High mortality among hospitalized adult patients with COVID-19 pneumonia in Peru: A single centre retrospective cohort study

Prediction models of COVID-19 fatality in nine Peruvian provinces: A secondary analysis of the national epidemiological surveillance system

There are initiatives to promote the creation of predictive COVID-19 fatality models to assist decision-makers. The study aimed to develop prediction models for COVID-19 fatality using population data recorded in the national epidemiological surveillance system of Peru. A retrospective cohort study was conducted (March to September of 2020). The study population consisted of confirmed COVID-19 cases reported in the surveillance system of nine provinces of Lima, Peru. A random sample of 80% of the study population was selected, and four prediction models were constructed using four different strategies to select variables: 1) previously analyzed variables in machine learning models; 2) based on the LASSO method; 3) based on significance; and 4) based on a post-hoc approach with variables consistently included in the three previous strategies. The internal validation was performed with the remaining 20% of the population. Four prediction models were successfully created and validate using data from 22,098 cases. All models performed adequately and similarly; however, we selected models derived from strategy 1 (AUC 0.89, CI95% 0.87-0.91) and strategy 4 (AUC 0.88, CI95% 0.86-0.90). The performance of both models was robust in validation and sensitivity analyses. This study offers insights into estimating COVID-19 fatality within the Peruvian population. Our findings contribute to the advancement of prediction models for COVID-19 fatality and may aid in identifying individuals at increased risk, enabling targeted interventions to mitigate the disease. Future studies should confirm the performance and validate the usefulness of the models described here under real-world conditions and settings.

Prevalence of post-traumatic stress disorder risk post-COVID-19 in 12 countries in Latin America: a cross-sectional survey

Introduction

Latin America was the region most affected by COVID-19 in the second quarter of 2020, and consequently, the impact on mental health requires evaluation. The aim of this study was to assess the risk of post-traumatic stress disorder (PTSD) caused by bereavement due to COVID-19 in 12 countries in Latin America.

Methods

The current study was an analytical cross-sectional study. Validated tests were applied for PTSD, depression, anxiety, and stress (DASS-21), questions about the respondent's condition or their environment, and demographic questions, as well as the length of the mourning period of suffering.

Results

The outcomes demonstrated that the PTSD risk increased for women (p < 0.001), when a friend or acquaintance had COVID-19 (p = 0.002), when a close relative died from COVID-19 (p = 0.010), having severe depression (p <0.001), severe anxiety (p  <0.001), severe stress (p  <0.001), residing in Chile (p  <0.001), Paraguay (p  <0.001), Bolivia (p  <0.001), Costa Rica (p  <0.001) or El Salvador (p  = 0.005). On the other hand, there was less risk of PTSD at an older age (p  <0.001) or if respondents had a sentimental partner (p  = 0.025). In the case of severe PTSD, there was a greater gender risk for women (p  <0.001), a close relative dying from COVID-19 (p  = 0.017), having severe depression (p  <0.001), severe anxiety (p  <0.001), severe stress (p  <0.001), residing in Chile (p  <0.001), Paraguay (p  <0.001), Bolivia (p  <0.001) and Costa Rica (p  = 0.002). It was also observed that there was less risk of severe PTSD at an older age demographic (p  <0.001).

Discussion

It can be concluded that the percentages of PTSD are high in its clinical presentation as severe, especially among Latin American women.

Risk factors for COVID-19 mortality in hospitalized patients in Bolivia

Objectives

This study aimed to ascertain which factors are associated with higher risk of mortality among hospitalized COVID-19 Bolivian patients.

Methods

This retrospective observational study assessed risk factors associated with mortality in patients (n = 549) hospitalized for SARS-CoV-2 infection in a Bolivian hospital between April 6, 2020, and August 18, 2022.

Results

The results provide evidence of association between male sex (odds ratio [OR] = 1.6, 95% confidence interval [CI] 1.06-2.6), older age, 51-61 years-old (OR = 5.2, 95% CI 2.2-12.6), 62-70 years-old (OR = 8.7, 95% CI 3.7-20.5), >70 years-old (OR = 16.9, 95% CI 7.1-39.9), and blood group A (OR = 1.9, 95% CI: 1.1-3.4) with higher mortality risk. The strong association between mortality and relatively young age, may be due to high frequency of undiagnosed comorbidities. Vaccination was associated with a reduction in mortality only when time period of hospitalization was not adjusted for.

Conclusion

Among hospitalized patients in Bolivia male sex, older age, and blood group A are associated with higher mortality risk. Mortality risk increased markedly from a relatively young age and decreased in parallel to the uptake of the vaccination program. However, the gradual reduction in mortality can also be due to improved patient management and changes in natural immunity and virulence of circulating strains as the pandemic progressed.

The Risk Factors of COVID-19 Infection and Mortality among Older Adults in South Korea

BACKGROUND

This study aimed to identify the risk factors associated with coronavirus disease 2019 (COVID-19) infection and mortality among older adults in South Korea.

METHODS

Using Korean National Health Insurance data from January 1, 2020, to March 31, 2022, we analyzed the impact of various factors, including age, comorbidity burden, and insurance type, on COVID-19 infection and mortality rates.

