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Background: The prognostic value of the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in patients with COVID-19 is rarely described in older adults. We aimed to estimate the prognostic value of NLR and PLR, determining the mortality of adults over 60 years of age hospitalized for COVID-19 in three hospitals in Peru from March to May 2020. Methods: We performed a secondary analysis of data from a retrospective cohort carried out in Lambayeque, Peru, from March 18 to May 13, 2020. Older adults hospitalized for COVID-19 were included. The outcome variable was in-hospital mortality by all causes, while the exposure variable was the NLR and PLR (categorized in tertiles and numerically, performing a logarithmic transformation). We included sociodemographic variables, comorbidities, vital functions, laboratory markers, and treatment received during hospital stay. We evaluated the association between NLR and PLR using the hazard ratio (HR) in a Cox regression model. We estimated HR with their respective 95% confidence intervals (95% CI). We estimated cumulative/dynamic time-dependent ROC curves and reported area under the curve ROC (AUC-ROC) for 15-, 30-, and 60-day mortality with their respective simultaneous confidence intervals (confidence bands (CB)). Also, we estimated an optimal cut-off point based on the maximally selected rank statistics. Results: A total of 262 hospitalized older adults were analyzed, 71.8% (n = 188) of whom were male with a median age of 70 years (interquartile range: 65-78). The mean NLR and PLR were 16.8 (95% CI: 14.9-18.7; SD: 15.5) and 50.3 (95% CI: 44.6-55.9; SD: 46.3), respectively. The mortality rate was 68.7% (95% CI: 62.7-74.3). The adjusted Cox regression analysis showed that the high NLR (adjusted HR (aHR) = 2.12; 95% CI: 1.43-3.14) and PLR (aHR = 1.90; 95% CI: 1.30-2.79) tertiles were associated with a higher risk of mortality. The maximum AUC-ROC values at 60 days of follow-up for NLR and PLR were 0.713 (95%CB: 0.627-0.800) and 0.697 (95%CB: 0.583-0.754), respectively. Conclusions: The NLR and PLR are predictors of higher risk of mortality, and these results suggest that both could be reliable and practical markers for the identification of older adults at high risk of mortality by COVID-19. NLR and PLR have prognostic value, with an AUC greater than 0.5; however, by themselves, they are weak prognostic markers. It is important to carry out future studies incorporating these two markers into preexisting models or designing new ones considering them.
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COVID-19 , Neutrófilos , Anciano , Biomarcadores , Femenino , Humanos , Linfocitos , Masculino , Persona de Mediana Edad , Perú , Estudios RetrospectivosRESUMEN
Introducción: Uno de los indicadores del impacto del establecimiento de prioridades en investigación en salud es la producción científica. EsSalud planteó nueve temas de investigación prioritarios (TIP) y 20 preguntas de investigación prioritarias (PIP) 2017-2019. Evaluamos el alineamiento a estas prioridades de investigación en los artículos científicos publicados con filiación de EsSalud durante 2017-2020, y caracterizamos aquellos financiados por esta institución. Material y Métodos: Análisis de los artículos científicos registrados en la base de datos de producción científica de EsSalud 2017-2020. Empleamos una metodología estandarizada y por duplicado para evaluar el alineamiento a los TIP y PIP 2017-2019 de EsSalud. La evaluación del alineamiento a las PIP sólo lo realizamos en artículos originales y resúmenes de congreso. Reportamos frecuencias de alineamiento a cada TIP y PIP, y frecuencia de alineamiento a por lo menos un TIP según características de los artículos. Además, se reportó las características de los artículos financiados por EsSalud. Resultados: Un total de 170 de 1283 artículos se alinearon a al menos un TIP. Ocho de las veinte PIP no fueron respondidas. Los artículos con autores que pertenecen o recibieron financiamiento del IETSI-EsSalud tuvieron la mayor tasa de alineación. Finalmente, los artículos financiados por EsSalud fueron principalmente estudios observacionales, guías de práctica clínica y revisiones sistemáticas. Conclusión: Los artículos científicos publicados con filiación de EsSalud durante el 2017 al 2020 tienen baja alineación con las prioridades de investigación de la institución. Por lo tanto, es necesario generar un proceso de gestión de implementación, seguimiento y evaluación de las prioridades de investigación en la institución.
