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Socio-Demographic and Clinical Characteristics of Adults with Sars-Cov-2 Infection in Two Hospitals in Bogota, Colombia
Journal of Clinical Trials

Journal of Clinical Trials
Open Access

ISSN: 2167-0870

+44 20 3868 9735

Research Article - (2021)

Socio-Demographic and Clinical Characteristics of Adults with Sars-Cov-2 Infection in Two Hospitals in Bogota, Colombia

Alejandro Moscoso D1*, Alejandra Sanchez1, Adriana Aya RN1, Carolina Gomez1, Yazmin Rodriguez2, Javier Garzon2 and Felipe Lobelo3
 
*Correspondence: Alejandro Moscoso D, Department of Research and Education, Country Clinic and La Colina Clinic, Bogota, Colombia, Email:

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Abstract

This study is a retrospective cohort of 122 adult patients with SARS-CoV-2 diagnosed and managed at two mediumsized, tertiary private hospitals. The analysis includes demographic and socio-economic information, symptoms, comorbidities, laboratory test results, therapeutic management, clinical outcomes and complications.

Keywords

COVID-19; Cohort study; Latin America; Hospitalization; Mortality

Introduction

As of May 29th, 2020, there were over 2.6 million Coronavirus disease 2019 (COVID-19) cases and over 151 thousand deaths in the Americas.

Surpassing the U.S. and Europe, most new cases and deaths are now being reported in Latin America (LA), the new epicenter of the pandemic [1].

The first confirmed case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was reported in Colombia on March 6, 2020. By March 25th the government instituted a national lockdown.

We report the characteristics of patients diagnosed and managed at Clinica del Country (CC) and Clinica La Colina (CLC), two medium-sized, tertiary private Hospitals, located in the northern region of Bogota, the fourth largest urban center in LA with a population of 7.86 million.

Methods

This study is a retrospective cohort of 122 adult patients (≥ 18 years) with positive polymerase chain reaction tests for SARS-CoV- 2, seen at CC & CLC from March 12th to May 25th, 2020. Testing, triaging and clinical management procedures were adopted from national guidelines [2].

Analyses include demographic and Socio-Economic (SES) information, symptoms, comorbidities, laboratory test results, therapeutic management, clinical outcomes and complications.

Data was stratified by Ambulatory Care (AC), General Ward hospitalization (GW) and Intensive Care Unit (ICU). Two of 27 ICU-managed patients were referred to other hospitals and their outcomes unknown.

We report numbers (percentages) for categorical variables and medians (interquartile ranges) for continuous variables.

In-hospital mortality and discharge dispositions are reported as of May 29th, with 5.7% of the cohort still hospitalized. The CC institutional review board approved the project with a waiver of informed consent.

Results

Of 2010 tests performed, 122 (6%) were positive for SARSCoV- 2. Of these, 26 (21.3%) were managed in the GW and 27 (22%) in the ICU.

The cohort median age was 46 years (33.8-57.3), 70 (57.4%) were women and 43 (35.2%) health workers (Table 1).

