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Quizhpe E, Montalvo E, Paéz
M, Guevara T, Flores D, et
al. Mortality and associated
risk factors in patients with
COVID-19: A hospital based
study in Ecuador Scientic
Magazine INSPILIP. 2022; 6
(1).
The author declares to be free of any
personal or commercial association
that could suppose a conict of
interest in connection with the article,
as well as having respected the
ethical principles of research, such as
having requested the authorizations
of the institution where the study
was carried out. , permission to use
the data, informed consent and in
the case of observational studies and
clinical trials, authorization from
a CEISH, ARCSA, Environment,
among others, according to the
category. In addition, the license
to publish images of the person or
persons that appear in the manuscript.
For this reason, INSPILIP is not
responsible for any aectation to
third parties, neither is INSPI as the
publishing entity, nor the Editor, the
responsibility of the publication is
the absolute responsibility of the
authors.
Edy Quizhpe
a,b,c
, edy.quizhpe@umu.se
Eduardo Montalvo
b
, eduardo.montalvo@hgdc.gob.ec
Maritza Paéz
b
, maritza.paez@hgdc.gob.ec
Tatiana Guevara
b
, tatiana.guevara@hgdc.gob.ec
Danny Flores
b
, danny.ores@hgdc.gob.ec
Dennise Costales
b
, denissempc@hotmail.com
Luis Vidal
b
, luis.vidal@hgdc.gob.ec
Augusto Maldonado
b
,
d
, mald1544@hotmail.com
a. Umea University. Umea, Sweden.
b. General Teaching Calderon Hospital. Quito, Ecuador.
c. San Francisco of Quito University. Quito, Ecuador.
d. Hofstra/Northwell University. New York, United States.
Correspondence: Edy Quizhpe E-mail: edy.quizhpe@umu.se
Identication of the responsibility and contribution of the authors: (EQ) Formal analysis:
(EQ, AM). Investigation: (EQ, EM, MP, TG, D F, DC, LV, AM). Methodology: (EQ, EM, MP,
TG). Writing – original draft: (EQ) Writing – review & editing: (EQ, MP, AM)
Date of admission: 18/10/2021. Approval date: 04/04/2022. Publication date: 05/05/2022.
Mortality and associated risk factors in patients with COVID-19
A hospital-based study in Ecuador
Mortalidad y factores de riesgo asociados en pacientes con COVID-19
Un estudio hospitalario en Ecuador
iD
iD
iD
iD
iD
iD
iD
iD
DOI: https://doi.org/10.31790/inspilip.v6i1.266
Original article
Open access
Abstract
Citatión
Background: Since the coronavirus disease 2019 (COVID-19) pandemic, increased
mortality has been reported in Ecuador, with an additional 59,000 deaths during
2019–2020, approximately doubling the mortality from other causes. Although Latin
America has faced epidemics of non-communicable diseases over the past decades,
the devastating eect of COVID-19 is unprecedented. This study aimed to describe
the clinical characteristics and risk factors observed in patients with COVID-19
treated in a general hospital in Ecuador. Methods: This hospital-based study was
conducted from March to July 2020. We obtained data from the clinical records of
157 adult men and women diagnosed with COVID-19 using the reverse transcrip-
tion-polymerase chain reaction test and admitted to an emergency service room. We
used descriptive statistics and performed a chi-square test and logistic regression
analysis to analyze the associations between the categorical variables. Results: We
found that the overall mortality rate was 37 % and was higher in men (39 %) than
in women (31 %). We observed a high prevalence of comorbidities (45 %) related
to non-communicable diseases, particularly diabetes and hypertension, signicantly
associated with mortality rates. Similarly, distribution by gender and abnormalities
in blood markers such as leukocytes, PO2, and D-dimer increased the risk of death.
Conclusions: The high and extensive prevalence of non-communicable diseases was
a risk factor for high mortality among patients diagnosed with COVID-19. In Latin
American countries, healthcare systems continue to experience severe challenges in
treating patients with such comorbid health conditions.
Keywords: COVID-19. Mortality. Ecuador. Non-communicable Diseases. Latin
America.
