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Effect of High Altitude on the Survival of COVID-19 Patients in Intensive Care Unit: A Cohort Study.
Jibaja, Manuel; Roldan-Vasquez, Estefania; Rello, Jordi; Shen, Hua; Maldonado, Nelson; Grunauer, Michelle; Díaz, Ana María; García, Fernanda; Ramírez, Vanessa; Sánchez, Hernán; Barberán, José Luis; Paredes, Juan Pablo; Cevallos, Mónica; Montenegro, Francisco; Puertas, Soraya; Briones, Killen; Martínez, Marlon; Vélez-Páez, Jorge; Montalvo-Villagómez, Mario; Herrera, Luis; Garrido, Santiago; Sisa, Ivan.
  • Jibaja M; Escuela de Medicina, Universidad Internacional del Ecuador UIDE, Quito, Ecuador.
  • Roldan-Vasquez E; Unidad de Cuidados Intensivos, 279710Hospital de Especialidades Eugenio Espejo, Quito, Ecuador.
  • Rello J; 27902Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador.
  • Shen H; Vall d'Hebrón Institute of Research (VHIR), Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
  • Maldonado N; CHRU Nîmes, Nîmes, France.
  • Grunauer M; Department of Mathematics and Statistics, 2129University of Calgary, Calgary, Alberta, Canada.
  • Díaz AM; 27902Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador.
  • García F; 27902Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Escuela de Medicina, Quito, Ecuador.
  • Ramírez V; Unidad de Cuidados Intensivos, 279710Hospital de Especialidades Eugenio Espejo, Quito, Ecuador.
  • Sánchez H; Unidad de Cuidados Intensivos, 279710Hospital de Especialidades Eugenio Espejo, Quito, Ecuador.
  • Barberán JL; Unidad de Cuidados Intensivos, 279710Hospital de Especialidades Eugenio Espejo, Quito, Ecuador.
  • Paredes JP; Unidad de Cuidados Intensivos, 279710Hospital de Especialidades Eugenio Espejo, Quito, Ecuador.
  • Cevallos M; Unidad de Cuidados Intensivos, Hospital de Especialidades, Portoviejo, Ecuador.
  • Montenegro F; Unidad de Cuidados Intensivos, Hospital de Especialidades, Portoviejo, Ecuador.
  • Puertas S; Unidad de Cuidados Intensivos, Hospital de Especialidades, Portoviejo, Ecuador.
  • Briones K; Unidad de Cuidados Intensivos, Hospital de Especialidades José Carrasco Arteaga, Cuenca, Ecuador.
  • Martínez M; Unidad de Cuidados Intensivos, Hospital de Especialidades José Carrasco Arteaga, Cuenca, Ecuador.
  • Vélez-Páez J; Unidad de Cuidados Intensivos, Hospital del IESS, Babahoyo, Ecuador.
  • Montalvo-Villagómez M; Unidad de Cuidados Intensivos, Hospital del IESS, Babahoyo, Ecuador.
  • Herrera L; Unidad de Cuidados Intensivos, Hospital General Pablo Arturo Suárez, Quito, Ecuador.
  • Garrido S; Unidad de Cuidados Intensivos, Hospital General Pablo Arturo Suárez, Quito, Ecuador.
  • Sisa I; Unidad de Cuidados Intensivos, Hospital del IESS, Ibarra, Ecuador.
J Intensive Care Med ; 37(9): 1265-1273, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1833014
ABSTRACT

Purpose:

The effect of high altitude ( ≥ 1500 m) and its potential association with mortality by COVID-19 remains controversial. We assessed the effect of high altitude on the survival/discharge of COVID-19 patients requiring intensive care unit (ICU) admission for mechanical ventilation compared to individuals treated at sea level.

Methods:

A retrospective cohort multi-center study of consecutive adults patients with a positive RT-PCR test for COVID-19 who were mechanically ventilated between March and November 2020. Data were collected from two sea-level hospitals and four high-altitude hospitals in Ecuador. The primary outcome was ICU and hospital survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models.

Results:

Of the study population (n = 670), 35.2% were female with a mean age of 58.3 ± 12.6 years. On admission, high-altitude patients were more likely to be younger (57.2 vs. 60.5 years old), presented with less comorbidities such as hypertension (25.9% vs. 54.9% with p-value <.001) and diabetes mellitus (20.5% vs. 37.2% with p-value <.001), less probability of having a capillary refill time > 3 sec (13.7% vs. 30.1%, p-value <.001), and less severity-of-illness condition (APACHE II score, 17.5 ± 8.1 vs. 20 ± 8.2, p < .01). After adjusting for key confounders high altitude is associated with significant higher probabilities of ICU survival/discharge (HR 1.74 [95% CI 1.46-2.08]) and hospital survival/discharge (HR 1.35 [95% CI 1.18-1.55]) than patients treated at sea level.

Conclusions:

Patients treated at high altitude at any time point during the study period were 74% more likely to experience ICU survival/discharge and 35% more likely to experience hospital survival/discharge than to the sea-level group. Possible reasons for these findings are genetic and physiological adaptations due to exposure to chronic hypoxia.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: J Intensive Care Med Journal subject: Critical Care Year: 2022 Document Type: Article Affiliation country: 08850666221099827

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: J Intensive Care Med Journal subject: Critical Care Year: 2022 Document Type: Article Affiliation country: 08850666221099827