Características de pacientes con SARS-CoV-2 en estado crítico en un centro COVID-19 de referencia en Uruguay

Autores/as

DOI:

https://doi.org/10.29193/RMU.39.4.6

Palabras clave:

SARS-COV-2, COVID-19, SÍNDROME DE DISTRÉS RESPIRATORIO AGUDO, VENTILACIÓN MECÁNICA INVASIVA

Resumen

Introducción: la pandemia de COVID-19 produjo una alta mortalidad en el mundo. Sin embargo, las presentaciones más críticas de la enfermedad han sido poco caracterizadas en nuestra región.
Objetivo: estudiar la presentación clínica, evolución y mortalidad en pacientes ingresados en la unidad de medicina intensiva de un centro COVID-19 de referencia.
Pacientes y método: estudio clínico, prospectivo, observacional de SARS-CoV-2 durante las primeras etapas de la pandemia en Uruguay. Se definió mortalidad en unidad de cuidados intensivos (UCI) como desenlace primario.
Resultados: en 274 pacientes, la edad mediana fue de 65 años (IQR 54-73), el sexo masculino representó el 57% y el índice de Charlson tuvo una mediana de 3 (IQR 2-5). La mortalidad en UCI fue 59,9%. Las principales causas de muerte fueron: hipoxemia refractaria, disfunción orgánica múltiple y shock refractario. La edad (Odds Ratio (OR) = 1,06; IC de 95% 1,03 - 1,09), ocupación de camas (OR = 1,04, IC 95%: 1,02 - 1,07), sexo masculino (OR = 2,14, IC 95%: 0,93 - 5,06), ventilación mecánica invasiva (OR = 51,7, IC 95%: 16,5 - 208,6), coinfección al ingreso (OR = 2,34, IC 95%: 0,88 - 6,77) y enfermedad renal crónica previa (OR = 13,1, IC 95%: 2,29 - 129,2) fueron predictores independientes de mortalidad. La primera ola de la pandemia se produjo por la circulación de las variantes P.6 y P.1 del coronavirus, en una población con muy bajo porcentaje de vacunación (8%).
Conclusiones: estos resultados en pacientes críticos aportan una descripción detallada del impacto de la pandemia por SARS-CoV-2 en un centro de referencia y constituyen una base para enfrentar futuros eventos epidémicos.

Citas

Wu Z, McGoogan JM. Characteristics of and important lessons from the Coronavirus Disease 2019 (COVID-19) outbreak in China: summary of a report of 72.314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; 323(13):1239-42. doi: 10.1001/jama.2020.2648.

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.

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395(10223):507-13. doi: 10.1016/S0140-6736(20)30211-7.

Koele K, Martin M, Antia R, Lopman B, Dean N. The changing epidemiology of SARS-CoV-2. Science 2022; 375(6585):1116-21. doi: 10.1126/science.abm4915.

Ranieri VM, Rubenfeld GD, Taylor BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA 2012; 307(23):2526-33. doi: 10.1001/jama.2012.5669.

Kellum JA, Lameire N, Aspelin P, Barsoum RS, Burdmann EA, Goldstein SL, et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012; 2(1):1-138. doi: 10.1038/kisup.2012.1

Singer M, Deutschman C, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016; 315(8):801-10. doi: 10.1001/jama.2016.0287.

Estenssoro E, Loudet C, Ríos F, Kanoore V, Plotnikow G, Andrian M, et al. Clinical characteristics and outcomes of invasively ventilated patients with COVID-19 in Argentina (SATICOVID): a prospective, multicenter cohort study. Lancet Respir Med 2021; 9(9):989-98. doi: 10.1016/S2213-2600(21)00229-0.

Ranzani OT, Bastos L, Gelli J, Marchesi JF, Bailão F, Hamacher S, et al. Characterisation of the first 250.000 hospital admissions for COVID-19 in Brazil: a retrospective analysis of nationwide data. Lancet Resp Med 2021; 9(4):407-18. doi: 10.1016/S2213-2600(20)30560-9.