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Resumen
Antecedentes: Desde la pandemia de la enfermedad
por coronavirus 2019 (COVID-19), se ha informado
un aumento de la mortalidad en Ecuador, con
59 000 muertes adicionales durante 2019-2020,
aproximadamente el doble de la mortalidad por
otras causas. Aunque América Latina ha enfrentado
epidemias de enfermedades no transmisibles en las
últimas décadas, el efecto devastador de la COVID-19
no tiene precedentes. Este estudio tuvo como objetivo
describir las características clínicas y los factores
de riesgo observados en pacientes con COVID-19
atendidos en un hospital general de Ecuador. Métodos:
Este estudio hospitalario se realizó de marzo a julio
de 2020. Se obtuvo datos de las historias clínicas
de 157 hombres y mujeres adultos diagnosticados
con COVID-19 mediante la prueba de reacción en
cadena de la polimerasa con transcriptasa inversa e
ingresados en una sala de servicio de emergencia. Se
utilizó estadística descriptiva y se realizó una prueba
de chi-cuadrado y análisis de regresión logística
para analizar las asociaciones entre las variables
categóricas. Resultados: Encontramos que la tasa
de mortalidad global fue del 37 % y fue mayor en
hombres (39 %) que en mujeres (31 %). Se observó
una alta prevalencia de comorbilidades (45 %)
relacionadas con enfermedades no transmisibles,
en particular diabetes e hipertensión, asociadas
signicativamente con las tasas de mortalidad. De
manera similar, la distribución por género y las
anomalías en los marcadores sanguíneos como
leucocitos, PO2 y dímero D aumentaron el riesgo
de muerte. Conclusiones: La alta prevalencia de
enfermedades no transmisibles fue un factor de riesgo
de alta mortalidad entre los pacientes diagnosticados
con COVID-19. En los países latinoamericanos,
los sistemas de salud continúan experimentando
desafíos severos en el tratamiento de pacientes con
tales condiciones de salud comórbidas.
Palabras clave: COVID-19. Mortalidad. Ecuador.
Enfermedades no Transmisibles. América Latina.
Introduction
The global spread of the novel severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) that causes
coronavirus disease 2019 (COVID-19) has severely
damaged economies and health systems worldwide.
In Latin America, COVID-19 has mainly aected
countries with high socioeconomic inequalities, such
as Brazil, Peru, and Ecuador, and most of these cases
have been correlated with social determinants such as
poverty, humanitarian crises, fragile health systems,
and persistent inequalities. Moreover, the continued
increase in non-communicable diseases such as
obesity and diabetes are likely the main contributors
to the elevated mortality rates
1
Ecuador is a middle-income Latin American country
characterized by high socioeconomic inequalities
and ethnic diversity
2
Its healthcare system is exceedingly fragmented, with
several sub-systems distributed throughout the public
and private sectors. The former includes the Ministry
of Health and the Ecuadorian Institute of Social
Security (Instituto Ecuatoriano de Seguridad Social
in Spanish), providing health insurance coverage to
the underprivileged and formal sector employees
3
However, the COVID-19 pandemic has resulted in
high mortality in Ecuador,
4
causing an additional
59000 deaths between 2019 and 2020, and
5
approximately doubling the existing mortality from
other causes. Very few studies have focused on
describing the main clinical characteristics and degree
of association between risk factors and mortality at
the local level
6
The pandemic peaked between 2019 and 2020,
creating severe limitations for patients to access
healthcare services, particularly intensive care
units.
7,8
This study aimed to describe the main clinical
characteristics and risk factors associated with
mortality in adult patients without health insurance
who were admitted into an emergency service room
in a hospital in Quito, the capital of Ecuador.
Methods
This hospital-based study recruited 157 patients,
both men and women, aged 18 years and above. All
patients admitted into the emergency service room
for suspected COVID-19 infection in a general
hospital in Quito between March to July 2020 were
included in the sample. Diagnoses were conrmed by
the reverse transcription-polymerase chain reaction
(RT-PCR) test.