Background: One of the impact indicators of priorities in health research-setting is the scientific production that refers to these priorities. EsSalud raised nine priority research topics (PRT) and 20 priority research questions (PRQ) for the 2017-2019 period. We assess the alignment to these research priorities in the scientific articles published during the 2017-2020 period by EsSalud, and we characterize those financed by this institution. Material and Methods: Analysis of the scientific articles registered in the EsSalud scientific production database for the period 2017-2020. We used a standardized methodology and in duplicate to evaluate the alignment of a scientific article to the PRTand PRQ 2017-2019 of EsSalud. The evaluation of the alignment to the PRQs is only carried out in original articles and congress summaries. We report alignment frequencies to each PRTand PRQ, and we report the frequency of alignment to at least one PRT according to the articles' characteristics. In addition, the characteristics of the articles financed by EsSalud were reported. Results: 170 out of 1283 articles were aligned to at least one PRT. Eight of the twenty PRQs went unanswered. Articles with authors who belong to or received funding from IETSI-EsSalud had the highest alignment rate. Finally, the highly cited articles financed by EsSalud were mainly observational studies, clinical practice guidelines and systematic reviews. Conclusion: The articles published by EsSalud during 2017 to 2020 have low alignment with institutional research priorities. Furthermore, it is necessary a process of implementation, monitoring, and evaluation of research priorities in the institution.
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BACKGROUND: Peru was one of the countries with the highest COVID-19 mortality worldwide during the first stage of the pandemic. It is then relevant to evaluate the risk factors for mortality in patients hospitalized for COVID-19 in three hospitals in Peru in 2020, from March to May, 2020. Methods: We carried out a retrospective cohort study. The population consisted of patients from three Peruvian hospitals hospitalized for a diagnosis of COVID-19 during the March-May 2020 period. Independent sociodemographic variables, medical history, symptoms, vital functions, laboratory parameters and medical treatment were evaluated. In-hospital mortality was assessed as the outcome. We performed Cox regression models (crude and adjusted) to evaluate risk factors for in-hospital mortality. Hazard ratios (HR) with their respective 95% confidence intervals (95% CI) were calculated. Results: We analyzed 493 hospitalized adults; 72.8% (n=359) were male and the mean age was 63.3 ± 14.4 years. COVID-19 symptoms appeared on average 7.9 ± 4.0 days before admission to the hospital, and the mean oxygen saturation on admission was 82.6 ± 13.8. While 67.6% (n=333) required intensive care unit admission, only 3.3% (n=16) were admitted to this unit, and 60.2% (n=297) of the sample died. In the adjusted regression analysis, it was found that being 60 years old or older (HR=1.57; 95% CI: 1.14-2.15), having two or more comorbidities (HR=1.53; 95% CI: 1.10-2.14), oxygen saturation between 85-80% (HR=2.52; 95% CI: 1.58-4.02), less than 80% (HR=4.59; 95% CI: 3.01-7.00), and being in the middle (HR=1.65; 95% CI: 1.15-2.39) and higher tertile (HR=2.18; 95% CI: 1.51-3.15) of the neutrophil-to-lymphocyte ratio, increased the risk of mortality. Conclusions: The risk factors found agree with what has been described in the literature and allow the identification of vulnerable groups in whom monitoring and early identification of symptoms should be prioritized in order to reduce mortality.
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COVID-19 , Adulto , Anciano , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Perú/epidemiología , Estudios Retrospectivos , Factores de Riesgo , SARS-CoV-2RESUMEN
Introducción: La producción científica de EsSalud ha aumentado progresivamente. Sin embargo, no se ha descrito su producción científica e identificado sus redes de colaboración en las principales bases de datos bibliográficas a nivel internacional. Objetivos: Describir la producción científica de EsSalud en revistas científicas indizadas durante el periodo 2008-2020. Material y Métodos: Estudio bibliométrico que evaluó artículos científicos y resúmenes de congresos, con al menos una filiación institucional relacionada a EsSalud entre sus autores, que se encuentren indizadas en las bases de datos bibliográficas de Scopus, Web of Science, Ovid-Medline o Scielo Citation Index durante el periodo 2008-2020. Se reporta la producción científica anual total y por separado, según base. Se identificaron las redes de colaboración intra y extrainstitucionales. Resultados: Se obtuvieron 4159 registros y, tras aplicar los criterios de selección, quedaron 2333 artículos. Se observó un incremento de publicaciones en todas las bases de datos, excepto en Scielo Citation Index. La mayoría de los artículos fueron originales, observacionales y autofinanciados. Dos hospitales nacionales de EsSalud aportaron casi dos tercios de toda la producción científica evaluada. Se identifico poca colaboración entre instituciones de EsSalud de Lima con las de otras regiones y entre regiones, pero sí con las universidades locales. El área médica que más fue abordada por las publicaciones científicas fue la relacionada con las especialidades de medicina clínica. Conclusiones: La producción científica de EsSalud ha aumentado y ha mejorado en calidad, con una importante colaboración con universidades locales. Es importante impulsar iniciativas que promuevan la investigación y colaboración dentro de EsSalud, en el marco de las prioridades de investigación y de las principales causas de mayor carga de enfermedad en la institución y el país.
