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Clinical and Demographic Characteristics on Admission and Their Prognostic Value at Discharge in 529 Consecutive COVID-19 Patients in Santiago, Chile
Clinical Medicine Research
Volume 10, Issue 1, January 2021, Pages: 1-8
Received: Dec. 13, 2020; Accepted: Dec. 28, 2020; Published: Jan. 4, 2021
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Authors
Cesar Maquilon Ortiz, Department of Pulmonary Diseases, Clinica Davila, Santiago, Chile
Jonas Alberto Gongora, Adult Intensive Care Unit, Clinica Davila, Santiago, Chile
Monica Antolini Toledo, Department of Pulmonary Diseases, Clinica Davila, Santiago, Chile
Nicolas Fernando Valdes, Department of Epidemiology, School of Nurse and Midwifery, Universidad de los Andes, Santiago, Chile
Angela Benavente, School of Medicine, Universidad de los Andes, Santiago, Chile
Maria Gabriela Bofill, School of Medicine, Universidad de los Andes, Santiago, Chile
Macarena Urra, School of Medicine, Universidad de los Andes, Santiago, Chile
Diego Rojas Carvajal, School of Medicine, Universidad de los Andes, Santiago, Chile
Javiera Huidobro Navarro, School of Medicine, Universidad de los Andes, Santiago, Chile
Bernardita Alvarado Breton, Department of Medical Management, Clinica Davila, Santiago, Chile
Maria Carolina Asenjo, Department of Medical Management, Clinica Davila, Santiago, Chile
Cherie Gutierrez Rojas, Department of Medical Management, Clinica Davila, Santiago, Chile
Jose Gajardo, Adult Intensive Care Unit, Clinica Davila, Santiago, Chile
Patricia Cisternas, Department of Surgery, Surgical Pavilions, Clinica Davila, Santiago, Chile
Guillermo Garcia, Emergency Service, Clinica Davila, Santiago, Chile
Juan Pablo Peralta, Adult Intensive Care Unit, Clinica Davila, Santiago, Chile
Lenny Loor Garcia, Adult Intensive Care Unit, Clinica Davila, Santiago, Chile
Annelise Sepulveda, Adult Intensive Care Unit, Clinica Davila, Santiago, Chile
Cecilia Tapia, Laboratory Service, Molecular Biology Section, Santiago, Chile
Luis Fernando Mallea, Pediatric Intensive Care Unit, Clinica Davila, Santiago, Chile
Felipe Rivera, Department of Pulmonary Diseases, Clinica Davila, Santiago, Chile
Ezio Parodi, Ethics Committee, Clinica Davila, Santiago, Chile
Jyh Kae Nien, Department of Medical Management, Clinica Davila, Santiago, Chile
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Abstract
On June 04, 2020, Chile had 113,628 cases COVID-19, 1275 deaths, 1450 patients were on invasive mechanical ventilation (IMV). The objective was describing the characteristics on admission and their relationship with the condition at discharge of patients with positive real-time polymerase chain reaction test for SARS CoV-2 (RT-PCR) in a tertiary health center. Methods: Retrospective and observational cohort study of 529 consecutive patients with positive RT-PCR for SARS CoV-2, discharged between March 14 and June 4, 2020 from Clinica Davila, Santiago. Demographic data, laboratory tests, Quality Adjusted Life Years (QALY), medical insurance, ventilatory assistance, and discharge condition were collected. Differences were evaluated by chi-square test, student’s t test, or Mann–Whitney U test. Logistic regression analysis was performed to identify variables that were predictive of condition at discharge. Results: A total of 529 patients were included (median age, 49 years [interquartile range {IQR}, 37-62; range, 0-97 years]; 45% women). The most common comorbidities were hypertension (171, 32.3%) and diabetes mellitus (98, 18.5%), On admission 352 patients (66.5%) had respiratory symptoms and 177 (33.4%) had other symptoms or other diagnoses. The median (IQR) PaO2 / FiO2 on admission of survivors, non-survivors and transferred were 316 (261-360), 167 (80-268) and 212 (130-261) respectively. At discharge, 448 (84.7%) were survivors, 54 (10.2%) non-survivors, and 27 (5.1%) were transferred to other centers. Median age of survivors and non-survivors was 46 (36-59) and 75.5 (66-84) years. Of the 116 patients (21,9%) who received support ventilation, 67 were discharged alive (57.8%), 28 died (24%), and 21 (18%) were transferred to another hospital. The variables associated with risk of death were: age ≥ 60 years (OR 15.3; 95% CI: 7.25–32.2; P = 0.001); QALY score ≤ 15 points (OR 14.01; 95% CI: 4.82 -40.67; P = 0.001); state health insurance (OR, 2.82; 95% CI: 1.38–5.77; P = 0.004); PaO2 / FiO2 on admission ≤ 200 (OR 5.2; 95% CI: 1.94-13.94; P = 0.001) and high sensitivity T Troponin ≥ 15 ng / L (OR 5.16; 95% CI: 1.95-13.64; P = 0.001). Conclusions: this cohort showed that on admission COVID-19 patients, the PaO2 / FiO2, creatinine and high sensitivity T troponin at the described cut-off points had prognostic value. At discharge, the non-survivors were the older, most often had state health insurance and their QALY scores were significantly lower.
