Clinical characteristics, systemic complications, and in-hospital outcomes for patients with COVID-19 in Latin America. LIVEN-Covid-19 study: A prospective, multicenter, multinational, cohort study

Abstract

Purpose The COVID-19 pandemic has spread worldwide, and almost 396 million people have been infected around the globe. Latin American countries have been deeply affected, and there is a lack of data in this regard. This study aims to identify the clinical characteristics, in-hospital outcomes, and factors associated with ICU admission due to COVID-19. Furthermore, to describe the functional status of patients at hospital discharge after the acute episode of COVID-19. Material and methods This was a prospective, multicenter, multinational observational cohort study of subjects admitted to 22 hospitals within Latin America. Data were collected prospectively. Descriptive statistics were used to characterize patients, and multivariate regression was carried out to identify factors associated with severe COVID-19. Results A total of 3008 patients were included in the study. A total of 64.3% of patients had severe COVID-19 and were admitted to the ICU. Patients admitted to the ICU had a higher mean (SD) 4C score (10 [3] vs. 7 [3)], p<0.001). The risk factors independently associated with progression to ICU admission were age, shortness of breath, and obesity. In-hospital mortality was 24.1%, whereas the ICU mortality rate was 35.1%. Most patients had equal self-care ability at discharge 43.8%; however, ICU patients had worse self-care ability at hospital discharge (25.7% [497/1934] vs. 3.7% [40/1074], p<0.001). Conclusions This study confirms that patients with SARS CoV-2 in the Latin American population had a lower mortality rate than previously reported. Systemic complications are frequent in patients admitted to the ICU due to COVID-19, as previously described in high-income countries.

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

“…These results highlight that fatality rates and treatments changed during the pandemic and differed for each country. Moreover, these data align with our results, showing that IMV was frequently used in LMIC and that many patients with severe COVID-19 were treated outside of ICU [ 8 , 26 ]. Notably, the impact of ICU admission on clinical outcomes was already explored in our cohort and published elsewhere [ 3 ].…”

“…Its most severe presentation is acute respiratory distress syndrome (ARDS), secondary to pneumonia [ 4 – 6 ]. Most critically ill patients with COVID-19 receive advanced respiratory support, defined as high-flow nasal cannula (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV) [ 3 , 7 , 8 ]. Up to 30% of hospitalised patients with COVID-19 are treated with one of these interventions [ 9 , 10 ]; however, the use and need for support have changed over time depending on COVID-19 vaccination coverage, circulating viral variants, an evolving treatment evidence base and practice variation [ 11 , 12 ].…”

The effects of biological sex and cardiovascular disease on COVID-19 mortality

“…Our data show that the proportion of COVID-19 in women was 35.41%, which is slightly smaller than those reported for women in the general Mexican population with 42% according to reported studies ( 16 – 18 ). Hospitalized Latin American patients show similar proportions of women as shown herein ( 19 – 22 ). These findings are significant as sex-specific COVID-19 outcomes are not well established and remain poorly understood, in part because of the scarcity of sex-disaggregated reports.…”

Predicting Intensive Care Unit Admission for COVID-19 Patients from Laboratory Results

“…Comorbidities, such as hypertension and diabetes, have been reported previously to affect the severity of the disease and the prognosis of COVID-19 patients [ 14 , 26 – 28 ]. Several mechanisms have been discussed for the effect of hypertension, one of which is related to distribution of ACE2 enzyme/receptor, expressed in different tissues, such as lung alveolar epithelial cells, cardiovascular, arterial smooth muscle, arterial and venous endothelial cells, and enterocytes of the small intestine [ 29 ].…”