A Cross-Sectional Study of Morbidity and Mortality Factors in COVID-19 ICU Patients from the Brazilian Mid-West
DOI:
https://doi.org/10.17921/2447-8938.2024v26n4p237-243Resumo
Abstract
Although the COVID-19 pandemic has officially ended, understanding factors influencing morbidity and mortality among ICU-admitted patients remains essential. This study aimed to investigate morbidity, mortality, and associated factors among SARS-CoV-2 patients admitted to an ICU in the Midwest region of Brazil. This observational, retrospective, cross-sectional study was conducted from March to December 2020, including patients with confirmed COVID-19 via RT-PCR upon ICU admission. Clinical and epidemiological data were extracted from medical records to analyze morbidity and mortality factors. A total of 69 medical records were reviewed, comprising 24 (35%) female and 45 (65%) male patients with a mean age of 58 years (range 30–91). Diabetes mellitus and obesity showed a positive correlation (95%CI=0.435; p=0.072). Factors associated with mortality and prolonged hospital stay included systemic arterial hypertension, chronic obstructive pulmonary disease, obesity, and smoking. Urea plasma levels significantly increased during ICU stay (p<0.001) among patients who did not survive, unlike those discharged. Length of stay correlated with in-hospital mortality (95%CI=0.031–0.479; p=0.002) and with diabetes mellitus (95%CI=0.143–0.572; p=0.025). Regression analysis identified significant associations between in-hospital mortality and elevated urea levels (OR=1.04; 95%CI=1.01–1.07; p=0.0005) and female gender (OR=13.1; 95%CI=1.58–108.85; p=0.017). Therapeutic heparin use was associated with a shorter hospital stay. Comorbidities were linked to extended hospitalization and increased mortality in COVID-19 patients. Elevated urea levels at admission and during ICU stay were strongly associated with in-hospital mortality, especially among female patients.
Keywords: Covid-19. Urea Levels. Comorbidities. Morbidity and Mortality.
Resumo
Embora a pandemia de COVID-19 tenha sido oficialmente declarada encerrada, compreender os fatores que influenciam a morbidade e mortalidade entre pacientes admitidos em UTI permanece essencial. Este estudo teve como objetivo investigar a morbidade, mortalidade e fatores associados entre pacientes com SARS-CoV-2 internados em uma Unidade de Terapia Intensiva (UTI) na região Centro-Oeste do Brasil. Trata-se de um estudo observacional, retrospectivo e transversal realizado entre março e dezembro de 2020, incluindo pacientes com COVID-19 confirmada por RT-PCR na admissão à UTI. Dados clínicos e epidemiológicos foram extraídos de prontuários médicos para análise de fatores de morbidade e mortalidade. Foram revisados 69 prontuários, incluindo 24 (35%) pacientes do sexo feminino e 45 (65%) do sexo masculino, com média de idade de 58 anos (variação de 30–91 anos). Observou-se uma correlação positiva entre diabetes mellitus e obesidade (IC95%=0,435; p=0,072). Os fatores associados à mortalidade e à maior permanência hospitalar incluíram hipertensão arterial sistêmica, doença pulmonar obstrutiva crônica, obesidade e tabagismo. Os níveis plasmáticos de ureia aumentaram significativamente durante a permanência na UTI (p<0,001) entre os pacientes que não sobreviveram, ao contrário daqueles que receberam alta. O tempo de internação mostrou correlação com a mortalidade hospitalar (IC95%=0,031–0,479; p=0,002) e com o diabetes mellitus (IC95%=0,143–0,572; p=0,025). A análise de regressão revelou associações significativas entre mortalidade hospitalar e níveis elevados de ureia (OR=1,04; IC95%=1,01–1,07; p=0,0005), bem como com o sexo feminino (OR=13,1; IC95%=1,58–108,85; p=0,017). O uso terapêutico de heparina foi associado a uma menor permanência hospitalar. Comorbidades foram associadas a hospitalização prolongada e aumento da mortalidade em pacientes com COVID-19. Níveis elevados de ureia na admissão e durante a hospitalização foram fortemente associados à mortalidade hospitalar, especialmente entre pacientes do sexo feminino.
Palavras-chave: Covid-19. Níveis de Ureia. Comorbidades. Morbidade e Mortalidade.
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Referências
Gautret P, Million M, Jarrot PA, Camoin-Jau L, Colson P, Fenollar F, et al. Natural history of COVID-19 and therapeutic options. Expert Rev Clin Immunol 2020;16(12):1159-84. doi:10.1080/1744666X.2021.1847640.
Dos Santos CV, Valiati NC, de Noronha TG, Porto VB, Pacheco AG, Freitas LP, et al. The effectiveness of COVID-19 vaccines against severe cases and deaths in Brazil from 2021 to 2022: a registry-based study. Lancet Regional Health–Americas 2023;20. doi: 10.1016/j.lana.2023.100465.
Chan JF, Kok KH, Zhu Z, Chu H, To KK, Yuan S, Yuen KY. Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan. Emerg Micro Infect 2020;9(1):221-36. doi:10.1080/22221751.2020.1719902
Kong WH, Li Y, Peng MW, Kong DG, Yang XB, Wang L, Liu MQ. SARS-CoV-2 detection in patients with influenza-like illness. Nat Microbiol 2020;5(5):675-8. doi:10.1038/s41564-020-0713-1
Mao R, Qiu Y, He JS, Tan JY, Li XH, Liang J, et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020;5(7):667-78. doi:10.1016/S2468-1253(20)30126-6
Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. The Lancet Haematology 2020;7(6):e438-40. doi:10.1016/S2352-3026(20)30145-9.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229):1054-62. doi: 10.1016/S0140-6736(20)30566-3.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395(10223):497-506. doi: 10.1016/S0140-6736(20)30183-5.
