Fatores de risco associados à mortalidade em pacientes gravemente doentes com covid-19: estudo de coorte
DOI:
https://doi.org/10.35454/rncm.v6n4.527Palavras-chave:
COVID-19, Mortalidade, Comorbidade, Nutrição, ObesidadeResumo
Introdução: Pacientes diagnosticados com COVID-19 que necessitam de unidade de terapia intensiva (UTI) demandam atendimento multidisciplinar, o que é decisivo para sua intervenção e prognóstico. O objetivo deste estudo foi identificar os fatores de risco para mortalidade em pacientes críticos com COVID-19 em Bogotá, Colômbia.
Métodos: Este foi um estudo descritivo retrospectivo (de março de 2020 a fevereiro de 2021) que incluiu pacientes criticamente doentes com COVID-19 internados na UTI. Os dados demográficos e clínicos foram coletados dos prontuários médicos digitais. Foi realizado um modelo de regressão logística, considerando a mortalidade como variável dependente e as variáveis clínicas e demográficas como fatores explicativos.
Resultados: Foram incluídos 562 pacientes, com mortalidade geral de 42%, comorbidades associadas como diabetes mellitus (51%), obesidade grau 2 (75%) e idade superior aos 65 anos (51%). O modelo de regressão logística mostrou que pacientes com mais de 65 anos [OR: 3,23 (2,28 - 4,59)]; diabetes mellitus [OR: 1,68 (1,16 - 2,44)] e obesidade grau 2 [OR: 3,5 (1,31 - 9,77)] foram fatores de risco para mortalidade em pacientes com COVID-19 na UTI.
Conclusão: Este estudo relatou que idade acima de 65 anos, diabetes mellitus e obesidade grau 2 foram fatores de risco para morte em pacientes criticamente doentes com COVID-19.
Downloads
Referências
New York City Department of Health and Mental Hygiene (DOHMH) COVID-19 Response Team. Preliminary Estimate of Excess Mortality During the COVID-19 Outbreak - New York City, March 11-May 2, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(19):603-605. doi: 10.15585/mmwr.mm6919e5
COVID-19 en Colombia [Internet]. Instituto Nacional de Salud [consultado el 27 de diciembre de 2022]. Disponible en: https://www.ins.gov.co/Noticias/paginas/coronavirus.aspx
Trujillo CHS. Consenso colombiano de atención, diagnóstico y manejo de la infección por SARS-COV-2/COVID 19 en establecimientos de atención de la salud. Recomendaciones basadas en consenso de expertos e informadas en la evidencia. Infectio. 2020;24(3 Supl 1)1-153. doi: 10.22354/in.v24i3.851
Machado-Alba JE, Valladales-Restrepo LF, Machado-Duque ME, Gaviria-Mendoza A, Sánchez-Ramírez N, Usma-Valencia AF, et al. Factors associated with admission to the intensive care unit and mortality in patients with COVID-19, Colombia. PLoS One. 2021;16(11):e0260169. doi: 10.1371/journal.pone.0260169
Wang X, Fang X, Cai Z, Wu X, Gao X, Min J, et al. Comorbid chronic diseases and acute organ injuries are strongly correlated with disease severity and mortality among COVID-19 patients: a systemic review and meta-analysis. Research (Wash DC). 2020;2020:2402961. doi: 10.34133/2020/2402961
Yang JK, Feng Y, Yuan MY, Yuan SY, Fu HJ, Wu BY, et al. Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS. Diabet Med. 2006;23:623-8. doi: 10.1111/j.1464-5491.2006.01861.x
Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity (Silver Spring). 2020;28(7):1195-9. doi: 10.1002/oby.22831
Ferrando C, Mellado-Artigas R, Gea A, Arruti E, Aldecoa C, Bordell A, et al. Patient characteristics, clinical course and factors associated to ICU mortality in critically ill patients infected with SARS-CoV-2 in Spain: a prospective, cohort, multicentre study. Rev Esp Anestesiol Reanim (Engl Ed). 2020;67(8):425-37. doi: 10.1016/j.redar.2020.07.003