Background: Scientific production of Social Security in Perú (EsSalud) has progressively increased. However, there is no description of its scientific production and collaboration networks in relevant international databases. Objectives: Describe the scientific production of EsSalud in indexed journals during the 2008-2020 period. Material and Methods: Bibliometric study that evaluated scientific articles and meeting abstracts,with at least one institutional affiliation related to EsSalud among its authors, indexed in the Scopus, Web of Science, Ovid-Medline, or Scielo Citation Index databases published during the period 2008-2020. The total annual scientific production is reported and separately according to base. Intra and extra-institutional collaboration networks were evaluated. 4159 records were Results: obtained and, after applying the selection criteria, 2333 articles remained. Scientific production from all data bases, except for the Scielo Citation Index, had a progressive increase. Most of articles were original, observational, and self-funded. Two national hospitals from EsSalud accounted for almost two-thirds of all analyzed scientific production. Institutions from Lima had little collaboration with other institutions from other regions, leading to little interregional collaboration. On the other side, there was a noticeable collaboration with local universities. The medical area that was most addressed by scientific publications was that related to clinical medicine specialties. EsSalud's Conclusions:scientific production number and quality had increased during last years in collaboration with local universities.It is important to promote initiatives thar boost the research and collaboration within EsSalud's institutions,emphasizing research priorities and the leading causes of national morbidity and mortality.
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Objective: To determine the variation of the epidemiological indicators of the new coronavirus (COVID-19) based on the public health emergency policies adopted by the South American countries. Material and methods: Ecological study where information is collected from 12 South American countries regarding the number of total cases per day, number of new cases, growth rate and case fatality rate with respect to COVID-19, until March 28, 2020. The emergency policies affected by the states were registered, which was verified by the residents of the affected countries. The data was stored in an Excel database and analysed in the STATA software. Results: The first countries to adopt emergency policies in South America adopted it when not many days have passed since the first confirmed case of COVID-19. Likewise, those countries that adopted measures in less than 11 days adopted a lower coefficient of growth of total cases and a lower-case fatality rate. Finally, the average growth rate in South America showed a considerable decrease during the first week, and then remained slightly constant until the selected date. Conclusion: The countries that adopted emergency policies 11 days or more from the first case of COVID-19 were those that presented a coefficient of growth of total cases and a higher case fatality rate. The growth of cases in South America has decreased since the first cases were registered.
Objetivo: Determinar la variación de los indicadores epidemiológicos del nuevo coronavirus (COVID-19) a partir de las políticas de emergencia en salud pública que adoptaron los países sudamericanos. Material y métodos: Estudio ecológico donde se recopiló información de 12 países sudamericanos respecto al número de casos totales por día, número de casos nuevos, coeficiente de crecimiento y tasa de letalidad respecto al COVID-19, hasta el 28 de marzo del 2020. Asimismo, se registraron las políticas de emergencia adoptadas por lo Estados, la cual fue verificada por residentes de los países considerados. Los datos fueron almacenados en una base Excel y analizados en el software STATA. Resultados: Los primeros países en adoptar políticas de emergencia en Sudamérica lo realizaron cuando no habían transcurrido muchos días desde el primer caso confirmado de COVID-19. Asimismo, aquellos países que adoptaron medidas en menos de 11 días presentaron un menor coeficiente de crecimiento de casos totales y una menor tasa de letalidad. Finalmente, el coeficiente de crecimiento promedio en Sudamérica presentó un descenso considerable durante la primera semana, para luego mantenerse ligeramente constante hasta la fecha evaluada. Conclusión: Los países que adoptaron políticas de emergencia a 11 días o más desde el primer caso de COVID-19 fueron aquellos que presentan un mayor coeficiente de crecimiento de casos totales y mayor tasa de letalidad. El crecimiento de casos en Sudamérica ha presentado un descenso desde que se registraron los primeros casos.
Objetivo: Determinar a variação dos indicadores epidemiológicos do novo coronavírus (COVID-19) com base nas políticas de emergência em saúde pública adotadas pelos países da América do Sul. Material e métodos: Estudo ecológico em que foram coletadas informações de 12 países da América do Sul sobre o número total de casos por dia, número de novos casos, taxa de crescimento e taxa de mortalidade em casos em relação ao COVID-19, até 28 de março de 2020. , foram registradas as políticas de emergência adotadas pelos Estados, verificadas pelos moradores dos países considerados. Os dados foram armazenados em um banco de dados Excel e analisados no software STATA. Resultados: Os primeiros países a adotar políticas de emergência na América do Sul o fizeram quando poucos dias se passaram desde o primeiro caso confirmado de COVID-19. Da mesma forma, os países que adotaram medidas em menos de 11 dias apresentaram menor taxa de crescimento do total de casos e menor taxa de fatalidade. Finalmente, o coeficiente médio de crescimento na América do Sul mostrou uma queda considerável durante a primeira semana, permanecendo ligeiramente constante até a data avaliada. Conclusão: Os países que adotaram políticas de emergência por 11 dias ou mais desde o primeiro caso de COVID-19 foram os que apresentaram a maior taxa de crescimento do total de casos e a maior taxa de fatalidade. O crescimento de casos na América do Sul tem mostrado uma queda desde que os primeiros casos foram registrados.
