Hernández-Cárdenas Carmen M, Choreño-Parra José Alberto, Torruco-Sotelo Carlos, Jurado Felipe, Serna-Secundino Héctor, Aguilar Cristina, García-Olazarán José G, Hernández-García Diana, Choreño-Parra Eduardo M, Zúñiga Joaquín, Lugo-Goytia Gustavo
Respiratory Intensive Care Unit, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
Front Med (Lausanne). 2021 Aug 27;8:699607. doi: 10.3389/fmed.2021.699607. eCollection 2021.
Little literature exists about critically ill patients with coronavirus disease 2019 (COVID-19) from Latin America. Here, we aimed to describe the clinical characteristics and mortality risk factors in mechanically ventilated COVID-19 patients from Mexico. For this purpose, we recruited 67 consecutive mechanically ventilated COVID-19 patients which were grouped according to their clinical outcome (survival vs. death). Clinical risk factors for mortality were identified by machine-learning and logistic regression models. The median age of participants was 42 years and 65% were men. The most common comorbidity observed was obesity (49.2%). Fever was the most frequent symptom of illness (88%), followed by dyspnea (84%). Multilobe ground-glass opacities were observed in 76% of patients by thoracic computed tomography (CT) scan. Fifty-two percent of study participants were ventilated in prone position, and 59% required cardiovascular support with norepinephrine. Furthermore, 49% of participants were coinfected with a second pathogen. Two-thirds of COVID-19 patients developed acute kidney injury (AKIN). The mortality of our cohort was 44.7%. AKIN, uric acid, lactate dehydrogenase (LDH), and a longitudinal increase in the ventilatory ratio were associated with mortality. Baseline PaO2/FiO2 values and a longitudinal recovery of lymphocytes were protective factors against mortality. Our study provides reference data about the clinical phenotype and risk factors for mortality in mechanically ventilated Mexican patients with COVID-19.
关于拉丁美洲2019冠状病毒病（COVID-19）危重症患者的文献较少。在此，我们旨在描述墨西哥接受机械通气的COVID-19患者的临床特征和死亡风险因素。为此，我们连续招募了67例接受机械通气的COVID-19患者，并根据其临床结局（存活与死亡）进行分组。通过机器学习和逻辑回归模型确定死亡的临床风险因素。参与者的中位年龄为42岁，65%为男性。观察到的最常见合并症是肥胖（49.2%）。发热是最常见的症状（88%），其次是呼吸困难（84%）。76%的患者通过胸部计算机断层扫描（CT）观察到多叶磨玻璃影。52%的研究参与者采用俯卧位通气，59%需要去甲肾上腺素进行心血管支持。此外，49%的参与者合并感染了第二种病原体。三分之二的COVID-19患者发生急性肾损伤（AKIN）。我们队列的死亡率为44.7%。AKIN、尿酸、乳酸脱氢酶（LDH）以及通气比的纵向增加与死亡率相关。基线PaO2/FiO2值和淋巴细胞的纵向恢复是死亡率的保护因素。我们的研究提供了关于墨西哥接受机械通气的COVID-19患者临床表型和死亡风险因素的参考数据。
