Observational studyPloS one2022
High-altitude is associated with better short-term survival in critically ill COVID-19 patients admitted to the ICU.
Observational study in PloS one, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
19 citing papers in PubMed.
- Variation of the Neutrophil-to-Lymphocyte Ratio and Mean Platelet Volume in a Multicenter Study of Critically Ill Patients with COVID-19 Living at Different Altitudes.Medical sciences (Basel, Switzerland) · 2026Article
- Chronic hypoxia adaptation at high altitude: a perspective on Its potential role in mortality in viral pneumonia-associated ARDS and implications for personalized critical care.Critical care (London, England) · 2026Review
- Evaluating the impact of altitudinal variations on COVID-19 mortality rates: a comprehensive analysis.BMC pulmonary medicine · 2025Article
- Pediatric pneumonia across altitudes in Ecuador: a countrywide, epidemiological analysis from 2010-2021.Italian journal of pediatrics · 2025Article
- Comparison of the Predictive Capacity of Oxygenation Parameters, Oxygenation Indices, and CURB-65 to Mortality, Mechanical Ventilation, and Vasopressor Support in Community-Acquired Pneumonia at Different Altitudes.Canadian respiratory journal · 2025Article
- High-altitude immune remodeling in children withFrontiers in immunology · 2025Article
- COVID-19 in the Tibet, China, the roof of the world: a comparative analysis of high-altitude residents and newcomers.BMC infectious diseases · 2024Article
- Receiver operating characteristic (ROC) to determine cut-off points of clinical and biomolecular markers to discriminate mortality in severe COVID-19 living at high altitude.BMC pulmonary medicine · 2023Article
- A U-shaped protection of altitude against mortality and infection of COVID-19 in Peru: an ecological study.BMC public health · 2023Article
- Solar desalination/purification (solar stills, humidification-dehumidification, solar disinfection) in high altitude during COVID19: Insights of gastrointestinal manifestations and systems' mechanism.Journal of hazardous materials advances · 2023Article
- Biomarkers as predictors of mortality in critically ill obese patients with COVID-19 at high altitude.BMC pulmonary medicine · 2023Article
- Factors Associated with COVID-19 Death in a High-Altitude Peruvian Setting during the First 14 Months of the Pandemic: A Retrospective Multicenter Cohort Study in Hospitalized Patients.Tropical medicine and infectious disease · 2023Article
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- Health Benefits of Residence at Moderate Altitude Do Not Reduce COVID-19 Mortality.International journal of environmental research and public health · 2022Article
- Long COVID at Different Altitudes: A Countrywide Epidemiological Analysis.International journal of environmental research and public health · 2022Article
- A comparative analysis of SARS-CoV-2 viral load across different altitudes.Scientific reports · 2022Article
- SARS-CoV-2 Viral Load Analysis at Low and High Altitude: A Case Study from Ecuador.International journal of environmental research and public health · 2022Article
- Addressing the 'hypoxia paradox' in severe COVID-19: literature review and report of four cases treated with erythropoietin analogues.Molecular medicine (Cambridge, Mass.) · 2021Review
Corrections and comments
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Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMultiple 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.
methodsA 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.
resultsFrom 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.
conclusionThere 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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