ABSTRACT
BackgroundSince its molecular isolation on January 7, 2020, the novel coronavirus SARS-CoV-2 has spread rapidly, taking governments worldwide off-guard. The virus arrived in low and middle-income countries violently, especially in Latin America. Ecuador received the worst outbreak in the world if we count excess mortality per capita. Although one study has reported the epidemiological impact of COVID-19 in Ecuador, there is no clinical course or outcome data among intensive care patients with COVID-19 in Ecuador. This study describes the clinical, epidemiological, and therapeutical features of 89 patients hospitalized in a secondary-level hospital in Quito, Ecuador.MethodsWe did a retrospective cohort study. We collected health records data from adult patients with severe COVID-19 admitted to the intensive care unit (ICU) in Quito, Ecuador, during the first five months of the SARS-CoV-2 outbreak in Ecuador. All patients had a confirmed SARS-CoV-2 RNA infection diagnostic, a positive real-time RT-PCR, and pulmonary imaging suggesting COVID-19. We used the Chi-square test or a Fisher's exact statistic to analyze risk and associations between survivors and non-survivors due to COVID-19. We used the ROC curve analysis to predict mortality, determining cut-off points for the parameters related to mechanical, analytical, and cytometry ventilation. At the multivariate level, we used the Wald test to evaluate model categorical predictors during the regression analysis.Results89 patients with COVID-19 were recruited during the study. The average age of the patients was 54.72 years. Man represented 68.54% (n = 61) and women 31,46% (n = 28). Significant differences were observed in terms of mortality (men 40.98% vs. women 17.76%). Serological parameters demonstrated that LDH and IL-6 at 24 hours were higher among non-survivors when compared with survivors. Persistent hypercapnia ( > > 45 mmHg), a PaFiO2 ratio of less than 140 mmHg, and a positive end-expiratory pressure (PEEP) titration greater than nine mmHg were also associated with higher mortality.ConclusionsIncreased levels of LDH at 24 hours, IL-6, the lymphocyte and platelet count at 48 hours, the neutrophil count at 48 hours, and the INL are factors associated with higher motility, increased risk of failed extubation and reintubation
Subject(s)
COVID-19ABSTRACT
BackgroundSince its molecular isolation on January 7, 2020, the novel coronavirus SARS-CoV-2 has spread rapidly, taking governments worldwide off-guard. The virus arrived in low and middle-income countries violently, especially in Latin America. Ecuador received the worst outbreak in the world if we count excess mortality per capita. Although one study has reported the epidemiological impact of COVID-19 in Ecuador, there is no clinical course or outcome data among intensive care patients with COVID-19 in Ecuador. This study describes the clinical, epidemiological, and therapeutical features of 89 patients hospitalized in a secondary-level hospital in Quito, Ecuador.MethodsWe did a retrospective cohort study. We collected health records data from adult patients with severe COVID-19 admitted to the intensive care unit (ICU) in Quito, Ecuador, during the first five months of the SARS-CoV-2 outbreak in Ecuador. All patients had a confirmed SARS-CoV-2 RNA infection diagnostic, a positive real-time RT-PCR, and pulmonary imaging suggesting COVID-19. We used the Chi-square test or a Fisher's exact statistic to analyze risk and associations between survivors and non-survivors due to COVID-19. We used the ROC curve analysis to predict mortality, determining cut-off points for the parameters related to mechanical, analytical, and cytometry ventilation. At the multivariate level, we used the Wald test to evaluate model categorical predictors during the regression analysis.Results89 patients with COVID-19 were recruited during the study. The average age of the patients was 54.72 years. Man represented 68.54% (n = 61) and women 31,46% (n = 28). Significant differences were observed in terms of mortality (men 40.98% vs. women 17.76%). Serological parameters demonstrated that LDH and IL-6 at 24 hours were higher among non-survivors when compared with survivors. Persistent hypercapnia ( > > 45 mmHg), a PaFiO2 ratio of less than 140 mmHg, and a positive end-expiratory pressure (PEEP) titration greater than nine mmHg were also associated with higher mortality.ConclusionsIncreased levels of LDH at 24 hours, IL-6, the lymphocyte and platelet count at 48 hours, the neutrophil count at 48 hours, and the INL are factors associated with higher motility, increased risk of failed extubation and reintubation
Subject(s)
COVID-19 , HypercapniaABSTRACT
Background: The SARS-CoV-2 virus has spread rapidly around the globe. Nevertheless, there is limited information describing the characteristics and outcomes of COVID-19 patients in Latin America. Methods: We conducted a cross-sectional analysis of 9,468 confirmed COVID-19 cases reported in Ecuador. We calculated overall incidence, mortality, case fatality rates, disability adjusted life years, attack and crude mortality rates, as well as relative risk and relative odds of death, adjusted for age, sex and presence of comorbidities. Results: A total of 9,468 positive COVID-19 cases and 474 deaths were included in the analysis. Men accounted for 55.4% (n = 5, 247) of cases and women for 44.6% (n = 4, 221). We found the presence of comorbidities, being male and older than 65 years were important determinants of mortality. Coastal regions were most affected by COVID-19, with higher mortality rates than the highlands. Fatigue was reported in 53.2% of the patients, followed by headache (43%), dry cough (41.7%), ageusia (37.1%) and anosmia (36.1%). Conclusion: We present the first analysis of the burden of COVID-19 in Ecuador. Our findings show that men are at higher risk of dying from COVID-19 than women, and risk increases with age and the presence of comorbidities. We also found that blue-collar workers and the unemployed are at greater risk of dying. These early observations offer clinical insights for the medical community to help improve patient care and for public health officials to strengthen Ecuador s response to the outbreak. Keywords: COVID-19; SARS-CoV-2; Ecuador; Epidemiology; Latin America