Modeling mortality risk in patients with severe COVID-19 from Mexico

Abstract

BackgroundSevere acute respiratory syndrome caused by a coronavirus (SARS-CoV-2) is responsible for the COVID-19 disease pandemic that began in Wuhan, China, in December 2019. Since then, nearly seven million deaths have occurred worldwide due to COVID-19. Mexicans are especially vulnerable to the COVID-19 pandemic as Mexico has nearly the worst observed case-fatality ratio (4.5%). As Mexican Latinos represent a vulnerable population, this study aimed to determine significant predictors of mortality in Mexicans with COVID-19 who were admitted to a large acute care hospital.MethodsIn this observational, cross-sectional study, 247 adult patients were consecutively admitted to a third-level referral center in Yucatan, Mexico, from March 1st, 2020, to August 31st, 2020, with COVID-19-related symptoms, participated in this study. Lasso logistic and binary logistic regression were used to identify clinical predictors of death.ResultsAfter a hospital stay of about eight days, 146 (60%) patients were discharged; however, 40% died by the twelfth day (on average) after hospital admission. Out of 22 possible predictors, five crucial predictors of death were found, ranked by the most to least important: (1) needing to be placed on a mechanical ventilator, (2) reduced platelet concentration at admission, (3) increased derived neutrophil to lymphocyte ratio, (4) increased age, and (5) reduced pulse oximetry saturation at admission. The model revealed that these five variables shared ~83% variance in outcome.ConclusionOf the 247 Mexican Latinos patients admitted with COVID-19, 40% died 12 days after admission. The patients’ need for mechanical ventilation (due to severe illness) was the most important predictor of mortality, as it increased the odds of death by nearly 200-fold.

Commentary: Modeling mortality risk in patients with severe COVID-19 from Mexico

“…A further upward bias is expected due to the fact that odds are obtained by taking the exponentiation of the coefficients which leads to impossibly huge odds ( 5 ). Cortes-Telles et al ( 1 ) report the need for a mechanical ventilator equal to 193 (43 to 878) and the logarithm of platelets counts as 0.002 (0.0003 to 0.09) and the logarithm of dNLR as 14.1 (1.2 to 169.5) which are not reliable.…”

“…We meticulously read the paper by Cortes-Telles et al ( 1 ) that was published online in Frontiers in Medicine in May 2023. The study was conducted to determine significant predictors of mortality among hospital-admitted COVID-19 patients.…”

“…The study was conducted to determine significant predictors of mortality among hospital-admitted COVID-19 patients. Finally, they ranked the five crucial predictors of death as (1) need to a mechanical ventilator, (2) platelet concentration at admission, (3) increased derived neutrophil to lymphocyte ratio, (4) age and (5) pulse oximetry saturation respectively ( 1 ). Undoubtedly, their study makes a valuable contribution to the area, but some methodological issues need to be taken into account to avoid misinterpretation of the study's results.…”