Severe SARS-CoV-2 infection: Mortality and comorbidities in a third level hospital in San Luis Potosi, Mexico

Abstract

The high rates of hypertension, obesity and diabetes in San Luis Potosí are worrying, since it has been shown that the existence of comorbidities associated with SARS-CoV-2 infection increases the risk of mortality, however most of the evidence comes from of other populations in the world for which it is necessary other investigations that focus on the Mexican population, in this case potosine. The objective of this study is to describe the clinical and respiratory characteristics of seriously ill and deceased patients with COVID-19, in a state in northeastern Mexico. And determine comorbidities, in order to apply better measures aimed at safeguarding the population at risk. Design: prospective and observational in the same medical center. Methods: Different types of variables, such as demographic data, severity, laboratory variables, ventilatory assistance received (high-flow oxygen therapy [HFO] and invasive mechanical ventilation [IMV]), oxygenation (PaO2 , PaO2 /FiO2 ), comorbidities and complications were automatically obtained. In order to analyze the difference between medians, the Fisher test (categorical variables) and the Mann-Whitney U test were used. A value of p <0.001 was considered significant. Results: 163 patients were included (G1 = 51 [31.2%]; G2 = 92 [56.44%] and G3 = 20 [31.74%]); age 65 (52-72) years; 68% men, APACHE II 18 (15 -24); SOFA 6 (4-7); arterial hypertension (25.11%) and obesity (16.82%) were the most frequent comorbidities. HFO was used in 62.7% of the patients, 85% failed. 95% of the patients required IMV and 85% ventilation in the prone position. In the population, baseline PaO2 /FiO2 improved at the 7th day (165 [125-210] vs 194 [153-285]; p = 0.02), as in G1 (164 [125-197] vs 207 [160-294]; p = 0.07), but not in G2 (163 [95-197] vs. 135 [85-177]). The development of pneumonia associated with IMV was high. The amount of D-dimer and IL-6 was also significantly increased in patients who died on the 7th day of the study. Conclusions: The lack of improvement in PaO2 /FiO2 at the 7th day could be a prognostic marker for deterioration, as well as D-dimer and IL-6 secretion. Special attention needs to be paid to managing hypertension and diabetes in adults over 60 years of age. Which was the age group with the highest mortality. .