Li G, Zhou CL, Ba YM, Wang YM, Song B, Cheng XB, et al. Nutritional risk and therapy for severe and critical COVID-19 patients: A multicenter retrospective observational study. Clinical Nutrition (Edinburgh, Scotland). 2021;40(4):2154-61. doi: 10.1016/j.clnu.2020.09.040
Czapla M, Juárez-Vela R, Gea-Caballero V, Zieliński S, Zielińska M. The Association between Nutritional Status and In-Hospital Mortality of COVID-19 in Critically-Ill Patients in the ICU. Nutrients. 2021;13(10):3302. doi: 10.3390/nu13103302
Martinuzzi ALN, Manzanares W, Quesada E, Reberendo MJ, Baccaro F, Aversa I, et al. Nutritional risk and clinical outcomes in critically ill adult patients with COVID-19. Nutr Hosp. 2021;38(6):1119-25. doi: 10.20960/nh.03749
Strobe Checklists [Internet]. Suiza: Strobe [consultado el 6 de septiembre de 2022]. Disponible en: https://www.strobe-statement.org/checklists
Wilches Luna EC, Hernández NL, Siriani de Oliveira A, Kenji Nawa R, Perme C, Gastaldi AC. Perme ICU Mobility Score (Perme Score) and the ICU Mobility Scale (IMS): translation and cultural adaptation for the Spanish language. Colomb Med (Cali). 2018;49(4):265-272. doi: 10.25100/cm.v49i3.4042
Cederholm T, Jensen GL, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, et al. GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community. Clin Nutr. 2019;38(1):1-9. doi: 10.1016/j.clnu.2018.08.002
Prabhudev P, Ramamoorthi K, Acharya RV. A Clinical and Demographic Profile of Elderly (>65 Years) in the Medical Intensive Care Units of a Tertiary Care Centre. Indian J Crit Care Med. 2023;27(3):166-75. doi: 10.5005/jp-journals-10071-24416
Dessie ZG, Zewotir T. Mortality-related risk factors of COVID-19: a systematic review and meta-analysis of 42 studies and 423,117 patients. BMC Infect Dis. 2021;21(1):855. doi: 10.1186/s12879-021-06536-3
Kumar A, Arora A, Sharma P, Anikhindi SA, Bansal N, Singla V, et al. Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis. Diabetes Metab Syndr. 2020;14(4):535-545. doi: 10.1016/j.dsx.2020.04.044
Muniyappa R, Gubbi S. COVID-19 pandemic, coronaviruses, and diabetes mellitus. Am J Physiol Endocrinol Metab. 2020;318(5):E736-41. doi: 10.1152/ajpendo.00124.2020
Sanchis-Gomar F, Lavie CJ, Mehra MR, Henry BM, Lippi G. Obesity and outcomes in COVID-19: when an epidemic and pandemic collide. Mayo Clin Proc. 2020;95(7):1445-53. doi: 10.1016/j.mayocp.2020.05.006
Kawai T, Autieri MV, Scalia R. Adipose tissue inflammation and metabolic dysfunction in obesity. Am J Physiol Cell Physiol. 2021;320(3):C375-C391. doi: 10.1152/ajpcell.00379.2020
Petrakis D, Margina D, Tsarouhas K, Tekos F, Stan M, Nikitovic D, et al. Obesity - a risk factor for increased COVID-19 prevalence, severity and lethality (review). Mol Med Rep. 2020;22(1):9-19. doi: 10.3892/mmr.2020.11127
Huang Y, Lu Y, Huang YM, Wang M, Ling W, Sui Y, et al. Obesity in patients with COVID-19: a systematic review and meta-analysis. Metabolism. 2020;113:154378. doi: 10.1016/j.metabol.2020.154378
Aggarwal A, Arora U, Mittal A, Aggarwal A, Singh K, Jorwal P, et al. Outcomes of HFNC Use in COVID-19 Patients in Non-ICU Settings: A Single-center Experience. Indian J Crit Care Med. 2022;26(4):530-2. doi: 10.5005/jp-journals-10071-24186
Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G, et al. Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. JAMA Intern Med. 2020;180(10):1345-55. doi: 10.1001/jamainternmed.2020.3539
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2023 Ricardo Alfonso Merchán Chaverra, Jhoana Patricia Ruiz Jiménez, Diana Marcela Sotelo Vergara, Mónica Vanessa Carrillo Ramirez, Jorge Medina Parra, Iván Camilo Alarcón Amaya, Jorge Iván Alvarado Sanchez
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