Characteristics All patients Management setting
Socio-demographics Total Intensive Care Unit n (%) General Ward n (%) Ambulatory Care n (%)
  122 27 (22.1) 26 (21.3) 69 (56.6)
Age, median (IQR) [range] 46 (33.8-57.3) [21-103] 61 (48-69) [26-91] 54 (36.62) [26-103] 37 (31-47) [21-80]
Sex        
Female 70 (57.4) 12 (44.4) 11 (42.3) 47 (68.1)
Male 52 (42.6) 15 (55.6) 15 (57.7) 22 (31.9)
Insurance Type        
Contributive 29 (23.8) 3 (11.1) 5 (19.2) 21 (30.4)
Private 93 (76.2) 24 (88.9) 21 (80.8) 48 (69.6)
Education level b        
Basic  2 (1.6) 2 (7.4) - -
Intermediate 23 (18.8) - 5 (19.2) 18 (26.1)
High 59 (48.3) 15 (55.6) 10 (38.5) 34 (49.3)
Socio-economic levelc        
Low 13 (10.6) 2 (7.4) 4 (15.4) 7 (10.1)
Middle 62 (50.8) 14 (51.9) 13 (50.0) 35 (50.7)
High 18 (14.7) 5 (22.2) 4 (15.4) 9 (13.0)
Occupation        
Health workersd 43 (35.2) 2 (7.4) 6 (23.1) 35 (50.7)
Frontline workerse 19 (15.6) 4 (14.8) 6 (23.1) 9 (13.0)
Non-essential workersf 60 (49.2) 21 (77.8) 14 (53.8) 25 (36.2)
Transmission mode        
Imported  20 (16.4) 4 (14.8) 3 (11.5) 13 (18.8)
Related to imported 58 (47.6) 10 (37.0) 8 (30.8) 40 (58.0)
Unknown/Community 44 (36.0) 13 (48.1) 15 (57.7) 16 (23.2)
Charlson comorbidity index score, mean (SD) 1.2 (1.9) 2.5 (2.1) 1.92 (2.5) 0.4 (1.0)
Clinical outcomes
Disease severity        
Uncomplicated disease 73 (59.8) - 6 (23.1) 67 (97.1)
Mild pneumonia 9 (7.38) - 7 (26.9) 2 (2.9)
Severe pneumonia 22 (18.0) 9 (33.3) 13 (50.0) -
ARDS 18 (14.7) 18 (66.7) - -
Septic shock 16 (13.1) 16 (59.3) - -
Mechanical ventilation 17 (13.9) 17 (63.0) - -
Median ventilator days (IQR) [range]   4.0 (0-16) [0-66] - -
Vasopressor support 17 (13.9) 17 (63.0) - -
Median vasopressor days (IQR) [range]   2.0 (0-11) [0-26] - -
Median Length of stay (IQR) [Range]        
General ward   7.0 (3-10) [0-25] 6.0 (4-8) [2-12] -
Intensive care unit   6.0 (3-19) [1-66] - -
Readmitted 17 (13.9) 2 (7.4) 6 (23.1) 9 (13.0)
Died 3 (2.5) 3 (11.1) - -
Complications        
Ventilatory failure 17 (13.9) 17 (63.0) - -
Cardiac complicationsg 11 (9.0) 9 (33.3) 2 (7.7) -
Multiple organ failure 8 (6.5) 8 (29.6) - -
Acute kidney injury 9 (7.4) 8 (29.6) 1 (3.8) -
Dialysis 6 (4.9) 6 (22.2) - -
Neurological complicationsh 4 (3.3) 4 (14.8) - -
Acute liver injury 2 (1.6) 2 (7.4) - -
Concomitant bacterial infection 10 (8.2) 9 (33.3) 1 (3.8) -
Concomitant fungal infection 1 (0.8) 1 (3.7) - -
Initial laboratory measures, median (IQR)i        
White blood cell count, mm3 6575 (5320-8330) 6700 (5000-10600) 7100 (5300-8050) 6050 (5580-7750)
Absolute neutrophil count, mm3 4550 (3180-6910) 5260 (3500-9400) 4950 (3880-6540) 3590 (3000-5460)
Absolute lymphocyte count, mm3 1240 (900-1760) 1000 (770-1510) 1030 (870-1480) 1760 (1360-2390)
Ferritin, ng/mL 863 (280-1502) 1250 (323-1751) 321 (247-1299) -
D-dimer, ng/mL 340 (193-660) 508 (260-777) 263 (154-585) 184 (100-440)
C-reactive protein, mg/dL 5.1 (0.6-11.3) 11.1 (6.3-19.8) 5.3 (1.3-11.3) 0.4 (0.2-0.7)
Lactate dehydrogenase, U/L 262 (210-351) 357 (284-438) 243 (216-299) 207 (190-224)
Alanine aminotransferase, U/L 34 (21-52) 44 (29-56) 33 (21-52) 30 (21-76)
Aspartate aminotransferase, U/L 35 (28-53) 37 (19-55) 33 (26-44) 33 (27-63)
Total bilirubin, mg/dL 1 (0-1) 1 (0-1) 1 (0-1) 1 (1-1)
Influenza A/B n (%) 1 (0.8) - 1 (3.8) -
Respiratory syncytial virus n (%) 2 (1.6) 2 (7.4) - -
Treatment        
Oxygen 47 (38.5) 26 (96.3) 21 (80.8) -
Nasal cannula 43 (35.2) 22 (81.5) 21 (80.8) -
High flow nasal cannula 4 (3.3) 4 (14.8) - -
Hydroxychloroquine 42 (34.4) 25 (92.6) 17 (65.4) -
Lopinavir/ritonavir 41 (33.6) 25 (92.6) 16 (61.5) -
Anticoagulation 39 (32.0) 21 (77.7) 18 (69.2) -
Enoxaparin 34 (27.9) 17 (63.0) 17 (65.4) -
Dalteparin 1 (0.8) 1 (3.70) - -
Unfractionated heparin 3 (2.5) 2 (7.40) 1 (3.8) -
Fondaparinux 1 (0.8) 1 (3.70) - -
Macrolides   8 (29.6) 3 (11.5)  
Azithromycin 4 (3.3) 3 (11.1) 1 (3.8) -
Clarithromycin 7 (5.7) 5 (18.5) 2 (7.7) -
Corticoids 6 (4.9) 6 (22.2) - -
Tocilizumab 1 (0.8) 1 (3.7) - -

Table 1: Characteristics of adults with SARS-CoV-2 managed in two hospitals, Bogota, Colombiaa.

