medigraphic.com

2021, Número 2

Rev cubana med 2021; 60 (2)


Análisis de mortalidad y comorbilidad por Covid-19 en Cuba

León ÁJL, Calderón MM, Gutiérrez RAR

Idioma: Español
Referencias bibliográficas: 35
Paginas: 1-11
Archivo PDF: 335.46 Kb.


RESUMEN

Introducción: Las comorbilidades se han relacionado con mayor riesgo de contraer COVID-19, de tener mala evolución y de mortalidad.
Objetivo: Identificar factores de riesgo asociados a la mortalidad al final de la estadía hospitalaria de los pacientes con diagnóstico de COVID-19 en Cuba.
Métodos: Investigación retrospectiva, de la totalidad de pacientes confirmados con COVID-19 en Cuba, con 18 años o más, diagnosticados entre el 11 de marzo al 15 de octubre de 2020. La fuente de información fue la base de datos nacional del Ministerio de Salud Pública. Se recopilaron edad, sexo y comorbilidades. Clasificados en recuperados y fallecidos. Estudio analítico de factores y comorbilidades asociadas a la mortalidad.
Resultados: Se analizaron 5 490 pacientes (97,7 % recuperados vs 2,3 % fallecidos). Los fallecidos tenían significativamente más edad (72,8 vs 44,5 años). Las comorbilidades más frecuentes en fallecidos fueron hipertensión (47,6 % vs 7,8 %), diabetes (27,4 % vs 2,6 %), cardiopatía isquémica (14,5 % vs 0,9 %), enfermedad renal crónica (11,3 % vs 0,3 %) y EPOC (11,3 % vs 0,5 %). Se encontró riesgo independiente de mortalidad a la edad de 60 años o más (OR:10,090, IC 95 %: 6,247-16,299), enfermedad renal crónica (OR:8,434, IC 95 %: 3,400-20,919), cáncer (OR:7,169, IC 95 %: 2,920-17,601), enfermedad pulmonar obstructiva crónica (OR:5,300, IC95 %: 2,376-11,822), obesidad (OR:4,230, IC 95 %: 1,362-13,139), insuficiencia cardiaca (OR:4,197, IC 95 %: 1,085-16,244), diabetes (OR:2,360, IC 95 %: 1,339-4,159), hipertensión (OR:2,264, IC 95 %: 1,398-3,668) y cardiopatía isquémica (OR:2,321, IC 95 %: 1,168-4,610). Se encontró asociación significativa de comorbilidades, con dos, tres y más de tres (OR: 22,9, IC 95 %: 13,4-39.2), (OR:72,5, IC 95 %: 39,8-132,1) y (OR:88,9, IC 95 %: 36,2-217,8), respectivamente. La combinación de comorbilidades más frecuente entre los fallecidos fue: hipertensión con diabetes (17,7 % vs 1,9 %) e hipertensión con enfermedad renal crónica (8,1 % vs 0,2 %).
Conclusiones: La edad avanzada, la enfermedad renal crónica, cardiopatía isquémica, insuficiencia cardiaca, hipertensión, diabetes, cáncer, enfermedad pulmonar obstructiva crónica, obesidad y el número de comorbilidades se relacionaron significativamente con la mortalidad y podrían ayudar a identificar a los pacientes con mayor riesgo.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. 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;323(13):1239-42. https://doi.org//10.1001/jama.2020.2648

  2. Ministerio de Salud Pública. Protocolo de Actuación Nacional para la COVID-19 Versión 1.5; julio 2020[acceso: 02/11/2020]. Disponible en: https://covid19cubadata.github.io/protocols.html

  3. Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li Y, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 2020;55(5):2000547. https://doi.org//10.1183/13993003.00547-2020

  4. Kumar A, Arora A, Sharma P, Anikhindi SA, Bansal N, Singla V, et al. Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis. Diabetes Metab Syndr. 2020;14(4):535-45. https://doi.org//10.1016/j.dsx.2020.04.044

  5. Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5(7):802-10. https://doi.org//10.1001/jamacardio.2020.0950

  6. Wynants L, Van Calster B, Bonten M, Collins GS, Debray T, de Vos M, et al. Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal. BMJ. 2020;369:1328. http://dx.doi.org/10.1136/bmj

  7. Du RH, Liang LR, Yang CQ, Wang W, Cao TZ, Li M, et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J. 2020;55(5):2000524. https://di.org//10.1183/13993003.00524-2020

  8. Guan WJ, Zheng-Yi, Ni ZY, Hu Y, Liang WH, Ou CQ, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-20. https://doi.org//10.1056/NEJMoa2002032

  9. Meng Y, Wu P, Lu W, Liu K, Ma K, Huang L, et al. Sex-specific clinical characteristics and prognosis of coronavirus disease-19 infection in Wuhan, China: A retrospective study of 168 severe patients. PLoS Pathog. 2020;16(4):e1008520. https://doi.org//10.1371/journal.ppat.1008520

  10. Wang Y, Lu X, Li Y, Chen H, Chen T, Su N, et al. Clinical course and outcomes of 344 intensive care patients with COVID-19. Am J Respir Crit Care Med. 2020;201(11):1430-34. https://doi.org//10.1164/rccm.202003-0736LE

  11. Sisó-Almirall A, Kostov B, Mas-Heredia M, Vilanova-Rotllan S, Sequeira-Aymar E, Sans-Corrales M, et al. Prognostic factors in Spanish COVID-19 patients: A case series from Barcelona. PLoS One. 2020;15(8):e0237960. https://doi.org//10.1371/journal.pone.0237960