The main sociodemographic characteristics and
clinical data were obtained from the epidemiological
surveillance system and the individuals’ medical
records. The laboratory conrmation of the
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Furthermore, 35.03 % of the patients died (39.02
% men and 30.67 % women). However, signicant
mortality (P= 0.02) was observed in the patients
with Medium NEWS2 scores as compared to those
with High NEWS2 scores (54.55 % and 42.82 %,
respectively), which were found to be higher in men
in cases with High NEWS2 score (71.88%).
Additionally, increased mortality (52.73 %) was
observed in patients aged 65 years and above and
was higher in women (56.52 %). Nevertheless, in
the 50–64 years group, men had signicantly higher
mortality (P= 0.02), more than twice that of women
(43.75 % and 17.39 %, respectively).
The multi-regression analysis was adjusted for age.
The probability of death increased with each day of
illness (OR: 1.04, 95% IC: 0.95-1.12) and was higher
in women (OR: 1.96, 95 % IC: 0.82-3.22). The
presence of comorbidities increased this probability
signicantly (OR: 2.38, 95% IC: 1.14-4.93). Patients
with diabetes (OR: 2.23, 95% IC: 0.76-6.48) and those
with hypertension (OR: 1.25, 95 % IC: 0.51-3.08)
were two times more likely to succumb to it.
Although diabetes and hypertension increased the
risk of death, it was not signicant (OR: 2.43, 95
% IC: 0.82-7.21). The analysis of sex dierences,
based on laboratory ndings, revealed poor health
outcomes for men regarding the severity of their
symptoms and mortality, whereas women suered
mostly from comorbidities and were at an increased
risk of death based on their age.
SARS-CoV-2 infection was performed using the
RT-PCR assay in nasopharyngeal swabs. The time of
illness was dened as the date of onset of symptoms
such as cough and fever. Furthermore, illness severity
was evaluated using the National Early Warning
Score 2 (NEWS2)
9
The laboratory parameters were evaluated
according to those recommended for the city of
Quito. Descriptive statistics were calculated for the
demographic and clinical data. The chi-square test
and logistic regression analysis were employed to
evaluate the associations between the variables.
The statistical analysis was performed using STATA
version 15.0. The Ecuadorian Ethical National
Committee approved the protocol of this study of
COVID-19 created by the Ecuadorian Ministry of
Health.
Results
Demographic and clinical characteristics
Table 1 presents the patients’ main characteristics.
The proportions of women and men were 48% and
52%, respectively. About 78 % of the patients were
aged over 50. Most patients had low educational
attainment (61 % had completed only primary
school). The average time from the onset of symptoms
was 7.4 days, longer in men (8.03) than in women
(6.73). Cough (77.07 %) and dyspnea (75.64 %) were
the most prevalent symptoms, followed by fever
(58.60 %) and fatigue (55.41 %), all of which were
more common in men.
Additionally, the association between symptoms
and mortality showed no signicant dierences.
Overall, while anosmia, runny nose, exanthema, and
conjunctive injection were almost absent, only fever
showed statistically signicant dierences between
the sexes (P= 0.00). All patients had tachypnea
(a mean respiratory frequency of 27.17) and oxygen
saturation below 90% (76.96 %; women 76.85 %; men
77.06 %). Those patients who died had signicantly
lower levels of saturation (69.27 %; P= 0.00).
Mortality distribution
The mortality and symptom severity distribution
among patients are presented in Table 2.
The mean score of the NEWS2 was 6.68 points,
indicating a high proportion of severe cases; all
the values were higher for men than for women.
