RESUMEN
Background: The COVID-19 pandemic generated high workloads given the high volume of seriously ill patients; conditions that could increase the risk of adverse events (AE). This study analyzed the frequency of AE in patients with COVID-19 and their effect on mortality, hospital stay and costs. Methods: This retrospective cohort study included in-patients with COVID-19 at a single hospital between March 2020-June 2021. Exposure was the occurrence of at least one AE. Hospital stay, costs and death were considered outcomes. Clinical information and direct costs were obtained from medical and billing records. Generalized linear models were used to estimate the association measures. Results: 405 patients were included, 55.8% (n=226) men, median age 56 years (IQR: 41.0-70.0) and with a history of hypertension (26.2%; n=106), diabetes mellitus (13.8%; n=56) and obesity (13.8%; n=56). The incidence of AE was 13.3% (n=54), 29 patients presented more than one AE, for a total of 70 events. Most events (74.3%; n=52) were preventable and the most frequent were healthcare-associated infections (50%; n=35), phlebitis (14.3%; n=10) and pressure ulcers (12.9%; n=9). AE prolonged hospital stay (change rate: 1.57; 95%CI: 1.26-1.95; P=0.001) and increased direct healthcare costs (change rate: 1.20; 95% CI: 1.03-1.39, P=0.019). Likewise, the risk of death was 56% higher in patients with AE. Conclusion: Pandemics are unexpected events that present challenges to safe healthcare. Improving quality policies, monitoring compliance with protocols and providing ongoing education are strategies to prevent AE such as healthcare-associated infections, which increase hospital costs and stay.
RESUMEN
A finales del 2019 un nuevo coronavirus SARS CoV 2 fue identificado como el agente etiológico del síndrome respiratorio agudo grave coronavirus 2 (SARS-CoV-2); como se le conoce, enfermedad del coronavirus 2019 (COVID-19) constituyendo un reto para el mundo ante tantos aspectos desconocidos y problema de salud pública. En el Ecuador el primer caso fue confirmado el 29 de febrero del 2020 y se inicia el 12 de marzo el estado de emergencia sanitaria. Objetivo Determinar las características epidemiológicas y los factores relacionados con sobrevida/muerte en pacientes atendidos con enfermedad COVID-19. Diseño Fue un estudio retrospectivo transversal, fueron elegibles pacientes atendidos en el área de sintomáticos respiratorios con sospecha de Enfermedad COVID-19 del Hospital Vozandes Quito, entre el 2 de marzo y el 30 de abril del 2020. Datos demográficos y los relacionados con los factores de riego para mortalidad fueron obtenidos del formulario EPI - 1 Individual, Ficha de Investigación Epidemiológica, Sistema Vi Epi y del prontuario electrónico de los pacientes. Resultados Se obtuvieron 250 pacientes, 87 casos confirmados para COVID-19, de ellos 8 fallecieron y 79 estaban vivos al finalizar el seguimiento. Con relación a la severidad de le enfermedad, 61% de los pacientes fueron clasificados como leves y el 6% graves (p =<0.001) Valores elevados de PCR (OR 1 IC 95% 1.000 1.024) y la presencia de hiporexia (OR 24 IC 95% 1.183 504.413) al diagnóstico se asociaron a mayor riesgo de muerte entre pacientes Covid-19 positivos. Conclusiones La mayoría de los casos COVID 19 presentaron manifestaciones no graves, fueron tratados sintomáticamente y con aislamiento domiciliario. Valores elevados de PCR e Hiporexia al diagnóstico fueron factores de riesgo para muerte. Futuras investigaciones son necesarias para determinar los factores asociados a peor pronóstico y curso clínico.
By the ending of 2019 a new type of coronavirus was identified named SARS-CoV 2, and now known to be the etiological agent of the acute respiratory syndrome coronavirus (SARS-CoV-2). Known as coronavirus 2019 disease or (COVID-19) constitutes a challenge for the world in many unknown aspects and problems in public health. In Ecuador the first reported of a confirmed appeared on February 29 2020, and in March 12 an emergency health status is declared. Objective To determine the epidemiological characteristics and factors related to death and survival in patients with COVID-19. Design The study is of transversal retrospective design, the patients chosen were those seen in the respiratory or suspicious of COVID-19 area of Hospital Vozandes Quito between March 2 and April 30. Demographic data and related risk factors for mortality were obtained using the EPI-1 individual form, epidemiological research files, the VI Epi system and electronic promptuary of patients. Results 250 patients were obtained for this study, 87 of those were confirmed COVID-19, out those eight died and 79 were alive at the ending of the follow up. Regarding the severity of illness, 61% of the patients were classified as mild and 6 % critical (p =<0.001). Elevated values of CRP (OR 1 IC 95% 1.000 1.024) and the presence of hiporexia (OR 24 IC 95% 1.183 504.413) were associated with higher mortality levels amongst COVID-19 positive patients. Conclusions The majority of COVID-19 cases showed no serious manifestations, were treated symptomatically and home isolation. Elevated values of CRP and the presence of hiporexia at the diagnosis are factors consistently with death. Future investigations are required to determine the risk factors associated with worst clinical course and prognosis.