ResumenFactores pronsticos de mortalidad intrahospitalaria en pacientes ancianos con infeccin por COVID 19 ingresados a un hospital de tercer nivel en Bogot, ColombiaEl presente estudio tiene como objetivo establecer los factores pronsticos asociados al desarrollo de muerte intrahospitalaria en pacientes adultos mayores de 65 aos con infeccin por SARS-CoV2/COVID -19 confirmado en el Hospital Universitario Nacional de Colombia.Mtodos: Este es un estudio observacional analtico.Se evaluaron pacientes adultos mayores de 65 aos con diagnstico de infeccin por SARS-CoV2/COVID-19 confirmado.Los pacientes fueron estratificados por estado de fragilidad y funcionalidad.La mortalidad se determin a los 28 das y se cre un modelo de regresin logstica incondicional, ajustando por factores de confusin.La significancia estadstica se estableci en p 0,05.Resultados: 170 pacientes fueron estratificados en sobrevivientes y no sobrevivientes .El porcentaje de hombres en los sobrevivientes y no sobrevivientes fue similar, sin diferencias significativas en la edad promedio entre ambos grupos, tampoco en relacin a la presencia de sntomas.En el anlisis multivariado, las siguientes variables predijeron la ocurrencia del desenlace mortalidad a 28 das: fragilidad, antecedente de cncer, SDRA, lesin renal aguda y SOFA.Conclusiones: La tasa mortalidad a 28 das en pacientes adultos mayores de 65 aos con infeccin por COVID 19 en este estudio fue de 38%.Al ajustar por antecedente de cncer, desarrollo de lesin renal aguda, SDRA, puntuacin SOFA y PAFI al ingreso, la fragilidad se asoci con una mayor mortalidad en la poblacin estudiada.
BACKGROUND: No therapeutics have yet been proven effective for the treatment of severe illness caused by SARS-CoV-2. METHODS: ) of less than 300 mm Hg. Patients were randomly assigned in a 1:1 ratio to receive either lopinavir-ritonavir (400 mg and 100 mg, respectively) twice a day for 14 days, in addition to standard care, or standard care alone. The primary end point was the time to clinical improvement, defined as the time from randomization to either an improvement of two points on a seven-category ordinal scale or discharge from the hospital, whichever came first. RESULTS: A total of 199 patients with laboratory-confirmed SARS-CoV-2 infection underwent randomization; 99 were assigned to the lopinavir-ritonavir group, and 100 to the standard-care group. Treatment with lopinavir-ritonavir was not associated with a difference from standard care in the time to clinical improvement (hazard ratio for clinical improvement, 1.31; 95% confidence interval [CI], 0.95 to 1.80). Mortality at 28 days was similar in the lopinavir-ritonavir group and the standard-care group (19.2% vs. 25.0%; difference, -5.8 percentage points; 95% CI, -17.3 to 5.7). The percentages of patients with detectable viral RNA at various time points were similar. In a modified intention-to-treat analysis, lopinavir-ritonavir led to a median time to clinical improvement that was shorter by 1 day than that observed with standard care (hazard ratio, 1.39; 95% CI, 1.00 to 1.91). Gastrointestinal adverse events were more common in the lopinavir-ritonavir group, but serious adverse events were more common in the standard-care group. Lopinavir-ritonavir treatment was stopped early in 13 patients (13.8%) because of adverse events. CONCLUSIONS: In hospitalized adult patients with severe Covid-19, no benefit was observed with lopinavir-ritonavir treatment beyond standard care. Future trials in patients with severe illness may help to confirm or exclude the possibility of a treatment benefit. (Funded by Major Projects of National Science and Technology on New Drug Creation and Development and others; Chinese Clinical Trial Register number, ChiCTR2000029308.).