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Variables
Total N (%)
Pa�ents died
P
157 (100)
55 (35.03)
Age group (years)
20 to 49 35 (22.29) 8 (14.55) 27 (26.47)
50 to 64
60 (38.22)
18 (32.73)
0.03
Above 65
62 (39.49)
29 (52.73)
Educa�on
None
23 (14.65)
11 (20.00)
Primary
96 (61.15)
29 (52.73)
0.27
Secondary
33 (21.02)
14 (25.45)
High
5 (3.18)
1 (1.82)
Comorbidi�es
Yes
71 (45.22)
20 (36.36)
0.10
No
86 (54.78)
35 (63.64)
Chronic diseases
Hypertension
28 (17.83)
10 (18.18)
0.93
Diabetes
23 (14.65)
5 (9.09)
0.14
Signs and Symptoms
Time of illness (days)
7.4 (6.73-8.06)
6.94 (8.85-8.03)
0.29
Cough
121 (77.07)
40 (72.73)
0.34
Dyspnea
118 (75.64)
45 (81.82)
0.18
Fever
92 (58.60)
24 (43.64)
0.00
Fa�gue
87 (55.41)
28 (50.91)
0.40
Sore throat
27 (17.20)
10 (18.18)
0.81
Cephalea
26 (16.56)
10 (18.18)
0.68
Produc�ve cough
26 (16.56)
8 (14.55)
0.61
Diarrhea
23 (14.65)
6 (10.91)
0.33
Myalgia
17 (10.83)
9 (16.36)
0.10
Nausea
9 (5.73)
5 (9.09)
0.18
Runny nose
7 (4.46)
2 (3.64)
0.71
Anosmia
2 (1.27)
0 (0.00)
0.29
Basic measures
Temperature
37.18 (37.04-37.32)
37.16 (36.92-37.40)
0.82
Respiratory frequency
27 (25.97-28.37)
29 (26.49-30.88)
0.06
Oxygen satura�on (%) 77 (74.69-79.22) 69 (64.84-73.69) 81 (78.89-83.31) 0.00
Systolic blood pressure 127 (123.11-129.90) 124 (117.96-130.25) 128 (123.70-131.90) 0.30
Pulse (bpm) 99 (96.03-102.09) 100 (95.33-106.19) 100 (96.26-105.22) 0.41
Glasgow scale 15 (14.72-14.99) 15 (14.21 - 14.98) 15 (15.00 - 15.00)
0.00
Table 1. Demographic and clinical characteriscs of paents with COVID-19 admied to the hospital
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Laboratory ndings
Table 3 presents the laboratory ndings according to
sex dierences and nal health outcomes.
The mean number of leukocytes and neutrophils was
higher than estimated. Furthermore, the lymphocyte
count indicated lymphopenia in men but not in women
(P= 0.02). The patients who died had signicantly
greater leukocytes and neutrophils than those who
survived (P= 0.00).
Those who died, specically men, had signicantly
elevated inammatory and infectious markers
(P= 0.05). Most of the patients presented hypoxia
(PO2 mean: 56.58 mmHg (53.45-59.72)); however,
this dierence was insignicant between men and
women.
Severity of illness
Total N (%)
Women N (%)
Men N (%)
P
NEWS2 Score
6.68 (6.36-6.99)
6.44 (5.97-6.90)
6.90 (6.48-7.32)
0.14
NEWS2 Score 1 -4 (LOW) 22 (14.01) 13 (17.33) 9 (10.98)
0.24 NEWS2 Score 5 -6 (MEDIUM) 47 (29.94) 25 (33.33) 22 (26.83)
NEWS2 Score >7 (HIGH) 88 (56.05) 37 (49.33) 51 (62.20)
Mortality
Overall 55 (35.03) 23 (30.67) 32 (39.02) 0.27
Mortality by NEWS2 Score
NEWS2 Score 1 -4 (LOW )
2 (3.64)
0 (0.00)
2 (6.25)
0.01
NEWS2 Score 5 -6 (MEDIUM ) 30 (54.55) 8 (34.78) 7 (21.88)
NEWS2 Score >7 (HIGH ) 23 (41.82) 15 (65.22) 23 (71.88)
Mortality by age group
20 to 49 8 (14.55) 6 (26.09) 2 (6.25)
0.03 50 to 64 18 (32.73) 4 (17.39) 14 (43.75)
Above 65 29 (52.73) 13 (56.52) 16 (50.00)
Table 2. Distribuon of paents with COVID-19 hospitalized according
to symptom severity and mortality by sex and age
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Table 3. Laboratory findings in paents with COVID-19 hospitalized by final health outcome
White cells Total (mean)
Pa�ents died
Pa�ents survive
P
Leukocytes (<4.5×10
9
/L -
>10×10
9
/L) N=156
10.21 (9.45-10.97) 13.03 (11.62-14.45) 8.69 (7.94-9.44) 0.00
