Clinical characteristics, systemic complications, and in-hospital outcomes for patients with COVID-19 in Latin America. LIVEN-Covid-19 study: A prospective, multicenter, multinational, cohort study

Abstract

Purpose: The COVID-19 pandemic has spread worldwide, and almost 396 million people have been infected around the globe. Latin American countries have been deeply affected, and there is a lack of data in this regard. This study aims to identify the clinical characteristics, in-hospital outcomes, and factors associated with ICU admission due to COVID-19. Furthermore, to describe the functional status of patients at hospital discharge after the acute episode of COVID-19.

Material and methods: This was a prospective, multicenter, multinational observational cohort study of subjects admitted to 22 hospitals within Latin America. Data were collected prospectively. Descriptive statistics were used to characterize patients, and multivariate regression was carried out to identify factors associated with severe COVID-19.

Results: A total of 3008 patients were included in the study. A total of 64.3% of patients had severe COVID-19 and were admitted to the ICU. Patients admitted to the ICU had a higher mean (SD) 4C score (10 [3] vs. 7 [3)], p<0.001). The risk factors independently associated with progression to ICU admission were age, shortness of breath, and obesity. In-hospital mortality was 24.1%, whereas the ICU mortality rate was 35.1%. Most patients had equal self-care ability at discharge 43.8%; however, ICU patients had worse self-care ability at hospital discharge (25.7% [497/1934] vs. 3.7% [40/1074], p<0.001).

Conclusions: This study confirms that patients with SARS CoV-2 in the Latin American population had a lower mortality rate than previously reported. Systemic complications are frequent in patients admitted to the ICU due to COVID-19, as previously described in high-income countries.

Fig 1. Older patients get sicker and have a higher cumulative frequency of ICU admission.

(A) The proportion of patients enrolled in the study per country. (B) The figure presents the cumulative number of cases included in the study; in purple, patients admitted to the Intensive Care Unit (ICU) and patients with no admission to the ICU in blue. (C) The age distribution of subjects in the study is shown in this figure. Age ranges are listed down the center of the graph, and sex distribution is displayed on each side.

Fig 2

(A) Correlation between the 4C score and the ICU admission rate. This figure compares the number of patients admitted to the ICU (Y-axis) and their punctuation in the 4C score (X-axis). In purple, the patients were admitted to the ICU, and in blue, patients were not admitted. The ICU admission rate increases as the 4C score do. In contrast, most patients rated with 4C scores of 6 or less were more frequently treated outside the ICU. (B) Comparison between PaO2/FiO2 ratio and the number of patients admitted to ICU. This figure compares the number of patients admitted to ICU in purple columns the number of patients who were not admitted to the ICU in blue columns. Patients with a low PaO2/FiO2 ratio were the most admitted to ICU.