Comorbilidades asociadas a la mortalidad por COVID-19 en adultos en Lima, Perú: un estudio de cohorte retrospectiva / Comorbidities associated with COVID-19 mortality in adults in Lima, Peru: a retrospective cohort study

RESUMEN Objetivos. Evaluar las comorbilidades asociadas a la mortalidad en pacientes adultos hospitalizados por COVID-19 de diferentes grupos de edad en hospitales de Lima y Callao. Materiales y métodos. En este estudio de cohorte retrospectiva analizamos datos de pacientes adultos hospitalizados por COVID-19, notificados al Sistema Nacional de Vigilancia Epidemiológica del Ministerio de Salud de Perú de marzo a octubre del 2020. Se estimaron riesgos relativos con intervalos de confianza al 95% mediante modelos de regresión de Poisson con varianza robusta para evaluar las comorbilidades asociadas a la mortalidad por grupos de edad: jóvenes (18-29 años), adultos (30-59 años) y mayores (≥60 años). Resultados. Se incluyeron 2366 jóvenes, 23781 adultos y 25356 adultos mayores en el análisis. Los adultos mayores presentaron la mortalidad más alta (63,7%) en comparación con adultos (27,1%) y jóvenes (8,5%). Independientemente del grupo de edad, la presencia de enfermedad neurológica, enfermedad renal, enfermedad hepática y cáncer se asoció a un mayor riesgo de mortalidad. Adicionalmente, la enfermedad cardiovascular fue también un factor de riesgo en los jóvenes; la obesidad, la diabetes, la enfermedad cardiovascular, la enfermedad pulmonar crónica y la inmunodeficiencia en los adultos; y la obesidad y la enfermedad pulmonar crónica en los mayores. Conclusiones: Independientemente de los grupos de edad, los individuos con enfermedad neurológica crónica, enfermedad renal, enfermedad hepática y cáncer tendrían un alto riesgo de morir por la COVID-19.

ABSTRACT Objectives. To evaluate comorbidities associated with mortality in adult patients hospitalized due to COVID-19 in hospitals in Lima and Callao. Materials and methods. In this retrospective cohort study, we analyzed data from adult patients hospitalized due to COVID-19 reported to the National Epidemiological Surveillance System of the Peruvian Ministry of Health from March to October 2020. We estimated relative risks with 95% confidence intervals using Poisson regression models with robust variance to assess comorbidities associated with mortality by age group: young adults (18-29 years), adults (30-59 years) and older adults (≥60 years). Results. We included 2366 young adults, 23,781 adults and 25,356 older adults. Older adults had the highest mortality (63.7%) compared to adults (27.1%) and young adults (8.5%). Regardless of age group, the presence of neurological disease, renal disease, liver disease, and cancer was associated with an increased risk of mortality. Additionally, cardiovascular disease was also a risk factor in young adults; obesity, diabetes, cardiovascular disease, chronic lung disease, and immunodeficiency in adults; and obesity and chronic lung disease in the elderly. Conclusions. Regardless of age groups, individuals with chronic neurologic disease, renal disease, liver disease, and cancer were at high risk of death from COVID-19.

Clinical features of Guillain-Barré syndrome and factors associated with mortality during the 2019 outbreak in Peru.

INTRODUCTION: Peru has suffered an increase of Guillain Barre Syndrome incidence since 2015, being the biggest outbreak during 2019. We aimed to describe the clinical features, outcomes, and factors associated with mortality among cases reported in the 2019 outbreak. METHODS: Cross-sectional analysis of data from the National Surveillance of Guillain Barre Syndrome of the National Center for Control Disease and Prevention of Peru. We included all cases that met the Brighton criteria, level 1 to level 3. We used multivariable logistic regression to determinate factors associated with mortality. RESULTS: Overall, 772 cases were analyzed (58.7% male; mean age, 41.7 ± 20.3). 86.0% of cases aged over 30 years. 71.4% had a respiratory or gastrointestinal infection in the last 4 weeks. Case fatality rate was 4.3% and 32.2% of survivors reported sequelae. Axonal subtypes were identified in 75.6% of cases with an available nerve conduction study (38.7%). Age and impaired function of cranial nerves were independently associated with mortality. CONCLUSIONS: The 2019 outbreak of Guillain Barre syndrome in Peru was an unprecedented event that affected several regions of the country. Axonal damage was more frequent than demyelinating involvement, which is compatible with findings pointing to Campylobacter jejuni as the triggering agent. The case fatality rate was similar to that reported previously in Peru and other countries, but the high frequency of sequelae is striking.