Lymphocytes (<1.1×10
9
/L
- >3.2×10
9
/L) N=156
1.15 (1.06-1.24) 1.13 (0.93-1.33) 1.16 (1.08-1.25) 0.72
Neutrophils (<2.2×10
9
/L -
>4.8×10
9
/L) N=156
8.52 (7.78 – 9.26) 11.19 (9.82-12.56) 7.08 (6.34-7.82)
0.00
Platelets (<150×10
9
/L-
>450×10
9
/L) N=156
280.23 (265.99-294.48) 281.23 (261.06-301.40) 279.69 (260.41-298.97)
0.91
Blood chemistry
Fibrinogen (<350 mg/dl)
N=96
639.82 (606.40-673.23) 634.52 (571.38-697.65) 643.29 (604.87-681.71) 0.80
Crea�nine (<1.25 mg/dl)
N=152
1.23 (0.96-1.49) 1.36 (1.05-1.66) 1.16 (0.79-1.53) 0.48
Urea (<42.9 mg/dl) N=1 54 46.77 (40.84-52.70) 59.46 (46.93-71.99) 39.99 (34.07-45.91) 0.00
TP (<13.7 s) N=140 12.12 (11.85-12.40) 12.44 (12.12-12.76) 11.95 (11.56-12.34) 0.09
TTP (<36.2 s) N=140 34.41 (33.34-35.48) 35.15 (33.21-37.10) 34.00 (32.72-35.28) 0.30
AST (<34 U/L) N= 145 53.84 (48.15-59.53) 63.13 (50.01-76.26) 48.79 (43.71-53.88) 0.01
ALT (<55 U/L) N=140 51.65 (43.43-59.86) 59.57 (37.62-81.52) 47.64 (41.79-53.49) 0.17
LDH (M:<275 U/L W:
<290 U/L) N=124
443.38 (412.08 – 474.6) 534.91 (472.89-596.92) 396.49 (365.08-427.91) 0.00
PCR (0.5 mg/dl) N=101 17.12 (13.31-20.94) 23.34 (12.31-34.37) 13.97 (12.53-15.42) 0.02
D-dimer (<500 ug/ml)
N=113
1685.35 (1228.13-2142.57) 2998.11 (1671.68-4324.55) 1120.36 (850.52-1390.20)
0.00
Troponin (39.2 pg/ml)
N=85
53.54 (21.40-85.59) 64.06 (29.09-99.04) 48.01 (2.24-93.95) 0.63
Ferri�n (<274 ng/ml)
N=127
964.6 (837.9 – 1091.2) 957.37 (765.95 – 1148.79) 967.72 (804.29 – 1131.15) 0.94
PCO2 (40 mmHg) N=149 32.51 (31.20-33.81) 33.73 (30.61-36.84) 31.82 (30.72-32.92) 0.16
PO2 (60 mmHg) N =149 56.58 (53.45-59.72) 52.98 (47.72-58.25) 58.61 (54.69-62.52) 0.08
Lactate (2.0 mmol/L)
N=149
2.19 (1.96-2.41) 2.72 (2.18-3.25) 1.89 (1.72-2.06) 0.00
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Discussion
Comorbidities were identied as the leading risk
factor for higher mortality in COVID-19 cases
during the study. Symptoms such as cough, dyspnea,
fever, and fatigue indicated that they had severe acute
respiratory syndrome. These ndings are consistent
with the World Health Organization’s concern that
people with these specic clinical characteristics
are at greater risk of contracting COVID-19
10-12
Furthermore, these results conform to the initial
cases reported in China
13-15
Our research highlights the risk factors associated
with high mortality, as previous studies conducted in
Peru and Brazil
16
The high prevalence of comorbidities such as
hypertension (44.6 %) and diabetes (33.5 %) in
Ecuador and other Latin American countries may be
key factors contributing to the rise in their mortality
rate compared with the other countries
17-19
Similar to previous research, we found that patients
with uctuations in blood inammatory reaction
markers had the weakest prognosis of health
outcomes
20
Specically, men had signicantly clinical severe
and laboratory ndings, which can be explained by
their immune system’s response to genetic issues
21
The increased probability of death in women could
be due to comorbidities such as obesity, diabetes, and
hypothyroidism, as reported by several studies
22,23
Moreover, our results highlighted the association
statistically signicant between biomarkers such
as D dimer, LDH, PO2, and urea as a predictor of
mortality
24
Nevertheless, this research has certain limitations.