Keywords
Coronavirus Infections, Quality Adjusted Life Years, Health Insurance, Pcr Sars CoV2, Prognostic Factors, COVID-19
To cite this article
Cesar Maquilon Ortiz, Jonas Alberto Gongora, Monica Antolini Toledo, Nicolas Fernando Valdes, Angela Benavente, Maria Gabriela Bofill, Macarena Urra, Diego Rojas Carvajal, Javiera Huidobro Navarro, Bernardita Alvarado Breton, Maria Carolina Asenjo, Cherie Gutierrez Rojas, Jose Gajardo, Patricia Cisternas, Guillermo Garcia, Juan Pablo Peralta, Lenny Loor Garcia, Annelise Sepulveda, Cecilia Tapia, Luis Fernando Mallea, Felipe Rivera, Ezio Parodi, Jyh Kae Nien, Clinical and Demographic Characteristics on Admission and Their Prognostic Value at Discharge in 529 Consecutive COVID-19 Patients in Santiago, Chile, Clinical Medicine Research. Vol. 10, No. 1, 2021, pp. 1-8. doi: 10.11648/j.cmr.20211001.11
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Copyright © 2021 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
[1]
https://www.diariooficial.interior.gob.cl/publicaciones/2020/06/04/42672/01/1769770.pdf
[2]
https://www.diariooficial.interior.gob.cl/publicaciones/2020/06/04/42672/01/1769770.pdf Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020, http://dx.doi.org/10.1001/jama.2020.2648 [Epub ahead of print].
[3]
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020, http://dx.doi.org/10.1056/NEJMoa2002032 [Epub ahead of print].
[4]
Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020; 8 (5): 475–81.
[5]
WMA – The World Medical Association- Declaration of Helsinki – Ethical principles for Medical Research involving Human Subjects [Internet]. [cited 2020 Jul 13]. Available from: https://www.wma.net/es/policies-post/declaracion-de-helsinki-de-la-amm-principios-eticos-para-las-investigaciones-medicas-en-seres-humanos/.
[6]
Technical guidance [Internet]. [cited 2020 Jul 13]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/ technical guidance.
[7]
Ingreso al sistema - SADEPI [Internet]. [cited 2020 Jul 13]. Available from: https://epivigila.minsal.cl/
[8]
Quality-Adjusted life years and the devaluation of life with Disability: Part of the bioethics and disability series, National Council on Disability, November 6, 2019. www.ncd.gov.
[9]
Haomiao Jia, Erica I. Lubetkin, John P. Barile, Willi Horner-Johnson, Kimberly DeMichele, Debra S. Stark, Matthew M. Zack, William W. Thompson. Quality-adjusted Life Years (QALY) for 15 Chronic Conditions and Combinations of Conditions Among US Adults Aged 65 and Older. Medical Care 2018; 56 (8): 740-746.
[10]
Alvis N, Valenzuela M. T., Los QALYs y DALYs como indicadores sintéticos de salud. Rev Med Chile 2010; 138 (Supl 2): 83-87.
[11]
www.ine.cl > poblacion > esperanza de vida.
[12]
Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. JAMA 2020 Apr 6; 323 (16): 1574-1581. Doi: 10.1001/jama.2020.5394. Online ahead of print.
[13]
Gupta S, Hayek S, Wang W, Chan L, Mathews K, Melamed M, et al. Factors Associated with Death in Critically III Patients with Coronavirus Disease 2019 in the US. JAMA Intern Med. 2020 Jul 15; e203596. Doi: 10.1001/jamaintermed.2020.3596.
[14]
Correspondence. Clinical Characteristics of COVID-19 in New York City. N Engl J Med 382; 24.
[15]
Richardson S, Hirsch J, Narasimhan M, Crawford J, McGinn T, Davidson K, Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized Witch COVID-19 in the New York City Area. 2020; 323 (20): 2052-2059.
[16]
Winck JC, Ambrosino N. COVID-19 pandemic and non-invasive respiratory management: Every Goliath needs a David. An evidence-based evaluation of problems. Pulmonology. 2020; 26 (4): 213–20
[17]
Gattinoni L, Chiumello D, Caironi P, et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med. 2020; 46 (6): 1099–102.
[18]
Charlson ME, Pompei P, Ales KL, MacKenzie CR.: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40 (5): 373-383.
[19]
Shi, S.; Qin, M.; Shen, B.; Cai, Y.; Liu, T.; Yang, F.; Gong, W.; Liu, X.; Liang, J.; Zhao, Q.; et al. Association of Cardiac Injury with Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol. 2020, 5, 802.
[20]
Lala, A.; Johnson, K. W.; Januzzi, J. L.; Russak, A. J.; Paranjpe, I.; Richter, F.; Zhao, S.; Somani, S.; Van Vleck, T.; Vaid, A.; et al. Prevalence and Impact of Myocardial Injury in Patients Hospitalized With COVID-19 Infection. J. Am. Coll. Cardiol. 2020, 76, 533–546.
[21]
Schiavone M, Gasperetti A, Mancone M, Kaplan A, Gobbi C, Mascioli G, Busana N, Saguner A, Mitacchione G, Giacomelli A, Sardella G, Viecca M, Duru F, Antonori S, Carugo S, Bartorelli A, Tondo C, Galli M, Fedele F and Forleo G B. Redefining the Prognostic Value of High-Sensitivity Trponin in COVID-19 Patients: The importance of Concomitant Coronary Artery Disease. J. Clin. Med. 2020, 9, 3263.
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