RESULTS

Age was the most significant risk factor for mortality in older adults. A higher comorbidity burden was also associated with increased infection (odds ratio [OR]=1.33 for Charlson Comorbidity Index [CCI] ≥2, 95% confidence interval [CI] 1.321-1.339) and mortality (OR=1.537 for CCI ≥2, 95% CI 1.459-1.618) rates. While Medical Aid recipients exhibited lower infection rates (OR=0.898, 95% CI 0.89-0.906) than National Health Insurance beneficiaries, they had higher mortality rates (OR=1.692, 95% CI 1.623-1.763).

CONCLUSION

These results emphasized the need to prioritize vaccination and allocate healthcare resources for older adults, particularly those with multiple comorbidities. Addressing socioeconomic disparities and ensuring equitable access to testing and healthcare services are crucial for mitigating the impact of COVID-19 on older adults.

Assessing the Influence of COVID-19 Vaccination Coverage on Excess Mortality across 178 Countries: A Cross-Sectional Study

The COVID-19 pandemic has had a devastating impact on global health, necessitating urgent and effective strategies to mitigate its consequences. Vaccination programs have been implemented worldwide to combat virus transmission and reduce the disease burden. This study aimed to investigate the relationship between COVID-19 vaccination coverage and all-cause excess mortality in 178 nations during the first two years of the pandemic. Multiple regression analysis, after adjusting for life expectancy at birth, confirmed a significant association between higher vaccination coverage and lower all-cause mortality rates (β = -106.8, 95% CI -175.4 to -38.2, p = 0.002). These findings underscore the importance of vaccination campaigns in reducing overall mortality during the COVID-19 pandemic. Evidence-based decision making and resource allocation can benefit from this information, facilitating the optimization of vaccination strategies for maximal impact on mortality reduction. Further research and continuous monitoring are crucial to understanding the long-term effects of vaccination coverage on population health in the ongoing pandemic.

Public trust of physicians in China improved since the COVID-19 pandemic Began

RATIONALE

Public trust in physicians had declined in China for decades before the COVID-19 pandemic. During the COVID-19 pandemic, frontline physicians have experienced high work volume despite a high risk of COVID-19 infection. The willingness of physicians to treat COVID patients with a high risk of exposure to the infection may have improved public trust in physicians.

OBJECTIVE

This study analyzes how public trust in physicians has changed since the pandemic started using a nationally representative survey.

METHODS

We used the China Family Panel Studies (CFPS), with 179,123 respondents 10 years or older who were eligible to answer the question on public trust in physicians from 2012 to 2020. Public trust has been measured by an 11-point Likert scale. A quasi pre-post study design using a segmented regression impact model was used to evaluate the impact of the COVID-19 pandemic on public trust in physicians.

RESULTS

At the start of the observation period, the average public trust score was 6.86 out of 10.00. The immediate unadjusted change of mean score for public trust during COVID-19 was significantly higher (Coef. = 0.361; 95% CI = 0.359, 0.364). Moreover, a significant increase in the unadjusted trend during the COVID-19 pandemic was observed in the mean score for public trust (Coef. = 0.005; 95% CI = 0.004, 0.006). The results were similar to the estimates obtained when we adjusted for demographic characteristics and health status.

CONCLUSIONS

The mean score for public trust increased during the COVID-19 pandemic. This study provides a new perspective on restoring public trust in physicians, a significant concern of the Chinese healthcare system. During the COVID-19 pandemic, social and mainstream media helped to establish the "good doctor" image, which may have improved patients' trust in physicians. Improving health literacy through effective communication and education may help increase public trust in physicians.

Factors Associated with COVID-19 Death in a High-Altitude Peruvian Setting during the First 14 Months of the Pandemic: A Retrospective Multicenter Cohort Study in Hospitalized Patients

Risk factors for COVID-19 death in high-altitude populations have been scarcely described. This study aimed to describe risk factors for COVID-19 death in three referral hospitals located at 3399 m in Cusco, Peru, during the first 14 months of the pandemic. A retrospective multicenter cohort study was conducted. A random sample of ~50% (1225/2674) of adult hospitalized patients who died between 1 March 2020 and 30 June 2021 was identified. Of those, 977 individuals met the definition of death by COVID-19. Demographic characteristics, intensive care unit (ICU) admission, invasive respiratory support (IRS), disease severity, comorbidities, and clinical manifestation at hospital admission were assessed as risk factors using Cox proportional-hazard models. In multivariable models adjusted by age, sex, and pandemic periods, critical disease (vs. moderate) was associated with a greater risk of death (aHR: 1.27; 95%CI: 1.14–1.142), whereas ICU admission (aHR: 0.39; 95%CI: 0.27–0.56), IRS (aHR: 0.37; 95%CI: 0.26–0.54), the ratio of oxygen saturation (ROX) index ≥ 5.3 (aHR: 0.87; 95%CI: 0.80–0.94), and the ratio of SatO2/FiO2 ≥ 122.6 (aHR: 0.96; 95%CI: 0.93–0.98) were associated with a lower risk of death. The risk factors described here may be useful in assisting decision making and resource allocation.

