key: cord-0803678-13myvm4c
authors: Parra-Bracamonte, G. M.; Lopez-Villalobos, N.; Parra-Bracamonte, F. E.
title: Clinical characteristics and risk factors for mortality of patients with COVID-19 in a large dataset from Mexico
date: 2020-08-14
journal: Annals of Epidemiology
DOI: 10.1016/j.annepidem.2020.08.005
sha: c98db11c37ff73f14bd0cd54b14602f2c9726ed0
doc_id: 803678
cord_uid: 13myvm4c

Abstract Purpose Purpose of this study was to assess clinical characteristics and risk factors for mortality of patients with COVID-19 from Mexico, given that currently is in active community transmission. Methods Multivariate logistic regression model and Kaplan-Meier survival curves were fitted to study odds of death of characteristics and comorbidities in COVID-19 patients in Mexico. Results Age, sex and the most frequent comorbidities diabetes, obesity and hypertension were significantly associated to risk of death by COVID-19 (P<0.0001). Smoking habits was not identified as risk factor for death. Less frequent comorbidities such as chronic obstructive pulmonary disease, chronic kidney disease and immunosuppressed patients also showed a significant risk for death (P<0.0001). Hospitalized and pneumonia patients had serious risks for mortality (P<0.0001) and more attention to specific conditions might be considered during clinical admission. Conclusions More vulnerable positive patient is depicted by a male patient, older that 41 years, that increase their hazard risk with more prevalent comorbidities diabetes, obesity and hypertension.

Conclusions: More vulnerable positive patient is depicted by a male patient, older that 41 years, 28 that increase their hazard risk with more prevalent comorbidities diabetes, obesity and hypertension.

In December 2019, a coronavirus disease 2019 (COVID-19) outbreak emerged in Wuhan City,

Hubei province in China [1] . COVID-19 is a disease of the respiratory tract characterized by a 36 severe acute respiratory syndrome; the causative agent is a betacoronavirus named SARS-CoV-2 Limited information has been available to describe the characteristics of the affected population and 51 outcomes of the disease so far. Given that the number of infected cases is still increasing it would 52 be important to perform analysis of current data to have a better comprehension of the relative 53 importance of some factors associated to the different events in the development of pandemics and 54 the mortality of the symptomatic COVID-19 patients. As the characteristics and risk factors 55 associated with risk of mortality are unclear, the assessment of available information is 56 fundamental. Hence, the objectives of the present study were to identify characteristics of patients 57 that are current positive cases of COVID-19 in Mexico and assess risk factors for mortality. 

Only 8% of patients diagnosed as COVID-19 positive had smoking habits, the other 92% was 117 recorded with non-smoking habits. Interestingly, 77% of smokers were males. Fatality rate among 118 females and males smokers was 15% and 7%, respectively. Records revealed that 33% of positive 119 cases were previously exposed to contact with other known COVID-19 positive patients. Thirty 120 three percent of patients diagnosed as positive to COVID-19 were hospitalized. More frequent 121 comorbidities of COVID-19 positive patients were hypertension, obesity and diabetes with 20%, 122 20% and 17%, respectively (Table 1) . Deaths associated with these comorbidities were 42%, 26% 123 and 37%, respectively. Fatality rates for these comorbidities were, 25%, 15% and 26%, 124 respectively. Twenty five percent of all positive cases exhibited pneumonia, and 77% of these were 125 non-survivors. Three percent of all positive cases needed the access to intensive care unit.

Odds ratios obtained from the multivariate logistic regression model were estimated for all clinical 128 characteristics of COVID-19 positive patients (Table 2) . Odds ratios for age classes showed a 129 gradual higher mortality risk as the patients become older (P<0.0001). Older categories from 41-60, patients without the comorbidity in all cases. Conversely, males with comorbidities presented 151 lowest survival probabilities, even lower when pneumonia condition is present ( Figure 1 ).

In the present study we analyzed a large dataset of registered positive cases of COVID-19 in 156 Mexico from 13 January to 13 June 2020. To our knowledge, this study represents one the first 157 large case study with confirmed COVID-19 in México. In general, older patients, men, and those 158 with preexisting comorbidities such like hypertension, obesity and diabetes were highly prevalent in 159 this assessment, which is similar pattern to that reported in China 

Our multivariate logistic regression model showed that smoking habit is not significantly associated 179 to the risk of death by COVID-19. Lippi and Henry [13] , using a meta-analysis based on Chinese 

Risk 275 factors for severity and mortality in adult COVID-19 inpatients in Wuhan

Case-fatality rate and characteristics of patients dying in 304 relation to COVID-19 in Italy

The immunopathogenesis of sepsis in elderly patients

Active smoking is not associated with severity of coronavirus disease 310 2019 (COVID-19)

DPP4, the Middle East respiratory syndrome coronavirus 313 receptor, is upregulated in lungs of smokers and chronic obstructive pulmonary disease 314 patients

Clinical characteristics of refractory COVID-19 pneumonia in Wuhan

319 Epidemiology of diabetes mellitus in Mexico

Chronic obstructive pulmonary disease is associated with severe 321 coronavirus disease 2019 (COVID-19)

Prevalence, severity and mortality associated with COPD and 324 smoking in patients with COVID-19: a rapid systematic review and meta-analysis

Kidney 327 disease is associated with in-hospital death of patients with COVID-19

Coronaviruses and immunosuppressed patients: the facts during the third 330 epidemic

Description of COVID-19 in HIV-infected