Characteristics and Clinical Course of Adult in-Patients with SARS-CoV-2 Pneumonia in Bogotá, Colombia

Abstract

Background: SARS-CoV-2 virus has spread worldwide causing a crisis in healthcare systems. We aimed to describe the clinical characteristics and to explore risk factors of death, critical care admission and use of invasive mechanical ventilation in hospitalized patients with SARS-CoV-2 pneumonia in Bogota, Colombia. Methods: We conducted a cross-sectional study of adult patients with laboratory-confirmed SARS-CoV-2 pneumonia. Demographic, clinical, and treatment data were extracted from electronic records. Univariate and multivariable methods were performed to investigate the relationship between each variable and clinical outcome at 28 days of follow-up. Results: Between March 20 and June 30, 2020, 377 adults (56.8% male) were included in the study, of whom 85 (22.6%) died. Non-survivors were older on average than survivors (mean age, 56.7 years [SD 15.8] vs. 70.1 years [SD 13.9]) and more likely male (28 [32.9%] vs. 57 [67.1%]). Most patients had at least one underlying disease (333 [88.3%]), including arterial hypertension (149 [39.5%]), overweight (145 [38.5%]), obesity (114 [30.2%]) and diabetes mellitus (82 [21.8%]). Frequency of critical care admission (158 [41.9%]) and invasive mechanical ventilation (123 [32.6%]) was high. Age over 65 years (OR 9.26, 95% CI 3.29-26.01; p=0.00), ICU admission (OR 12.37, 95% CI 6.08-25.18; p=0.00), and arterial pH higher than 7.47 (OR 0.25, 95% CI 0.08-0.74; p=0.01) were independently associated with in-hospital mortality. Model based on clinical characteristics on admission yielded an area under the receiver operating characteristic curve of 0.869. Discussion and Conclusions: To december 2020, this single-center study is the first report of hospitalized adult patients with SARS-CoV-2 pneumonia in Andean subregion. In this study of in-hospital patients with SARS-CoV-2 pneumonia frequency of death was similar to what has been reported. ICU admission and use of invasive mechanical ventilation was high and most patients had a mild pneumonia at admission, according to CURB-65 and qSOFA scores. Most of our patients had at least one comorbidity. The prevalence of obesity was considerably higher than the overall prevalence in Colombian adults. Further studies may help to understand the impact of high-altitude on Covid-19 outcomes given Bogota is situated at an altitude of 2,640 mamsl . Figure. Receiver ROC curves for (a) the model of age, ICU admission and arterial pH as a predictor of in-hospital mortality (area under the curve 0.869), and (b) the model of age, male sex, peripheral oxygen saturation and white blood cell count as a predictor of invasive mechanical ventilation due to SARS-CoV-2 pneumonia (AUC 0.761).