Reyes L, Bastidas A, Narváez P, Parra-Tanoux D, Fuentes YV, Serrano-Mayorga C, et al. Clinical characteristics, systemic complications, and in-hospital outcomes for patients with COVID-19 in Latin America. LIVEN-COVID-19 study: a prospective, multicenter, multinational, cohort study. Plos One 2022; 17(3):e0265529. doi: 10.1371/journal.pone.0265529.

Ñamendys-Silva S, Alvarado-Avila P, Domínguez-Cherit G, Rivero-Sigarroa E, Sánchez-Hurtado LA, Gutiérrez-Villaseñor A, et al. Outcomes of patients with COVID-19 in the intensive care unit in Mexico: a multicenter observational study. Heart Lung 2021; 50(1):28-32. doi: 10.1016/j.hrtlng.2020.10.013.

Gupta A, Marzook H, Ahmad F. Comorbidities and clinical complications associated with SARS-CoV-2 infection: an overview. Clin Exp Med 2023; 23(2):313-31. doi: 10.1007/s10238-022-00821-4.

Gibertoni D, Reno C, Rucci P, Fantini MP, Buscaroli A, Mosconi G, et al. COVID-19 incidence and mortality in non dialysis chronic kidney disease patients. Plos One 2021; 16(7):e0254525. doi: 10.1371/journal.pone.0254525.

Richardson S, Hirsch J, Narasimhan M, Crawford J, McGinn T, Davidson K, et al. Presenting characteristics, comorbidities, and outcomes among 5.700 patients hospitalized with COVID-19 in the New York city area. JAMA 2020; 323(20):2052-9. doi: 10.1001/jama.2020.6775.

Langford B, So M, Raybarhan S, Leung V, Westwood D, MacFaden D, et al. Bacterial co-infection and secondary infection in patients with COVID19: a living rapid review and meta-analysis. Clin Microbiol Infect 2020; 26(12):1622-9. doi: 10.1016/j.cmi.2020.07.016.

Feldman C, Anderson R. The role of co-infections and secondary infections in patients with COVID-19. Pneumonia (Nathan) 2021; 13(1):5. doi: 10.1186/s41479-021-00083-w.

Rostami M, Mansouritorghabeh H. D-dimer level in COVID-19 infection: a systematic review. Expert Rev Hematol 2020; 13(11):1265-75. doi: 10.1080/17474086.2020.1831383.

Gungor B, Atici A, Baycan OF, Alici G, Ozturk F, Tugrul S, et al. Elevated D-dimer levels on admission are associated with severity and increased risk of mortality in COVID-19: a systematic review and meta-analysis. Am J Emerg Med 2021; 39:173-9. doi: 10.1016/j.ajem.2020.09.018.

Richards-Belle A, Orzechowska I, Gould DW, Thomas K, Doidge JC Mouncey PR, et al. COVID-19 in critical care: epidemiology of the first epidemic wave across England, Wales and Northern Ireland. Intensive Care Med 2020; 46(11):2035-47. doi: 10.1007/s00134-020-06267-0.

COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators. Clinical characteristics and day-90 outcomes of 4.244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med 2021; 47(1):60-73. doi: 10.1007/s00134-020-06294-x.

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.

Karagiannidis C, Mostert C, Hentschker C, Voshaar T, Malzahn J, Schillinger G, et al. Case characteristics, resource use, and outcomes of 10.021 patients with COVID-19 admitted to 920 german hospitals: an observational study. Lancet 2020; 8(9):853-62. doi: 10.1016/S2213-2600(20)30316-7.

Greco M, De Corte T, Ercole A, Antonelli M, Azoulay E, Citerio G, et al. Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study. Intensive Care Med 2022; 48(6):690-705. doi: 10.1007/s00134-022-06705-1.