Platelet-to-White Blood Cell Ratio as a Predictor of Mortality in Patients with Severe COVID-19 Pneumonia: A Retrospective Cohort Study

Purpose

Complete blood count (CBC) parameters are widely used as predictors of Coronavirus disease 2019 (COVID-19) severity. However, the clinical significance of these markers in severe COVID-19 pneumonia remains unclear. This study aimed to investigate the role of CBC parameters in predicting mortality in patients with severe COVID-19 pneumonia.

Patients and Methods

We conducted a retrospective study at a tertiary care center in southern Thailand. Between January 2020 and December 2021, adult patients who had been diagnosed with severe COVID-19 pneumonia were enrolled. Demographic and clinical data, including CBC data on admission, were analyzed and compared between survivors and non-survivors.

Results

A total of 215 patients with severe COVID-19 pneumonia were enrolled. The in-hospital mortality was 29.3%. Non-survivors had a significantly lower platelet-to-white blood cell ratio (PWR) than survivors (15.8 vs 29.0, p < 0.001). PWR had the best accuracy in predicting in-hospital mortality, with an area under the curve (AUC) of the receiver operating characteristic curve of 0.801, followed by the CURB-65 of 0.789.

Conclusion

PWR appears to be a simple independent predictor of mortality in patients with severe COVID-19 pneumonia.

Factors associated with mortality in patients hospitalized for COVID-19 admitted to a tertiary hospital in Lambayeque, Peru, during the first wave of the pandemic

INTRODUCTION

COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has spread worldwide, becoming a long-term pandemic.

OBJECTIVES

To analyze the factors associated with mortality in patients hospitalized for COVID-19 in a tertiary hospital in the Lambayeque region of Peru.

METHODS

A retrospective cohort study of patients with a diagnosis of COVID-19, hospitalized in a hospital in northern Peru, was conducted from March to September 2020.

RESULTS

Of the 297 patients studied, 69% were women, the mean age was 63.99 years (SD = ±15.33 years). Hypertension was the most frequent comorbidity (36.67%), followed by diabetes mellitus (24.67%) and obesity (8.33%). The probability of survival at 3 days of ICU stay was 65.3%, at 7 days 24.2%, and 0% on day 14. Risk factors associated with mortality in patients hospitalized for COVID-19 are age, male sex, tachypnea, low systolic blood pressure, low peripheral oxygen saturation, impaired renal function, elevated IL-6 and elevated D-dimer.

CONCLUSIONS

Mortality in hospitalized patients with COVID-19 was 51.18 per 100 persons, Mortality was found to be associated with hypertension, type of infiltrating, and sepsis.

The difference in strategies for prevention of COVID-19 transmission in hospitals: A nationwide survey results in the Republic of Korea

BACKGROUND

Hospital infection control measures against coronavirus disease 2019 (COVID-19) are often based on expert discretion due to the lack of detailed guidelines.

AIM

To survey the current strategies for preventing COVID-19 spread in medical institutions.

METHODS

Thirteen key issues related to COVID-19 transmission prevention within medical institutions were selected via discussion among infectious diseases specialists, and related critical questions were subsequently obtained following a review of national-level guidelines in government databases. Six hospitals had an open survey between 11^th and 25^th August 2020 to provide responses to these topics. An online questionnaire developed from these data was sent to infection control teams of 46 South Korean hospitals between 31^st January 2021 and 20^th February 2021.

FINDINGS

All 46 hospitals responded to the survey. All operated screening clinics, but 89.1% (41/46) allowed symptomatic patients without COVID-19-associated symptoms to visit the general outpatient clinics. Most hospitals (87.2%; 34/39) conducted PCR tests for all hospitalised patients. Of 35/46 (76.1%) hospitals with preemptive isolation policies for hospitalised patients, 31 (88.6%) released patients from isolation after a single negative PCR test while most (76.9%; 20/26) allowed shared-room accommodation for patients meeting the national criteria for release from isolation despite positive PCR results with above cycle threshold values (34.6%; 9/26) or after a certain period that satisfied the national criteria (26.9%; 7/26).

CONCLUSION

Individual hospitals in South Korea are currently relying on experience to frame relevant guidelines and responded differently to some infection control issues on hospital settings during the COVID-19 pandemic.

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

Trends in routine laboratory tests, such as high white blood cell and low platelet counts, correlate with COVID-19-related intensive care unit (ICU) admissions. Other related biomarkers include elevated troponin, alanine aminotransferase, and aspartate transaminase levels (liver function tests). To this end, the aim of this study was to investigate the effect of changes in laboratory test parameters on ward-based and ICU COVID-19 patients. A total of 280 COVID-19 patients were included in the study and were divided based on admission status into ICU (37) or ward (243) patients. ICU admission correlated significantly with higher levels of several tested parameters, including lactate dehydrogenase, creatinine, D-dimer, creatine kinase, white blood cell count, and neutrophil count. In conclusion, routine laboratory tests offer an indication of which COVID-19 patients are most likely to be admitted to the ICU. These associations can assist healthcare providers in addressing the needs of patients who are at risk of COVID-19 complications.