key: cord-0684343-x8cevt8d authors: Ruiz-Quinonez, J. A.; Guzman-Priego, C.; Nolasco-Rosales, G. A.; Tovilla-Zarate, C. A.; Flores-Barrientos, O. I.; Narvaez-Osorio, V.; Baeza-Flores, G. d. C.; Gonzalez-Castro, T. B.; Lopez-Brito, C. R.; Denis-Garcia, C. A.; Perez-Garcia, A.; Juarez-Rojop, I. E. title: Features of patients that died for COVID-19 in a Hospital in the south of Mexico: A observational cohort study date: 2020-09-23 journal: nan DOI: 10.1101/2020.09.21.20199117 sha: 635ac10286cdb89d1fbb02ed2b269a5bbb36c513 doc_id: 684343 cord_uid: x8cevt8d Background: Due to the wide spread of SARS-CoV2 around the world, the risk of death in individuals with metabolic comorbidities has dangerously increased. Mexico has a high number of infected individuals and deaths by COVID-19, as well as an important burden of metabolic diseases. However, reports about features of Mexican individuals with COVID-19 are scarce. The aim of this study was to evaluate demographic features, clinical characteristics, and the pharmacological treatment of individuals who died by COVID-19 in the south of Mexico. Methods: We performed an observational study including 185 deceased individuals with confirmed diagnosis of COVID-19. Data were retrieved from medical records. Categorical data was expressed as proportions (%) and numerical data were expressed as mean, standard deviation. Comorbidities and overlapping symptoms where plotted as Venn diagrams. Drug clusters were plotted as dendrograms. Results: The mean age was 59.53 years. There was a male predominance (60.1%). The mean hospital stay was 4.75 days. The most frequent symptoms were dyspnea (88.77%), fever (71.42%) and dry cough (64.28%). Present comorbidities were diabetes (60.63%), hypertension (59.57%) and obesity (43.61%). The main drugs used were azithromycin (60.6%), hydroxychloroquine (53.0%) and oseltamivir (27.3%). Conclusions: Mexican individuals who died of COVID-19 had shorter hospital stays, higher frequency of shortness of breath, and higher prevalence of diabetes compared with individuals from other countries. Also, there was a high frequency of off-label use of drugs for their treatment. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. COVID-19 (10). 76 We believe it is important to evaluate which pharmacological treatment are used. Although there is not directed antiviral therapy recommended against SARS-CoV-2 78 (11-13), in our sample some off-label drugs were administrated regardless of what 79 has been observed in clinical trials, particularly at the beginning of the pandemic. All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this this version posted September 23, 2020. . https://doi.org/10.1101/2020.09.21.20199117 doi: medRxiv preprint 5 This was an observational retrospective study performed at the High Specialty 86 Regional Hospital "Dr. Juan Graham Casasús" (HJGC) in Villahermosa, Tabasco, 87 Mexico. We used the medical records of every individual with COVID-19 as the 88 cause of death, who was admitted to the HJGC from April 15th to May 12th, 2020. We performed a descriptive report. Numerical data was expressed as mean ± 98 standard deviation and proportions (%) for categorical data. Gender, age and 99 comorbidities were compared using the Chi-squared test, with significance of p = 100 0.05. Comorbidities and overlapping symptoms where plotted as Venn diagrams. Drug clusters were plotted as dendrograms. All data were analyzed using SPSS 102 v.23. Results. 105 In this study, the files of 185 deceased individuals were included; these individuals 106 had been diagnosed and treated for COVID-19 between April 15 and May 12, 2020 107 All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this this version posted September 23, 2020. