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Effect of High Altitude on the Survival of COVID-19 Patients in Intensive Care Unit: A Cohort Study

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dc.contributor.authorJibaja, Manuel
dc.contributor.authorRoldan-Vasquez, Estefania
dc.contributor.authorRello, Jordi
dc.contributor.authorShen, Hua
dc.contributor.authorMaldonado, Nelson
dc.contributor.authorGrunauer, Michelle
dc.contributor.authorDíaz, Ana María
dc.contributor.authorGarcía, Fernanda
dc.contributor.authorRamírez, Vanessa
dc.contributor.authorSánchez, Hernán
dc.contributor.authorBarberán, José Luis
dc.contributor.authorParedes, Juan Pablo
dc.contributor.authorCevallos, Mónica
dc.contributor.authorMontenegro, Francisco
dc.contributor.authorPuertas, Soraya
dc.contributor.authorBriones, Killen
dc.contributor.authorMartínez, Marlon
dc.contributor.authorVélez-Páez, Jorge
dc.contributor.authorMontalvo-Villagómez, Mario
dc.contributor.authorHerrera, Luis
dc.contributor.authorGarrido, Santiago
dc.contributor.authorSisa, Ivan
dc.date.accessioned2026-03-12T15:43:42Z
dc.date.available2026-03-12T15:43:42Z
dc.date.issued2022
dc.description.abstractPurpose: The effect of high altitude ( ≥ 1500 m) and its potential association with mortality by COVID-19 remains controversial. We assessed the effect of high altitude on the survival/discharge of COVID-19 patients requiring intensive care unit (ICU) admission for mechanical ventilation compared to individuals treated at sea level. Methods: A retrospective cohort multi-center study of consecutive adults patients with a positive RT-PCR test for COVID-19 who were mechanically ventilated between March and November 2020. Data were collected from two sea-level hospitals and four high-altitude hospitals in Ecuador. The primary outcome was ICU and hospital survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Results: Of the study population (n = 670), 35.2% were female with a mean age of 58.3 ± 12.6 years. On admission, high-altitude patients were more likely to be younger (57.2 vs. 60.5 years old), presented with less comorbidities such as hypertension (25.9% vs. 54.9% with p-value <.001) and diabetes mellitus (20.5% vs. 37.2% with p-value <.001), less probability of having a capillary refill time > 3 sec (13.7% vs. 30.1%, p-value <.001), and less severity-of-illness condition (APACHE II score, 17.5 ± 8.1 vs. 20 ± 8.2, p < .01). After adjusting for key confounders high altitude is associated with significant higher probabilities of ICU survival/discharge (HR: 1.74 [95% CI: 1.46-2.08]) and hospital survival/discharge (HR: 1.35 [95% CI: 1.18-1.55]) than patients treated at sea level. Conclusions: Patients treated at high altitude at any time point during the study period were 74% more likely to experience ICU survival/discharge and 35% more likely to experience hospital survival/discharge than to the sea-level group. Possible reasons for these findings are genetic and physiological adaptations due to exposure to chronic hypoxia. Keywords: COVID-19; ICU; SARS-CoV-2; high altitude; sea level; survival.
dc.identifier.citationJibaja M, Roldan-Vasquez E, Rello J, Shen H, Maldonado N, Grunauer M, Díaz AM, García F, Ramírez V, Sánchez H, Barberán JL, Paredes JP, Cevallos M, Montenegro F, Puertas S, Briones K, Martínez M, Vélez-Páez J, Montalvo-Villagómez M, Herrera L, Garrido S, Sisa I. Effect of High Altitude on the Survival of COVID-19 Patients in Intensive Care Unit: A Cohort Study. J Intensive Care Med. 2022 Sep;37(9):1265-1273. doi: 10.1177/08850666221099827. Epub 2022 May 9. PMID: 35532089; PMCID: PMC9095997.
dc.identifier.urihttps://biblioteca.solcaquito.org.ec/handle/123456789/1745
dc.language.isoen_US
dc.titleEffect of High Altitude on the Survival of COVID-19 Patients in Intensive Care Unit: A Cohort Study
dc.typeArticle
dspace.entity.typePublication
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