Associated factors for mortality in a COVID-19 colombian cohort: is the third wave relevant when Mu variant was predominant epidemiologically?

OBJECTIVES: To evaluate the association between Colombia's third wave when the Mu variant was predominant epidemiologically (until 75%) in Colombia and COVID-19 all-cause in-hospital mortality. METHODS: In this retrospective cohort, we included hospitalized patients ≥18 years with SARS-CoV-2 infection between March 2020 to September 2021 in ten hospitals from three cities in Colombia. Description analysis, survival, and multivariate Cox regression analyses were performed to evaluate the association between the third epidemic wave and in-hospital mortality. RESULTS: A total of 25,371 patients were included. The age-stratified time-to-mortality curves showed differences according to epidemic waves in patients ≥75 years (log-rank test p = 0.012). In the multivariate Cox analysis, the third wave was not associated with increased mortality relative to the first wave (aHR 0.95; 95%CI 0.84-1.08), but there was an interaction between age ≥75 years and the third wave finding a lower HR for mortality (aHR 0.56, 95%CI 0.36-0.86). CONCLUSIONS: We did not find an increase in in-hospital mortality during the third epidemic wave in which the Mu variant was predominant in Colombia. The reduced hazard in mortality in patients ≥75 years hospitalized in the third wave could be explained by the high coverage of SARS-CoV-2 vaccination in this population and patients with underlying conditions.

Impact of SARS-CoV-2 vaccination in healthcare workers in a network of clinics in Latin America.

Objectives: Healthcare workers (HCWs) have been severely affected in terms of both morbidity and mortality since the beginning of the COVID-19 pandemic. During the first few months of 2021, Colombia experienced a surge in positive cases. This study aimed to evaluate the effect of vaccination on the incidence of new positive cases in HCWs. Design: This was a retrospective cohort study of frontline employees in a network of clinics in Colombia, who were prioritized for COVID-19 vaccination from February to March 2021. Results: Our findings were consistent with recent reports. During early 2020, the incidence of HCWs positively diagnosed with COVID-19 in Colombia was higher than that for the general population. With the start of the national vaccination program, the incidence among HCWs decreased from April 2021, while that for the general population remained relatively unchanged. Our study identified lower infection rates among HCWs during April (odds ratio [OR], 0.72 [95% CI 0.58-0.90]; p < 0.01) and May (odds ratio [OR], 0.25 [95% CI 0.18-0.36]; p < 0.01). Conclusions: COVID-19 vaccination rollout in Colombia during early 2021 led to a decrease in the incidence of new positive cases among HCWs, in contrast to a continuing surge in the general population. Our findings suggested that COVID-19 vaccination provided adequate immunity, which guaranteed protection to HCWs.

Características clínicas, morbilidad y mortalidad de los pacientes con síndrome coronario agudo y elevación del segmento ST en la derivada aVR / Clinical features, morbidity and mortality of patients with acute coronary syndrome and elevation of the ST segment in the lead aVR

Objetivo. Determinar las características clínicas, morbilidad y mortalidad de los pacientes con síndrome coronario agudo (SICA) y elevación del segmento ST en aVR. Material y Métodos. Estudio descriptivo y retrospectivo. Se evaluó 219 historias clínicas de pacientes con el diagnóstico de síndrome coronario agudo (SICA). Se registró datos demográficos, factores de riesgo de enfermedad coronaria, tipo de SICA; datos clínicos, electrocardiográficos, ecocardiográficos y angiográficos; mortalidad y morbilidad. Los pacientes con elevación del segmento ST en aVR > 0,5 mm se incluyó en el grupo aVR(+) y los pacientes sin elevación del segmento ST en aVR, en el grupo aVR(-). resultadOs. Cincuenta y dos pacientes (23,7%) estuvieron en el grupo aVR(+). Al comparar las características del grupo aVR(+) respecto al grupo aVR(-) se encontró: clase Killip-Kimbal > II en 42,3% vs. 24,5% (p = 0,024), score TIMI intermedio/ alto en 90,4% vs. 60,5% (p < 0,001), infradesnivel del ST en 88,5% vs 46,1% (p < 0,001); no hubo diferencias en la frecuencia cardíaca ni la presión arterial, ni en fracción de eyección entre ambos grupos. La frecuencia de lesión del tronco coronario izquierdo (TCI) en ambos grupos fue: 16,7% vs. 2,6% (p = 0,045); lesión de la arteria descendente anterior (DA): 83,3% vs. 53,2% (p = 0,045); lesión de tres vasos (3V): 44,4% vs. 10,4% (p = 0,001); lesión de TCI y/o 3V: 50% vs. 12,9% (p < 0,001). La mortalidad fue 15,4% vs. 6,6% (p = 0,049) entre ambos grupos; además hubo mayor indicación de revascularización urgente, mayor frecuencia de shock cardiogénico e insuficiencia cardíaca en el grupo aVR (+). cOnclusión. Los pacientes aVR(+) en el SICA presentaron una mayor clase Killip-Kimbal, un mayor score TIMI, una enfermedad coronaria más severa, mayor mortalidad, mayor necesidad de revascularización urgente y mayor frecuencia de insuficiencia cardíaca y choque cardiogénico.

Objective. Determine the clinical characteristics, morbidity and mortality of patients with acute coronary syndrome(ACS) and ST-segment elevation in lead aVR. Material and Methods. A descriptive and retrospective study was carried out. We evaluated 219 medical records of patients with diagnosis of cute coronary syndrome (ACS). Demographic data, risk factors for coronary heart disease, type of ACS; clinical, electrocardiographic, echocardiographic and angiographic findings; mortality andmorbidity were recorded. Patients with ST elevation in aVR > 0,5 mm were included in the aVR(+) group and patients without ST-segment elevation in lead aVR were in the aVR(-) group. results. 52 patients (23,7%) were in the aVR(+) group. Comparing characteristics in aVR(+) group with aVR(-) group was found: Killip-Kimball class > II in 42,3% vs. 24,5% (p = 0,024), intermediate/high TIMI score in 90,4% vs. 60,5% p < 0,001), ST-depression in 88,5% vs. 46,1% (p < 0,001) there were no differences in heart rate, arterial pressure, or ejection fraction versus aVR(-) group. Left main artery (LM) disease in both groups was: 16,7% vs. 2,6% (p = 0,045), left anterior descending artery disease: 83,3% vs. 53,2% (p = 0,045), 3-vessel disease (3VD): 44,4% vs. 10,4% (p = 0,001), LM/3V disease: 50% vs. 12,9% (p < 0,001). Mortality was 15,4% in the aVR(+) group and 6,6% in aVR(-) group (p = 0,049), moreover indication for urgent revascularization, frequency of cardiogenic shock and heart failure were greater in the aVR(+) group. cOnclusiOn. Patients with ST-segment elevation in aVR during ACS had a higher Killip-Kimball class, higher TIMI score, more severe coronary heart disease, higher mortality, higher indication for urgent revascularization and higher frequency of heart failure and cardiogenic shock.