Qin C, Ziwei MP, Tao SY, Ke PC, Shang MM. Dysregulation of immune response in patients with COVID-19 in Wuhan. Clin Infect Dis 2020;71(15):762-8. doi:10.1093/cid/ciaa248.
Gattinoni L, Chiumello D, Caironi P, Busana M, Romitti F, Brazzi L, Camporota L. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive care medicine 2020;46:1099-102. doi:10.1007/s00134-020-06033-2.
Long QX, Liu BZ, Deng HJ, Wu GC, Deng K, Chen YK, et al. Antibody responses to SARS-CoV-2 in patients with COVID-19. Nat Med 2020;26(6):845-8. doi:10.1038/s41591-020-0897-1.
Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana JP, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis 2020;34:101623. doi: 10.1016/j.tmaid.2020.101623.
Zhang S, Zhang J, Wang C, Chen X, Zhao X, Jing H, et al. COVID 19 and ischemic stroke: Mechanisms of hypercoagulability. Int J Mol Med 2021;47(3):21. doi:10.3892/ijmm.2021.4854
Mathieu E, Ritchie H, Rodés-Guirao L, Appel C, Giattino C, Hasell J, Macdonald B, et al. (2020) - "Coronavirus Pandemic (COVID-19)". Published online at OurWorldInData.org. https://ourworldindata.org/coronavirus Accessed [1/15/2024];
COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Available at https://www.covid19treatmentguidelines.nih.gov/. Accessed [1/15/2024]. NIH Guidelines for COVID-19 treatment, 2023
Link-Gelles R, Weber ZA, Reese SE, et al. Estimates of bivalent mRNA vaccine durability in preventing COVID-19-associated hospitalization and critical illness among adults with and without immunocompromising conditions—VISION Network, September 2022–April 2023. MMWR Morb Mortal Wkly Rep 2023;72(21):579-588. doi:10.15585/mmwr.mm7221a3
Creswell JW. A concise introduction to mixed methods research. SAGE; 2021.
WHO, Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected, World Health Organization, 2020. https://www.who.int/publications/i/item/10665-332299
Izcovich A, Ragusa MA, Tortosa F, Lavena Marzio MA, Agnoletti C, Bengolea A, et al. Prognostic factors for severity and mortality in patients infected with COVID-19: A systematic review. PLoS One 2020;15(11):e0241955. doi: 10.1371/journal.pone.0241955
Lei F, Liu YM, Zhou F, Qin JJ, Zhang P, Zhu L, et al. Longitudinal association between markers of liver injury and mortality in COVID-19 in China. Hepatol 2020;72(2):389-398. doi: 10.1002/hep.31301.
Lavrentieva A, Kaimakamis E, Voutsas V, Bitzani M. An observational study on factors associated with ICU mortality in Covid-19 patients and critical review of the literature. Sci Rep 2023;13:7804. doi:10.1038/s41598-023-34613-x.
Chee, Y.J.; Tan, S.K.; Yeoh, E. Dissecting the interaction between COVID-19 and diabetes mellitus. J Diabetes Investig 2020;11(5):1104-14. doi: 10.1111/jdi.13326.
Vaduganathan M, Vardeny O, Michel T, McMurray JJ, Pfeffer MA, Solomon SD. Renin–angiotensin–aldosterone system inhibitors in patients with Covid-19. N Engl J Med 2020;382(17):1653-9. doi: 10.1056/NEJMsr2005760.
Fernández A. Targeted Disassembling of SARS-CoV-2 as It Gets Ready for Cell Penetration. ACS Med Chem Lett 2020;11(11):2055-7. doi: 10.1021/acsmedchemlett.0c00548.
Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int 2020 May 1;97(5):829-38. doi:10.1016/j.kint.2020.03.005
Bertsimas D, Lukin G, Mingardi L, Nohadani O, Orfanoudaki A, Stellato B, et al. COVID-19 mortality risk assessment: An international multi-center study. PloS One 2020 Dec 9;15(12): e0243262. doi:10.1371/journal.pone.0243262.
Miesbach W, Makris M. COVID-19: Coagulopathy, Risk of Thrombosis, and the Rationale for Anticoagulation. Clin Appl Thromb Hemost 2020 Jan-Dec;26:1076029620938149. doi:10.1177/1076029620938149.
Viecca M, Radovanovic D, Forleo GB, Santus P. Enhanced platelet inhibition treatment improves hypoxemia in patients with severe Covid-19 and hypercoagulability. A case control, proof of concept study. Pharmacol Res 2020;158:104950. doi: 10.1016/j.phrs.2020.104950
Ionescu F, Jaiyesimi I, Petrescu I, Lawler PR, Castillo E, Munoz‐Maldonado Y, et al. Association of anticoagulation dose and survival in hospitalized COVID‐19 patients: a retrospective propensity score‐weighted analysis. Eur J Haematol 2021;106(2):165-74. doi:10.1111/ejh.13533.
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