Comorbidities associated with COVID-19 mortality in adults in Lima, Peru: a retrospective cohort study. / Comorbilidades asociadas a la mortalidad por COVID-19 en adultos en Lima, Perú: un estudio de cohorte retrospectiva.

OBJECTIVES.: Motivation for the study. During the COVID-19 pandemic, the mortality rate from this disease was higher in adults and the elderly. Therefore, it is important to identify the factors that were associated with mortality from COVID-19 in adults, by age group. Main findings. Chronic neurological disease, kidney disease, liver disease, and cancer increased the risk of dying from COVID-19 in the three age groups we analyzed, which were made up of hospitalized patients from Lima and Callao. The risk of mortality associated with comorbidities was higher in patients aged 18 to 29. Implications. This study helps to identify the groups of patients with the highest risk of death from COVID-19, according to age group and type of comorbidity. . To evaluate comorbidities associated with mortality in adult patients hospitalized due to COVID-19 in hospitals in Lima and Callao. MATERIALS AND METHODS.: In this retrospective cohort study, we analyzed data from adult patients hospitalized due to COVID-19 reported to the National Epidemiological Surveillance System of the Peruvian Ministry of Health from March to October 2020. We estimated relative risks with 95% confidence intervals using Poisson regression models with robust variance to assess comorbidities associated with mortality by age group: young adults (18-29 years), adults (30-59 years) and older adults (≥60 years). RESULTS.: We included 2366 young adults, 23,781 adults and 25,356 older adults. Older adults had the highest mortality (63.7%) compared to adults (27.1%) and young adults (8.5%). Regardless of age group, the presence of neurological disease, renal disease, liver disease, and cancer was associated with an increased risk of mortality. Additionally, cardiovascular disease was also a risk factor in young adults; obesity, diabetes, cardiovascular disease, chronic lung disease, and immunodeficiency in adults; and obesity and chronic lung disease in the elderly. CONCLUSIONS.: Regardless of age groups, individuals with chronic neurologic disease, renal disease, liver disease, and cancer were at high risk of death from COVID-19.

OBJETIVOS.: Motivation for the study. During the COVID-19 pandemic, the mortality rate from this disease was higher in adults and the elderly. Therefore, it is important to identify the factors that were associated with mortality from COVID-19 in adults, by age group. Main findings. Chronic neurological disease, kidney disease, liver disease, and cancer increased the risk of dying from COVID-19 in the three age groups we analyzed, which were made up of hospitalized patients from Lima and Callao. The risk of mortality associated with comorbidities was higher in patients aged 18 to 29. Implications. This study helps to identify the groups of patients with the highest risk of death from COVID-19, according to age group and type of comorbidity. . Evaluar las comorbilidades asociadas a la mortalidad en pacientes adultos hospitalizados por COVID-19 de diferentes grupos de edad en hospitales de Lima y Callao. MATERIALES Y MÉTODOS.: En este estudio de cohorte retrospectiva analizamos datos de pacientes adultos hospitalizados por COVID-19, notificados al Sistema Nacional de Vigilancia Epidemiológica del Ministerio de Salud de Perú de marzo a octubre del 2020. Se estimaron riesgos relativos con intervalos de confianza al 95% mediante modelos de regresión de Poisson con varianza robusta para evaluar las comorbilidades asociadas a la mortalidad por grupos de edad: jóvenes (18-29 años), adultos (30-59 años) y mayores (≥60 años). RESULTADOS.: Se incluyeron 2366 jóvenes, 23781 adultos y 25356 adultos mayores en el análisis. Los adultos mayores presentaron la mortalidad más alta (63,7%) en comparación con adultos (27,1%) y jóvenes (8,5%). Independientemente del grupo de edad, la presencia de enfermedad neurológica, enfermedad renal, enfermedad hepática y cáncer se asoció a un mayor riesgo de mortalidad. Adicionalmente, la enfermedad cardiovascular fue también un factor de riesgo en los jóvenes; la obesidad, la diabetes, la enfermedad cardiovascular, la enfermedad pulmonar crónica y la inmunodeficiencia en los adultos; y la obesidad y la enfermedad pulmonar crónica en los mayores. CONCLUSIONES: Independientemente de los grupos de edad, los individuos con enfermedad neurológica crónica, enfermedad renal, enfermedad hepática y cáncer tendrían un alto riesgo de morir por la COVID-19.