  12. Robert Koch Institute. Coronavirus Disease 2019 (COVID-19) Daily Situation. Report of the Robert Koch Institute. 2020[acceso: 05/11/2020]. Disponible en: https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/2020-04-19-en.pdf?__blob=publicationFile

  13. Goyal P, Choi JJ, Pinheiro LC, Schenck EJ, Chen R, Jabri A, et al. Clinical characteristics of Covid-19 in New York City. N Engl J Med. 2020;382(24):2372-74. https://doi.org//10.1056/NEJMc2010419

  14. Sorbello M, El-Boghdadly K, Di Giacinto I, Cataldo R, Esposito C, Falcetta S, et al. The Italian coronavirus disease 2019 outbreak: recommendations from clinical practice. Anaesthesia. 2020;75(6):724-32. https://doi.org//10.1111/anae.15049

  15. Baldi E, Sechi GM, Mare C, Canevari F, Brancaglione A, Primi R, et al. Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy. N Engl J Med. 2020;383(5):496-98. https://doi.org//10.1056/NEJMc2010418

  16. Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-81. https://doi.org//10.1001/jama.2020.5394

  17. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA. 2020;323(20):2052-59. https://doi.org//10.1001/jama.2020.6775

  18. Schiffrin EL, Flack J, Ito S, Muntner P, Webb C. Hypertension and COVID-19. Am J Hypertens. 2020;33(5):373-74. https://doi.org//10.1093/ajh/hpaa057

  19. Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, et al. COVID-19 and Cardiovascular Disease. Circulation. 2020;141(20):1648-55. https://doi.org//10.1161/CIRCULATIONAHA.120.046941

  20. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. https://doi.org//10.1016/S0140-6736(20)30566-3

  21. de Lusignan S, Dorward J, Correa A, Jones N, Akinyemi O, Amirthalingam G, et al. Risk factors for SARS-CoV-2 among patients in the Oxford Royal College of General Practitioners Research and Surveillance Centre primary care network: a cross-sectional study. Lancet Infect Dis. 2020;20(9):1034-42. https://doi.org//10.1016/S1473-3099(20)30371-6

  22. McMichael TM, Currie DW, Clark S, Pogosjans S, Kay M, Schwartz NG, et al. Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington. N Engl J Med. 2020;382(21):2005-11. https://doi.org//10.1056/NEJMoa2005412

  23. Young BE, Ong SWX, Kalimuddin S, Low JG, Tan SYT, Loh J, et al. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. JAMA. 2020;323(15):1488-94. https://doi.org//10.1001/jama.2020.3204

  24. Lian J, Jin X, Hao S, Cai H, Zhang S, Zheng L, et al. Analysis of epidemiological and clinical features in older patients with coronavirus disease 2019 (COVID-19) Outside Wuhan. Clin Infect Dis. 2020;71(15):740-47. https://doi.org//10.1093/cid/ciaa242

  25. Alqahtani JS, Oyelade T, Aldhahir AM, Alghamdi SM, Almehmadi M, Alqahtani AS, et al. Prevalence, severity and mortality associated with COPD and Smoking in patients with COVID-19: A Rapid Systematic Review and Meta-Analysis. PLoS One. 2020;15(5):e0233147. https://doi.org//10.1371/journal.pone.0233147

  26. Cheng VCC, Wong SC, Chen JHK, Yip CCY, Chuang VWM, Tsang OTY, et al. Escalating infection control response to the rapidly evolving epidemiology of the Coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in Hong Kong. Infect Control Hosp Epidemiol. 2020;41(5):493-98. https://doi.org//10.1017/ice.2020.58

  27. Gervasoni C, Meraviglia P, Riva A, Giacomelli A, Oreni L, Minisci D, et al. Clinical features and outcomes of HIV patients with coronavirus disease 2019. Clin Infect Dis. 2020. https://doi.org//10.1093/cid/ciaa579

  28. Härter G, Spinner CD, Roider J, Bickel M, Krznaric I, Grunwald S, et al. COVID-19 in people living with human immunodeficiency virus: a case series of 33 patients. Infection. 2020;48(5):681-86. https://doi.org//10.1007/s15010-020-01438-z

  29. Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020;368:m1091. https://doi.org//10.1136/bmj.m1091

  30. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-69. https://doi.org//10.1001/jama.2020.1585

  31. Kuderer NM, Choueiri TK, Shah DP, Shyr Y, Rubinstein SM, Rivera DR, et al. Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. Lancet. 2020;395(10241):1907-18. https://doi.org//10.1016/S0140-6736(20)31187-9

  32. Liang W, Guan W, Chen R, Wang W, Li J, Xu K, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21(3):335-37. https://doi.org//10.1016/S1470-2045(20)30096-6

  33. Xiong F, Tang H, Liu L, Tu C, Tian JB, Lei CT, et al. Clinical characteristics of and medical interventions for COVID-19 in hemodialysis patients in Wuhan, China. J Am Soc Nephrol. 2020;31(7):1387-97. https://doi.org//10.1681/ASN.2020030354

  34. Shi Y, Yu X, Zhao H, Wang H, Zhao R, Sheng J. Host susceptibility to severe COVID-19 and establishment of a host risk score: findings of 487 cases outside Wuhan. Crit Care. 2020;24(1):108. https://doi.org//10.1186/s13054-020-2833-7

  35. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. https://doi.org//10.1016/S0140-6736(20)30183-5




2020     |     www.medigraphic.com