The evaluated patients were recruited from a single
hospital; therefore, the results may not be nationally
representative of the situation. In addition, many
patients were unable to access the RT-PCR test
due to several factors, such as illness severity,
limited availability of testing kits, and lack of time
for sampling, which could have resulted in an
under-registration of the mortality cases during this
period.
Conclusion
This study increases the understanding of the clinical
course of infection and its correlation with several
risk factors. Mortality was strongly related to the
presence of diabetes and hypertension in Ecuador.
The presence of these comorbidities and lack of
access to health care services may have increased
the mortality in patients with COVID-19. We
recommend addressing groups with these specic
clinical characteristics on a priority basis due to the
high prevalence in the regional context. Additionally,
specic medical scales and blood markers during
health care must be considered in medical practice.
Abbreviations:
AST: Aspartate aminotransferase, PO2: partial
pressure of oxygen, COVID-19: coronavirus disease
2019.
Competing interests: The authors report no conict
of interest.
Grant information: This study did not receive any
funding.
Ethical considerations: This study was approved
for the national committee created for the COVID-19
research by the Minister of Health.
Acknowledgment: The authors would like to
thank the authorities of General Teaching Calderon
Hospital.
References
1. COVID-19 in Latin America: a humanitarian crisis.
Lancet. 2020;396(10261):1463. https://doi.org/10.1016/
S0140-6736(20)32328-X
2. Censo de Población y Vivienda 2010 Ecuador [https://
www.ecuadorencifras.gob.ec/base-de-datos-cen-
so-de-poblacion-y-vivienda/] Accessed on December
12, 2019.
3. Lucio R, Villacrés N, Henríquez R. Sistema de salud
de Ecuador [The health system of Ecuador]. Salud
Publica Mex. 2011;53(2):s177–187.
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4. Atamari-Anahui N, Cruz-Nina ND, Condori-Huaraka
M, Nuñez-Paucar H, Rondón-Abuhadba EA,
Ordoñez-Linares ME, Pereira-Victorio CJ.
Characterization of coronavirus disease 2019
(COVID-19) in children and adolescents in Latin
American and the Caribbean countries: A descriptive
study. Medwave. 2020;20(8):e8025. Spanish. https://
doi: 10.5867/medwave.2020.08.8025.
5. Torres I, Sacoto F. Localising an asset-based COVID-19
response in Ecuador. Lancet. 2020;395(10233):1339.
https://doi.org/10.1016/s0140-6736(20)30851-5
6. Ortiz-Prado E, Simbaña-Rivera K, Barreno LG, Díaz
AM, Barreto A, Moyano C, et al. Epidemiological,
socio-demographic and clinical features of the early
phase of the COVID-19 epidemic in Ecuador. PLoS
Negl Trop Dis. 2021;15(1):e0008958. https://doi.
org/10.1371/journal.pntd.0008958
7. Navarro JC, Arrivillaga-Henríquez J, Salazar-Loor
J, Rodriguez-Morales AJ. COVID-19 and dengue,
co-epidemics in Ecuador and other countries in Latin
America: Pushing strained health care systems over the
edge. Travel Med Infect Dis. 2020;37:101656. https://
dx.doi.org/10.1016%2Fj.tmaid.2020.101656
8. Burki T. COVID-19 in Latin America. Lancet
Infect Dis. 2020;20(5):547-548. https://dx.doi.
org/10.1016%2FS1473-3099(20)30303-0
9. NICE NEWS2 Score. https://www.cebm.net/covid-19/
should-we-use-the-news-or-news2-score-when-as-
sessing-patients-with-possible-covid-19-in-primary-
care/ Accessed December 12, 2020.