COVID-19 among Amazonian indigenous in Peru: mortality, incidence, and clinical characteristics.

BACKGROUND: Few studies have described the clinical characteristics of patients with COVID-19 from ethnic minority groups. Our objective was to evaluate the mortality and incidence rates, clinical characteristics and factors associated with mortality in cases with COVID-19 belonging to the Amazonian indigenous ethnic group in Peru. METHODS: We performed a retrospective cohort study including all cases from COVID-19 among Peruvian people identified as Amazonian indigenous from 07 March to 31 October 2020. We calculated the standardized mortality and incidence ratios using the indirect age-adjusted method to determine the differences between Amazonian Indigenous and the general population. In addition, we used multivariable logistic regression to determine the risk factors for death. RESULTS: A total of 19 018 laboratory confirmed COVID-19 cases were analyzed. Indigenous people had 3.18 (95% CI, 3.13-3.23) times the risk of infection and 0.34 (0.31-0.37) times the mortality risk of the general Peruvian population. Males had 1.29 (1.04-1.61) times the odds of death compared with females and for each year of age, the odds of mortality increased 1.03 (1.03-1.04) times. Cases with respiratory distress had 2.47 (1.96-3.10) times more likely to die. Having an immunodeficiency was 18.7 (6.12-57.00) times more likely to die. DISCUSSION: The Amazonian indigenous population in Peru was strongly affected by COVID-19 compared with the general Peruvian population.

SARS-CoV-2 prevalence associated to low socioeconomic status and overcrowding in an LMIC megacity: A population-based seroepidemiological survey in Lima, Peru.

BACKGROUND: Worldwide, Peru has one of the highest infection fatality rates of COVID-19, and its capital city, Lima, accumulates roughly 50% of diagnosed cases. Despite surveillance efforts to assess the extent of the pandemic, reported cases and deaths only capture a fraction of its impact due to COVID-19's broad clinical spectrum. This study aimed to estimate the seroprevalence of SARS-CoV-2 in Lima, stratified by age, sex, region, socioeconomic status (SES), overcrowding, and symptoms. METHODS: We conducted a multi-stage, population-based serosurvey in Lima, between June 28th and July 9th, 2020, after 115 days of the index case and after the first peak cases. We collected whole blood samples by finger-prick and applied a structured questionnaire. A point-of-care rapid serological test assessed IgM and IgG antibodies against SARS-CoV-2. Seroprevalence estimates were adjusted by sampling weights and test performance. Additionally, we performed RT-PCR molecular assays to seronegatives and estimated the infection prevalence. FINDINGS: We enrolled 3212 participants from 797 households and 241 sample clusters from Lima in the analysis. The SARS-CoV-2 seroprevalence was 20·8% (95%CI 17·2-23·5), and the prevalence was 25·2% (95%CI 22·5-28·2). Seroprevalence was equally distributed by sex (aPR=0·96 [95%CI 0·85-1·09, p = 0·547]) and across all age groups, including ≥60 versus ≤11 years old (aPR=0·96 [95%CI 0·73-1·27, p = 0·783]). A gradual decrease in SES was associated with higher seroprevalence (aPR=3·41 [95%CI 1·90-6·12, p<0·001] in low SES). Also, a gradual increase in the overcrowding index was associated with higher seroprevalence (aPR=1·99 [95%CI 1·41-2·81, p<0·001] in the fourth quartile). Seroprevalence was also associated with contact with a suspected or confirmed COVID-19 case, whether a household member (48·9%, aPR=2·67 [95%CI 2·06-3·47, p<0·001]), other family members (27·3%, aPR=1·66 [95%CI 1·15-2·40, p = 0·008]) or a workmate (34·1%, aPR=2·26 [95%CI 1·53-3·35, p<0·001]). More than half of seropositive participants reported never having had symptoms (56·1%, 95% CI 49·7-62·3). INTERPRETATION: This first estimate of SARS-CoV-2 seroprevalence in Lima shows an intense transmission scenario, despite the government's numerous interventions early established. Susceptibles across age groups show that physical distancing interventions must not be relaxed. SES and overcrowding households are associated with seroprevalence. This study highlights the importance of considering the existing social inequalities for implementing the response to control transmission in low- and middle-income countries.

