Covid risk factors for ICU admission or death — Argentinian national analysis

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A nationwide analysis of data by Daniel Schönfeld of Centro Diagnóstico San Jorge in Puerto Madryn, Argentina, and colleagues from the first 6 months of the COVID-19 pandemic in Argentina (population of 45m) has identified factors associated with increased risk of death or admission to an intensive care unit (ICU) due to the disease, including older age, male sex, coma, seizures, and underlying comorbidities.

Argentina reported its first case of COVID-19 on 3 March, 2020, and a national lockdown has been in place since 20 March, 2020. As of 10 January, 2021, a total of 1,714,409 cases and 44,417 deaths had been reported. However, few studies have examined the clinical characteristics of COVID-19 in Latin America.

To address that knowledge gap, Schönfeld and colleagues examined COVID-19 patient characteristics and outcomes reported across Argentina in health records from 3 March to 2 October, 2020. Out of over 700,000 total confirmed cases, 207,079 patients’ health records contained enough follow-up information for analysis. Half of these patients were male, and 80.7% were younger than 60.

Most of the 207,079 COVID-19 patients had mild cases and favourable outcomes, but 5,652 were admitted to an ICU and 10,913 died. Increased risk of ICU admission or death was most strongly associated with underlying comorbidities, such as immunodeficiency, chronic renal failure, and liver disease. Other risk factors for ICU admission or death were older age, male sex, coma, dyspnoea or tachypnoea, and seizures.

The analysis also identified the most common initial symptoms experienced by the patients, including fever, cough, headache, and sore throat. Common co-existing conditions among the patients included hypertension, diabetes, asthma, and obesity.

This analysis was limited to positive cases with complete records, and there may be many additional cases of COVID-19 that were never officially registered. Still, the authors note, the new findings could help inform public health measures to optimise COVID-19 care in low-to-middle income and Latin American countries.

The authors add: "Our study of more than 200,000 people shows the risk of hospitalisation in ICU and dying by age, sex and comorbidities in Argentina. Severe cases can be identified based on the predictors we described in the study and may be useful for setting priorities in the healthcare process and allocate resources."

 

Study details
Clinical presentation and outcomes of the first patients with COVID-19 in Argentina: Results of 207079 cases from a national database

Daniel Schönfeld, Sergio Arias, Juan Carlos Bossio, Hugo Fernández, David Gozal, Daniel Pérez-Chada

Published in PLOS ONE on 11 February 2021

Abstract
Background
There is limited evidence on the clinical characteristics of SARS-CoV-2 infection in Latin America. We present findings from a nationwide study in Argentina.
Research question
What is disease severity measures and risk factors are associated with admission to an intensive care unit and mortality?
Study design and methods
Data were extracted from the COVID-19 database of the Integrated Argentina Health Information System, encompassing the period of March 3rd to October 2nd, 2020, using a standardized case report form that included information on contact history, clinical signs and symptoms, and clinical diagnosis. Information was collected at the initial site of care and follow-up conducted through calls by the regional healthcare authorities. A confirmed case of COVID-19 was defined as having a positive result through sequencing or real-time reverse-transcriptase polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swab specimens.
Results
RT-PCR testing was positive in 738,776 cases. Complete datasets were available for analysis in 207,079 cases. Mean age was 42.9±18.8 years, 50.0% were males. Frequent co-existing conditions included hypertension (19.2%), diabetes (9.7%), asthma (6.1%) and obesity (5.2%). Most common symptoms included fever (58.5%), cough (58.0%), headache (45.4%), and sore throat (42.1%). Death or ICU admission were independently associated with older age, male, coma, dyspnea or tachypnea, and seizures, with underlying co-morbidities such as immunodeficiency, chronic renal failure, and liver disease showing the strongest effects.
Interpretation
Most cases of COVID-19 diagnosed in Argentina were mild and had a favorable outcome, but fatality rates were relatively elevated. Risk factors for adverse outcome included older age, male sex, coma and seizures, and the concurrent presence of several morbidities. These data may be useful for healthcare providers and healthcare policy makers of low-middle income and Latin American countries to guide decisions toward optimized care during the pandemic.

 

PLOS ONE study (Restricted access)

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