Open AccessHigh-altitude is associated with better short-term survival in critically ill COVID-19 patients admitted to the ICU
Author(s) -
Katherine Simbaña-Rivera,
Pablo R Morocho Jaramillo,
Javier V Velastegui Silva,
Lenin Gómez-Barreno,
Ana Campoverde,
Juan F Novillo Cevallos,
Washington E. Almache Guanoquiza,
Silvio L. Cedeño Guevara,
Luis Gonzalez Castro,
Nelson A Moran Puerta,
Alex W. Guayta Valladares,
Alex Lister,
Esteban OrtizPrado
Publication year - 2022
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0262423
Subject(s) - medicine , comorbidity , effects of high altitude on humans , incidence (geometry) , intensive care unit , altitude (triangle) , diabetes mellitus , mortality rate , prospective cohort study , cohort study , physics , geometry , mathematics , optics , anatomy , endocrinology
Background Multiple studies have attempted to elucidate the relationship between chronic hypoxia and SARS-CoV-2 infection. It seems that high-altitude is associated with lower COVID-19 related mortality and incidence rates; nevertheless, all the data came from observational studies, being this the first one looking into prospectively collected clinical data from severely ill patients residing at two significantly different altitudes. Methods A prospective cohort, a two-center study among COVID-19 confirmed adult patients admitted to a low (sea level) and high-altitude (2,850 m) ICU unit in Ecuador was conducted. Two hundred and thirty confirmed patients were enrolled from March 15 th to July 15 th , 2020. Results From 230 patients, 149 were men (64.8%) and 81 women (35.2%). The median age of all the patients was 60 years, and at least 105 (45.7%) of patients had at least one underlying comorbidity, including hypertension (33.5%), diabetes (16.5%), and chronic kidney failure (5.7%). The APACHE II scale (Score that estimates ICU mortality) at 72 hours was especially higher in the low altitude group with a median of 18 points (IQR: 9.5–24.0), compared to 9 points (IQR: 5.0–22.0) obtained in the high-altitude group. There is evidence of a difference in survival in favor of the high-altitude group (p = 0.006), the median survival being 39 days, compared to 21 days in the low altitude group. Conclusion There has been a substantial improvement in survival amongst people admitted to the high-altitude ICU. Residing at high-altitudes was associated with improved survival, especially among patients with no comorbidities. COVID-19 patients admitted to the high-altitude ICU unit have improved severity-of-disease classification system scores at 72 hours.