medigraphic.com
ISSN 1561-302X (Print)

2021, Number 2

<< Back Next >>

Rev cubana med 2021; 60 (2)

Analysis of mortality and comorbidity due to covid-19 in Cuba

León ÁJL, Calderón MM, Gutiérrez RAR

Language: Spanish
References: 35
Page: 1-11
PDF size: 335.46 Kb.


ABSTRACT

Introduction: Comorbidities have been related to highrisk of contracting COVID-19, and of having poor evolution and mortality.
Objective: To identify risk factors associated with mortality at the end of the hospital stay in patients diagnosed with COVID-19 in Cuba.
Methods: A retrospective cohort of all patients confirmed COVID-19 in Cuba, aged 18 years or older, diagnosed from March 11 to October 15, 2020. The source of information was the national database of the Ministry of Public health. Age, sex and comorbidities were collected, and classified as recovered and deceased. This is an analytical study of factors and comorbidities associated with mortality.
Results: This study analyzed 5,490 patients (97.7% recovered vs 2.3% deceased). The deceased were significantly older (72.8 vs 44.5 years). The most frequent comorbidities in the deceased were hypertension (47.6% vs 7.8%), diabetes (27.4% vs 2.6%), ischemic heart disease (14.5% vs 0.9%), chronic kidney disease (11.3% vs 0.3%) and COPD (11.3% vs 0.5%). An independent risk of mortality was found at the age of 60 years or more (OR: 10,090, 95% CI: 6,247-16,299), chronic kidney disease (OR: 8,434, 95% CI: 3,400-20,919), cancer (OR: 7,169 , 95% CI: 2,920-17,601), chronic obstructive pulmonary disease (OR: 5,300, 95% CI: 2,376-11,822), obesity (OR: 4,230, 95% CI: 1,362-13,139), heart failure (OR: 4,197, CI 95%: 1,085-16,244), diabetes (OR: 2,360, 95% CI: 1,339-4,159), hypertension (OR: 2,264, 95% CI: 1,398-3,668) and ischemic heart disease (OR: 2,321, 95% CI: 1,168 -4,610). A significant association of comorbidities was found, with two, three and more than three (OR: 22.9, 95% CI: 13.4-39.2), (OR: 72.5, 95% CI: 39.8-132, 1) and (OR: 88.9, 95% CI: 36.2-217.8) respectively. The most frequent combination of comorbidities among the deceased subjects was hypertension with diabetes (17.7% vs 1.9%) and hypertension with chronic kidney disease (8.1% vs 0.2%).
Conclusions: Advanced age, chronic kidney disease, ischemic heart disease, heart failure, hypertension, diabetes, cancer, chronic obstructive pulmonary disease, obesity and the number of comorbidities were significantly related to mortality and could help to identify patients with higher risk.


REFERENCES

  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