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this this version posted September 23, 2020. arthralgia without headache. And fever and shortness of breath (Fig 2) . The most common comorbidities on admission were Type 2 Diabetes (60.63%), 140 hypertension (59.57%) and obesity (43.61%). The main overlap between these 141 All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this this version posted September 23, 2020. . https://doi.org/10.1101/2020.09.21.20199117 doi: medRxiv preprint 8 comorbidities were T2D-Hypertensión. The second cluster was T2DM-142 Hypertension-Obesity and finally Hypertension-Obesity (Fig 3) . Drugs for various purposes (e.g. paracetamol, dexamethasone) were grouped as 152 others, these were given to 66.7% of the patients. Clustering drugs. We observed that azithromycin and hydroxychloroquine were 154 frequently given together, followed by lopinavir-ritonavir with tocilizumab, and 155 oseltamivir with lopinavir-ritonavir or tocilizumab (Fig 4) . preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (10, 15, 18, 19 ). In our sample, shortness of breath was the most prevalent symptom 179 and it was present in every cluster of symptoms, which could indicate that shortness 180 of breath is an early symptom and bad prognosis. The most common comorbidities in our sample were type 2 diabetes, hypertension 182 and obesity. Remarkably, diabetes and hypertension had similar frequencies. In Mexican individuals with COVID-19, it is reported a slightly higher frequency of 184 All rights reserved. No reuse allowed without permission. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this this version posted September 23, 2020. . https://doi.org/10.1101/2020.09.21.20199117 doi: medRxiv preprint hypertension compared with diabetes (8, 10). Nonetheless, in other populations 185 hypertension has a much higher prevalence compared to diabetes (5, 18). In two 186 meta-analyses from the same work group (20, 21), hypertension and diabetes were 187 associated with poor outcomes in COVID-19. The hypertension association was 188 influenced by gender, but not by age or diabetes, while the diabetes association was preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this this version posted September 23, 2020. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this this version posted September 23, 2020. . https://doi.org/10.1101/2020.09.21.20199117 doi: medRxiv preprint Geneva: World 232 Health Organization A Novel Coronavirus 236 from Patients with Pneumonia in China World Health Organization. Naming the coronavirus disease (COVID-19) and 239 the virus that causes it COVID-19): A Review Mexico City: Instituto Nacional de Estadística 254 y Geografía Predicting Mortality Due to SARS-CoV-258 2: A Mechanistic Score Relating Obesity and Diabetes to COVID-19 Outcomes in Impact of Comorbidities in Mexican 262 SARS-CoV-2-Positive Patients: A Restrospective Analysis in a National Cohort Revista de investigacion clinica; organo del Hospital de Enfermedades de la 264 Nutricion Initial Gastrointestinal 267 Manifestations in Patients with SARS-CoV-2 in 112 patients from Veracruz 268 (Southeastern Mexico) Surviving 271 Sepsis Campaign: guidelines on the management of critically ill adults with 272 COVID-19) COVID-19 Treatment Guidelines Panel. Coronavirus Disease Bethesda: National Institutes of Health All rights reserved. No reuse allowed without permission preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this this version posted Secretaría de Salud. Recomendaciones para el tratamiento de la infección 279 por SARS-CoV2, agente causal de COVID-19 China: a cross-sectional study patients' clinical characteristics, discharge rate, and fatality rate of meta-analysis Factors associated with COVID-19-related death using OpenSAFELY Clinical Features, Diagnosis, and Treatment of COVID-19 in Hospitalized 296 Patients: A Systematic Review of Case Reports and Case Series The prevalence of symptoms in 24 All rights reserved. No reuse allowed without permission preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this this version posted doi: medRxiv preprint (SARS-CoV-2; COVID-19): A systematic review and meta-analysis of 148 studies 301 from 9 countries Diabetes mellitus is associated with increased 303 mortality and severity of disease in COVID-19 pneumonia -A systematic review, 304 meta-analysis, and meta-regression Hypertension is 307 associated with increased mortality and severity of disease in COVID-19 pneumonia: 308 A systematic review, meta-analysis and meta-regression Stevens 311 RW, Razonable RR. Treatment Considerations for COVID-19: A Critical Review of 312 the Evidence (or Lack Thereof) Pharmacologic 314 Treatments for Coronavirus Disease 2019 (COVID-19): A Review preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.The copyright holder for this this version posted September 23, 2020. . https://doi.org/10.1101/2020.09.21.20199117 doi: medRxiv preprint