Risk factors for COVID-19 and their association with mortality in Ecuadorian patients admitted to the ICU: A retrospective cohort multicentric study.

Several risk factors were associated with mortality in patients with coronavirus disease 2019 (COVID-19) infection in intensive care units (ICU). We assessed the effect of risk factors related to the characteristics and clinical history of the population, laboratory test results, drug management, and type of ventilation on the probability of survival/discharge from the ICU. A retrospective cohort multicentric study of adults with COVID-19 admitted to the ICU between March 2020 and December 2021. Data were collected from 6 hospitals in 5 cities in Ecuador. The primary outcome was ICU survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Of those admitted to the ICU with COVID-19, (n = 991), mean age was 56.76 ±â€…13.14, and 65.9% were male. Regarding the primary outcome, 51.1% (n = 506) died and 48.9% (n = 485) survived. Of the group that died, their mean age was higher than the survivors (60.7 vs 52.60 years, respectively), and they had a higher prevalence of comorbidities such as arterial hypertension (37.2% vs 20.4%, respectively) and diabetes mellitus (26.9% vs 15.7%, respectively), with P < .001. In ventilatory management, 32.7% of patients used noninvasive ventilation and high-flow nasal cannula, and 67.3% required invasive ventilatory support. After adjusting for confounders, Cox regression analysis showed that patients were less likely to be discharged alive from the ICU if they met the following conditions: arterial hypertension (hazard ratio [HR] = 0.83 95% CI 0.723-0.964), diabetes mellitus (HR = 0.80 95% CI 0.696-0.938), older than 62 years (HR = 0.86 95% CI 0.790-0.956), obese (body mass index ≥ 30) (HR = 0.78 95% CI 0.697-0.887), 1 unit increase in SOFA score (HR = 0.94 95% CI 0.937-0.961), PaO2/FiO2 ratio <100 mm Hg (HR = 0.84 95% CI 0.786-0.914), and the use of invasive mechanical ventilation (HR = 0.68 95% CI 0.614-0.769). Risk factors associated with increased mortality were older age, obesity, arterial hypertension, and diabetes. Factors such as male gender, chronic obstructive pulmonary disease, acute kidney injury, and cancer reported in other investigations did not have the same effect on mortality in our study.

Effect of High Altitude on the Survival of COVID-19 Patients in Intensive Care Unit: A Cohort Study.

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.

Valoraciones entorno al riesgo financiero en las medianas empresas de la Provincia de Manabí / Assessments about financial risk in the medium-sized companies of Manabí / Valorações meio ao risco financeiro nas médias empresas da Província de Manabí

Resumen Introducción: El riesgo financiero en las empresas es uno de los problemas científicos de relevancia, que preocupan a: empresarios, gerentes, emprendedores, entre otros. La sostenibilidad y eficiencia de las empresas, en especial de las medianas empresas, depende, en gran medida, del sistema financiero que adopten. Evaluar la probabilidad de riesgo, adquiere una gran relevancia. La presente investigación realizada en la provincia de Manabí, tiene como objetivo analizar la necesidad de la introducción del análisis del riesgo en el financiamiento de las medianas empresas (Me). Para el desarrollo de la investigación se utilizaron materiales y métodos, entre los que se puede mencionar: el análisis de documentos, el método hipotético deductivo, el método comparativo, la abstracción científica, el análisis de documentos y el método hermenéutico. En calidad de resultados fundamentales de la investigación se pueden citar: la determinación de las fuentes de financiamientos para la Me, el perfeccionamiento de la definición de riesgo financiero y las sugerencias para un uso racional de los recursos financieros y para obtención de crédito. Conclusión. Se caracterizó la mediana empresa de la provincia, determinando así las vías de financiamientos para las mismas.

Abstract Introduction: Financial risk in companies is one of the relevant scientific problems, which concern: entrepreneurs, managers, entrepreneurs, among others. The sustainability and efficiency of companies, especially medium-sized companies, depends to a large extent on the financial system they adopt. Assess the probability of risk, acquires great relevance. The present investigation carried out in the province of Manabí, has like objective analyze the necessity of the introduction of the analysis of the risk in the financing of the medium companies (Me). For the development of the research materials and methods were used, among which we can mention: the analysis of documents, the deductive hypothetical method, the comparative method, scientific abstraction, the analysis of documents and the hermeneutical method. The following are fundamental results of the research: the identification of financing sources for the Me, the improvement of the definition of financial risk and the suggestions for a rational use of financial resources and for obtaining credit. Conclusion. The medium-sized company of the province was characterized, thus determining the means of financing for them.

Resumo Introdução: O risco financeiro nas empresas é um dos problemas científicos relevantes, que dizem respeito a: empresários, gestores, empresários, entre outros. A sustentabilidade e a eficiência das empresas, especialmente as médias empresas, dependem em grande medida do sistema financeiro que adotam. Avalie a probabilidade de risco, adquira grande relevância. A presente investigação realizada na província de Manabí, tem como objetivo analisar a necessidade da introdução da análise do risco no financiamento das médias empresas (Me). Para o desenvolvimento dos materiais e métodos de pesquisa foram utilizados, dentre os quais podemos citar: a análise de documentos, o método hipotético-dedutivo, o método comparativo, a abstração científica, a análise de documentos e o método hermenêutico. A seguir, são apresentados os resultados fundamentais da pesquisa: a identificação de fontes de financiamento para o eu, o aprimoramento da definição de risco financeiro e as sugestões para o uso racional dos recursos financeiros e para obtenção de crédito. Conclusão A empresa de tamanho médio da província foi caracterizada, determinando assim os meios de financiamento para eles.