10. Andrus JK, Evans-Gilbert T, Santos JI, Guzman MG,
Rosenthal PJ, Toscano C, et al. Perspectives on battling
COVID-19 in Latin America and the Caribbean
countries. Am J Trop Med Hyg. 2020;103(2):593–596.
https://dx.doi.org/10.4269%2Fajtmh.20-0571
11. Ji Y, Ma Z, Peppelenbosch MP, Pan Q. The potential
association between COVID-19 mortality and
healthcare resource availability. Lancet Global
Health. 2020;8(4):e480. https://doi.org/10.1016/
s2214-109x(20)30068-1
12. World Health Organization. COVID-19: vulnerable
and high-risk groups. https://www.who.int/
westernpacific/emergencies/covid-19/information/
high-risk-groups Accessed December 12, 2020.
13. 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;382:1708-20. https://doi.
org/10.1056/NEJMoa2002032
14. Huang C, Wang Y, Li X, Ren L, Zhao J, Fan G,
et al. Clinical features of patients infected with
2019 novel coronavirus in Wuhan, China. Lancet.
2020;395(10223):497-506. https://doi.org/10.1016/
S0140-6736(20)30183-5
15. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical
course and risk factors for mortality of adult inpatients
with COVID-19 in Wuhan, China: a retrospective
cohort study. Lancet. 2020;395(10229):1054–1062.
https://doi.org/10.1016/S0140-6736(20)30566-3
16. Munayco C, Chowell G, Tariq A, Undurraga EA,
Mizumoto K. Risk of death by age and gender
from CoVID-19 in Peru, March-May 2020.
Aging. 2020;12(14):13869-13881. https://dx.doi.
org/10.18632%2Faging.103687
17. 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;323:1574-1581. doi:10.1001/jama.2020.5394
Código ISSN 2588-0551
https://www.inspilip.gob.ec
Mortality and associated risk factors in patients with COVID-19
Quizhpe E
37
6
6
Magazine INSPILIP - V 6 - Number 1 - May 2022
Código ISSN 2588-0551
18. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al.
Clinical characteristics of 138 hospitalized patients
with 2019 novel coronavirus–infected pneumonia
in Wuhan, China. JAMA. 2020;323(11):1061-1069.
https://doi.org/10.1001/jama.2020.1585
19. Indicadores Básicos de salud. PAHO. 2018. https://
iris.paho.org/handle/10665.2/49511
20. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation
parameters are associated with poor prognosis
in patients with novel coronavirus pneumonia. J
Thromb Haemost. 2020;18(4):844–847. https://doi.
org/10.1111/jth.14768
21. Gal-Oz ST, Maier B, Yoshida H, Seddu K,
Elbaz N, Czysz C, et al. ImmGen report: sexual
dimorphism in the immune system transcriptome. Nat
Commun. 2019;10(4295). https://doi.org/10.1038/
s41467-019-12348-6
22. Xu XW, Wu XX, Jiang XG, Xu KJ, Ying LJ, Ma CL,
et al. Clinical ndings in a group of patients infected
with the 2019 novel coronavirus (SARS-Cov-2)
outside of Wuhan, China: retrospective case series.
BMJ. 2020;368:m606. https://doi.org/10.1136/bmj.
m606
23. Zheng Z, Peng F, Xu B, Zhao J, Liu H, Peng J, et al.
Risk factors of critical & mortal COVID-19 cases: A
systematic literature review and meta-analysis. J Infect.
2020;81(2):e16–e25. https://dx.doi.org/10.1016%2Fj.
jinf.2020.04.021
24. Asghar MS, Haider Kazmi SJ, Khan NA, Akram
M, Hassan M, Rasheed U, Ahmed Khan S. Poor
Prognostic Biochemical Markers Predicting Fatalities
Caused by COVID-19: A Retrospective Observational
Study From a Developing Country. Cureus. 2020 Aug
5;12(8):e9575. doi: 10.7759/cureus.9575.