Most patients had private health insurance 93(76.2%) and lived in northeast neighborhoods (https://bit.ly/36VE9Sm).

The majority of patients presented with cough, fever and shortness of breath and 29 (23.8%) had diarrhea/vomiting. Overall, the most prevalent comorbidities were hypertension and metabolic diseases. Most patients requiring hospitalization were in the 45-64 years group (22%) (Figure 1).

clinical-trials-Bogota

Figure 1: Distribution of ages (A), (B) presetting symptoms and (C) comorbidities of adults with SARS-CoV-2, stratified by management setting, in two hospitals, Bogota, Colombia.

Of the GW patients, 21 (80.8%) required oxygen support by nasal cannula. The primary reason for ICU admission was ventilator failure with a median length of stay of 6 (3-19) days and 17 (63%) requiring invasive mechanical ventilation.

Discussion

To our knowledge, this is the first case series of patients with SARS-CoV-2 infection managed in outpatient and inpatient settings in Colombia and LA. With a median age of 46 years, our cohort is younger compared to series from China, Italy and the US [3-6]. This may be explained by the population age structure in Bogota and the early adoption of mitigation and suppression strategies, particularly protecting populations 70 and older. The median age and prevalence of comorbidities in our ICU-managed patients were similar to U.S series, with a modest mortality rate (11.1%).

Conclusion

The major limitation of this study is that our series mostly represents the earliest wave of SARS-CoV-2imported infections into the country, primarily among individuals of mid to high SES status. In our cohort, most patients 68 (64%) had a recent history of international travel or were related to imported cases. As the Bogota epidemic achieved sustained community transmission, subsequent infection waves have affected more frontline workers and lower SES status individuals. This is not surprising given the high levels of social inequality in large LA cities highlighting the importance of sustained local public health measures to reduce virus transmission and control the overall COVID-19 disease burden in the region.

Acknowledgements

Special thanks to Dr. Santiago Lopez, Medical Vice President CC and CLC and Dr. Alfonso Correa, Education and Research Subdirector CC and CLC for their support to conduct this study.

Author contributions

Drs. Moscoso, Sanchez and Rodriguez had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Aya, Moscoso, Sanchez, Lobelo

Drafting of the manuscript: Moscoso, Sanchez, Gomez

Critical revision of the manuscript for important intellectual content: Rodriguez, Garzon, Lobelo

Statistical analysis: Sanchez and Moscoso

Obtained funding: N/A

Administrative, technical, or material support: Moscoso, Sanchez, Aya, Gomez

Supervision: Moscoso, Lobelo.

Conflict of interest disclosures: No disclosures to report

References

  1. Colombian consensus of care, diagnosis and management of SARS-CoV-2/COVID 19 infection in health care establishments. Rev Colomb Infection. 2020;24;3(S1).
  2. Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 Admitted to ICUs of the lombardy region, Italy. JAMA. 2020;323(16):1574.
  3. Myers LC, Parodi SM, Escobar GJ, Liu VX. Characteristics of hospitalized adults with COVID-19 in an integrated health care system in California. JAMA. 2020.
  4. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients Hospitalized with COVID-19 in the New York city area. JAMA. 2020;323(20):2052.
  5. Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720.

Author Info

Alejandro Moscoso D1*, Alejandra Sanchez1, Adriana Aya RN1, Carolina Gomez1, Yazmin Rodriguez2, Javier Garzon2 and Felipe Lobelo3
 
1Department of Research and Education, Country Clinic and La Colina Clinic, Bogota, Colombia
2Department of Infectology, Country Clinic and La Colina Clinic, Bogota, Colombia
3Department of Hubert Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
 

Citation: Moscoso DM, Sanchez S, Aya RNA, Gomez C, Rodriguez Y, Garzon J, et al. (2021) Socio-Demographic and Clinical Characteristics of Adults with Sars-Cov-2 Infection in Two Hospitals in Bogota, Colombia. J Clin Trials. S9:003.

Received: 19-Jan-2021 Accepted: 01-Feb-2021 Published: 08-Feb-2021 , DOI: 10.35248/2167-0870.21.s9.003

Copyright: © 2021 Moscoso DM, et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.