High-altitude is associated with better short-term survival in critically ill COVID-19 patients admitted to the ICU

Simbaña-Rivera, Katherine, Jaramillo, Pablo R Morocho, Silva, Javier V Velastegui, Gómez-Barreno, Lenin, Campoverde, Ana B Ventimilla, Novillo Cevallos, Juan F, Guanoquiza, Washington E Almache, Guevara, Silvio L Cedeño, Castro, Luis G Imba, Puerta, Nelson A Moran, Guayta Valladares, Alex W, Lister, Alex and Ortiz-Prado, Esteban (2022) High-altitude is associated with better short-term survival in critically ill COVID-19 patients admitted to the ICU. PLoS ONE, 17 (3), [e0262423]. (doi:10.1371/journal.pone.0262423).

Abstract

BACKGROUND: Multiple studies have attempted to elucidate the relationship between chronic hypoxia and SARS-CoV-2 infection. It seems that high-altitude is associated with lower COVID-19 related mortality and incidence rates; nevertheless, all the data came from observational studies, being this the first one looking into prospectively collected clinical data from severely ill patients residing at two significantly different altitudes.

METHODS: A prospective cohort, a two-center study among COVID-19 confirmed adult patients admitted to a low (sea level) and high-altitude (2,850 m) ICU unit in Ecuador was conducted. Two hundred and thirty confirmed patients were enrolled from March 15th to July 15th, 2020.

RESULTS: From 230 patients, 149 were men (64.8%) and 81 women (35.2%). The median age of all the patients was 60 years, and at least 105 (45.7%) of patients had at least one underlying comorbidity, including hypertension (33.5%), diabetes (16.5%), and chronic kidney failure (5.7%). The APACHE II scale (Score that estimates ICU mortality) at 72 hours was especially higher in the low altitude group with a median of 18 points (IQR: 9.5-24.0), compared to 9 points (IQR: 5.0-22.0) obtained in the high-altitude group. There is evidence of a difference in survival in favor of the high-altitude group (p = 0.006), the median survival being 39 days, compared to 21 days in the low altitude group.

CONCLUSION: There has been a substantial improvement in survival amongst people admitted to the high-altitude ICU. Residing at high-altitudes was associated with improved survival, especially among patients with no comorbidities. COVID-19 patients admitted to the high-altitude ICU unit have improved severity-of-disease classification system scores at 72 hours.

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Contributors

Author: Alex Lister

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