Estenssoro E, Loudet C, Dubin A, Kanoore Edul VS, Plotnikow G, Andrian M, et al. Clinical characteristics, respiratory management, and determinants of oxygenation in COVID-19 ARDS: a prospective cohort study. J Crit Care 2022; 71:154021. doi: 10.1016/j.jcrc.2022.154021.

Rodríguez F, Nin N, Fajardo A, Auchayna M, Guerendiaín R, Hurtado J. Early lung autopsy in deceased patients with acute respiratory distress syndrome due to infection by SARS.CoV-2. Med Intensiva (Engl Ed) 2023; 47(3):173-5. doi: 10.1016/j.medine.2022.10.001.

Gupta S, Coca SG, Chan L, Melamed ML, Brenner SK, Hayek SS, et al. AKI treated with renal replacement therapy in critically ill patients with COVID-19. J Am Soc Nephrol 2021; 32(1):161-76. doi: 10.1681/ASN.2020060897.

Rego N, Salazar C, Paz M, Costábile A, Fajardo A, Ferrés I, et al. Emergence and spread of a B.1.1.28-Derived P.6 Lineage with Q675H and Q677H Spike Mutations in Uruguay. Viruses 2021; 13(9):1801. doi: 10.3390/v13091801.

Fiori M, Bello G, Wschebor N, Lecumberry F, Ferragut A, Mordecki E. Decoupling between SARS-CoV-2 transmissibility and population mobility associated with increasing immunity from vaccination and infection in South America. Sci Rep 2022; 12(1):6874. doi: 10.1038/s41598-022-10896-4.

Gupta S, Hayek S, Wang W, Chan L, Mathews KS, Melamed ML, et al. Factors associated with death in critically ill patients with coronavirus disease 2019 in the US. JAMA Intern Med 2020; 180(11):1436-47. doi: 10.1001/jamainternmed.2020.3596.

Gallo Marin B, Aghagoli G, Lavine K, Yang L, Siff EJ, Chiang SS, et al. Predictors of COVID-19 severity: a literature review. Rev Med Virol 2021; 31(1):1-10. doi: 10.1002/rmv.2146.

Churpek MM, Gupta S, Spicer AB, Parker WF, Fahrenbach J, Brenner SK, et al. Hospital-level variation in death for critically ill patients with COVID-19. Am J Respir Crit Care Med 2021; 204(4):403-11. doi: 10.1164/rccm.202012-4547OC.

Bravata DM, Perkins AJ, Myers LJ, Arling G, Zhang Y, Zillich AJ, et al. Association of Intensive Care Unit patients load and demand with mortality rates in US Department of Veterans Affairs hospitals during the COVID-19 pandemic. JAMA Netw Open 2021; 4(1):e2034266. doi: 10.1001/jamanetworkopen.2020.34266.

Rewa OG, Stelfox HT, Ingolfsson A, Zygun DA, Featherstone R, Oppenorth D, et al. Indicators of intensive care unit capacity strain: a systematic review. Crit Care 2018; 22(1):86. doi: 10.1186/s13054-018-1975-3.

Lam B, Stepanova M, Venkatesan C, García I, Reyes M, Mannan A, et al. Outcomes of hospitalized patients with COVID-19 during the course of the pandemic in a fully integrated health system. PloS One 2022; 17(2): e0263417.doi: 10.1371/journal.pone.0263417.

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Publicado

2023-12-22

Cómo citar

1.
Hurtado J, Goldman I, Buroni M, Quiroga C, Rodríguez F, Tenzi J, et al. Características de pacientes con SARS-CoV-2 en estado crítico en un centro COVID-19 de referencia en Uruguay. Rev. Méd. Urug. [Internet]. 22 de diciembre de 2023 [citado 18 de abril de 2024];39(4):e206. Disponible en: https://revista.rmu.org.uy/index.php/rmu/article/view/1062

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