Use of magnetic particles in the purification of IgM antibodies against Taenia solium. / Uso de partículas magnéticas en la purificación de anticuerpos IgM contra Taenia solium.

The use of L protein coupled magnetic particles for the concentration and purification of immunoglobulin M (mIgM) monoclonal antibodies against Taenia solium was evaluated. Three concentration methods and different elution times were evaluated and the ratio of particles to the ratio of mIgM was optimized. It is demonstrated that: 1) with the use of magnetic particles, a previous concentration of mIgM is not required, which reduces the manipulation of the antibodies and improves the recovery, 2) the use of a binding buffer can be omitted, since the pH of most cell culture supernatants are neutral, and 3) longer elution times (~ 45 minutes) are needed to increase recovery to a level greater than 80%. The study demonstrates that the use of L protein-coupled magnetic particles is a simple and efficient tool for mIgM concentration and purification.

Se evaluó el uso de partículas magnéticas acopladas a proteína L para la concentración y purificación de anticuerpos monoclonales inmunoglobulina M (mIgM) contra Taenia solium. Se evaluaron tres métodos de concentración y diferentes tiempos de elución y se optimizó la proporción de partículas a la proporción de mIgM. Demostramos que: 1) con el uso partículas magnéticas no se requiere de una concentración previa de mIgM, lo que disminuye la manipulación de los anticuerpos y mejora la recuperación, 2) se puede omitir el uso de un tampón de unión, ya que el pH de la mayoría de los sobrenadantes de cultivo celular son neutros, y 3) se necesitan tiempos de elución más largos (~45 minutos) para aumentar la recuperación a un nivel mayor a 80%. El estudio demuestra que el uso de partículas magnéticas acopladas a proteína L es una herramienta simple y eficiente para la concentración y purificación de mIgM.

Uso de partículas magnéticas en la purificación de anticuerpos IgM contra Taenia solium / Use of magnetic particles in the purification of IgM antibodies against Taenia solium

RESUMEN Se evaluó el uso de partículas magnéticas acopladas a proteína L para la concentración y purificación de anticuerpos monoclonales inmunoglobulina M (mIgM) contra Taenia solium. Se evaluaron tres métodos de concentración y diferentes tiempos de elución y se optimizó la proporción de partículas a la proporción de mIgM. Demostramos que: 1) con el uso partículas magnéticas no se requiere de una concentración previa de mIgM, lo que disminuye la manipulación de los anticuerpos y mejora la recuperación, 2) se puede omitir el uso de un tampón de unión, ya que el pH de la mayoría de los sobrenadantes de cultivo celular son neutros, y 3) se necesitan tiempos de elución más largos (~45 minutos) para aumentar la recuperación a un nivel mayor a 80%. El estudio demuestra que el uso de partículas magnéticas acopladas a proteína L es una herramienta simple y eficiente para la concentración y purificación de mIgM.

ABSTRACT The use of L protein coupled magnetic particles for the concentration and purification of immunoglobulin M (mIgM) monoclonal antibodies against Taenia solium was evaluated. Three concentration methods and different elution times were evaluated and the ratio of particles to the ratio of mIgM was optimized. It is demonstrated that: 1) with the use of magnetic particles, a previous concentration of mIgM is not required, which reduces the manipulation of the antibodies and improves the recovery, 2) the use of a binding buffer can be omitted, since the pH of most cell culture supernatants are neutral, and 3) longer elution times (~ 45 minutes) are needed to increase recovery to a level greater than 80%. The study demonstrates that the use of L protein-coupled magnetic particles is a simple and efficient tool for mIgM concentration and purification.