Romero RS, Muralla SLI, Cerón DUW

Language: Spanish
References: 7
Page: 228-232
PDF size: 330.56 Kb.

ABSTRACT

Introduction: in the Intensive Care Unit, mortality is the primary clinical outcome and increases with age, although its behavior is not homogeneous across different age groups. In Mexico, there are few publications evaluating the relationship between age and mortality in critically ill patients across different epidemiological periods, such as those observed during the COVID-19 pandemic. Objective: to analyze the association between age and hospital mortality in patients admitted to a private intensive care unit in Mexico during the pre-pandemic, pandemic, and post-pandemic periods of COVID-19. Material and methods: this retrospective cohort study included 2,238 critically ill patients, stratified into twelve groups according to two criteria: age (adults: 18-64 years, young elderly: 65-74 years, elderly: 75-84 years, and oldest old: ≥ 85 years) and three time periods (pre-pandemic: 2018-2019, n = 715; pandemic: 2020-2021, n = 883; post-pandemic: 2022-2023, n = 640). For each group, mortality was adjusted using the standardized mortality ratio (SMR), with the SAPS-3 model as a predictor of expected mortality. Ninety-five percent confidence intervals were calculated to determine whether observed mortality differed significantly from expected mortality. Results: across all periods, no SMR was significantly greater than 1, indicating that observed hospital mortality never exceeded expected mortality. In the pre-pandemic period, the SMR was 0.69 [0.58-0.80], significantly lower than 1, reflecting mortality below the estimated rate. During the pandemic, the SMR increased to 0.94 [0.82-1.05], with no significant difference from 1, suggesting mortality was not different to the expected value. In the post-pandemic period, the SMR declined again to 0.74 [0.63-0.85], remaining significantly lower than 1. Conclusions: although hospital mortality during the pandemic did not differ from expected mortality, it contrasted with the significantly lower mortality observed in the pre- and post-pandemic periods. These findings are consistent with global reports on the impact of the pandemic on the effectiveness of healthcare systems.

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