Risk factors for mortality in hospitalized patients with COVID-19 from three hospitals in Peru: a retrospective cohort study.

BACKGROUND: Peru was one of the countries with the highest COVID-19 mortality worldwide during the first stage of the pandemic. It is then relevant to evaluate the risk factors for mortality in patients hospitalized for COVID-19 in three hospitals in Peru in 2020, from March to May, 2020.  Methods: We carried out a retrospective cohort study. The population consisted of patients from three Peruvian hospitals hospitalized for a diagnosis of COVID-19 during the March-May 2020 period. Independent sociodemographic variables, medical history, symptoms, vital functions, laboratory parameters and medical treatment were evaluated. In-hospital mortality was assessed as the outcome. We performed Cox regression models (crude and adjusted) to evaluate risk factors for in-hospital mortality. Hazard ratios (HR) with their respective 95% confidence intervals (95% CI) were calculated.  Results: We analyzed 493 hospitalized adults; 72.8% (n=359) were male and the mean age was 63.3 ± 14.4 years. COVID-19 symptoms appeared on average 7.9 ± 4.0 days before admission to the hospital, and the mean oxygen saturation on admission was 82.6 ± 13.8. While 67.6% (n=333) required intensive care unit admission, only 3.3% (n=16) were admitted to this unit, and 60.2% (n=297) of the sample died. In the adjusted regression analysis, it was found that being 60 years old or older (HR=1.57; 95% CI: 1.14-2.15), having two or more comorbidities (HR=1.53; 95% CI: 1.10-2.14), oxygen saturation between 85-80% (HR=2.52; 95% CI: 1.58-4.02), less than 80% (HR=4.59; 95% CI: 3.01-7.00), and being in the middle (HR=1.65; 95% CI: 1.15-2.39) and higher tertile (HR=2.18; 95% CI: 1.51-3.15) of the neutrophil-to-lymphocyte ratio, increased the risk of mortality.  Conclusions: The risk factors found agree with what has been described in the literature and allow the identification of vulnerable groups in whom monitoring and early identification of symptoms should be prioritized in order to reduce mortality.

Malaria grave, pielonefritis, sepsis, reacción leucemoide, abscesos hepáticos. A propósito de un caso clínico / Serious Malaria, pyelonephritis, sepsis, leucemoide reaction, liver abscesses. With regard to a clinical case

Caso problema de una paciente joven procedente de una zona endémica de malaria y una zona emergente de bartonellosis, que inicia un cuadro agudo de fiebre, ictericia y gran compromiso del estado general que la llevo al estado de shock séptico y por lo que fue atendida en este hospital. Durante su ingreso se plantearon patologías y diferentes entidades patológicas y que por prueba terapéutica se llegó al diagnóstico de malaria grave por Plasmodium falciparum. Presentó durante su evolución una serie de complicaciones tales como abscesos hepáticos y anemia severa, quedando por dilucidar si podría corresponder a un caso de bartonellosis.