a new coronavirus were reported in Wuhan, China. Severe respiratory failure requiring intensive care was reported in up to 5% of cases. There is, however, limited information available in Mexico. Objectives: The purpose of this study was to describe the clinical manifestations, and outcomes in a COVID-19 cohort attended to from March to May 2020 in our RICU. In addition, we explored the association of clinical variables with mortality. Methods: The first consecutive patients admitted to the RICU from March 3, 2020, to Jun 24, 2020, with confirmed COVID-19 were investigated. Clinical and laboratory data were obtained. Odds ratios (ORs) were calculated using a logistic regression model. The survival endpoint was mortality at discharge from the RICU. Results: Data from 68 consecutive patients were analyzed. Thirty-eight patients survived, and 30 died (mortality: 44.1 %). Of the 16 predictive variables analyzed, only 6 remained significant in the multivariate analysis [OR (95% confidence interval)]: no acute kidney injury (AKI)/AKI 1: [.61 (.001;.192)]; delta lymphocyte count: [.061 (.006;.619)]; delta ventilatory ratio: [8.19 (1.40;47.8)]; norepinephrine support at admission: [34.3 (2.1;550)]; body mass index: [1.41 (1.09;1.83)]; and bacterial coinfection: [18.5 (1.4;232)]. Conclusions: We report the characteristics and outcome of patients with ARDS and COVID-19. We found six independent factors associated with the mortality risk: delta lymphocyte count, delta ventilatory ratio, BMI, norepinephrine support, no AKI/AKI 1, and bacterial coinfection .