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

Javier Hurtado; Irina Goldman; María Buroni; Carlos Quiroga; Fernando Rodríguez; Jordán Tenzi; Elizabeth Montoya; Silvia Viera; Evangelina Alfonso; Cecilia Villarino; Nicolás Nin; Álvaro Giordano; Fiorella Cavalieri

doi:10.29193/RMU.39.4.6

Authors

Javier Hurtado Administración de los Servicios de Salud del Estado (ASSE), Hospital Español, Unidad de Medicina Intensiva. Centro COVID-19 de referencia https://orcid.org/0000-0002-2570-5467
Irina Goldman Administración de los Servicios de Salud del Estado (ASSE), Hospital Español, Unidad de Medicina Intensiva. Centro COVID-19 de referencia https://orcid.org/0009-0005-5233-4859
María Buroni Administración de los Servicios de Salud del Estado (ASSE), Hospital Español, Unidad de Medicina Intensiva. Centro COVID-19 de referencia https://orcid.org/0000-0002-6302-3969
Carlos Quiroga Administración de los Servicios de Salud del Estado (ASSE), Hospital Español, Unidad de Medicina Intensiva. Centro COVID-19 de referencia https://orcid.org/0009-0001-3020-5678
Fernando Rodríguez Administración de los Servicios de Salud del Estado (ASSE), Hospital Español, Unidad de Medicina Intensiva. Centro COVID-19 de referencia https://orcid.org/0000-0003-3928-5077
Jordán Tenzi Administración de los Servicios de Salud del Estado (ASSE), Hospital Español, Unidad de Medicina Intensiva. Centro COVID-19 de referencia https://orcid.org/0000-0002-7994-042X
Elizabeth Montoya Administración de los Servicios de Salud del Estado (ASSE), Hospital Español, Unidad de Medicina Intensiva. Centro COVID-19 de referencia https://orcid.org/0009-0001-1886-9113
Silvia Viera Administración de los Servicios de Salud del Estado (ASSE), Hospital Español, Unidad de Medicina Intensiva. Centro COVID-19 de referencia https://orcid.org/0009-0009-2742-6734
Evangelina Alfonso Administración de los Servicios de Salud del Estado (ASSE), Hospital Español, Unidad de Medicina Intensiva. Centro COVID-19 de referencia https://orcid.org/0009-0005-3426-0016
Cecilia Villarino Administración de los Servicios de Salud del Estado (ASSE), Hospital Español, Unidad de Medicina Intensiva. Centro COVID-19 de referencia https://orcid.org/0009-0006-6200-5423
Nicolás Nin Administración de los Servicios de Salud del Estado (ASSE), Hospital Español, Unidad de Medicina Intensiva. Centro COVID-19 de referencia https://orcid.org/0000-0001-6037-2357
Álvaro Giordano Administración de los Servicios de Salud del Estado (ASSE), Hospital Español, Unidad de Medicina Intensiva. Centro COVID-19 de referencia https://orcid.org/0000-0001-5468-7555
Fiorella Cavalieri Universidad de la República, Facultad de Medicina, Departamento de Medicina Preventiva y Social https://orcid.org/0000-0002-0028-3544

DOI:

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

Keywords:

SARS-COV-2, COVID-19, ACUTE RESPIRATORY DISTRESS SYNDROME, INVASIVE MECHANICAL VENTILATION

Abstract

Introduction: COVID-19 has caused high mortality worldwide. However, the most critical presentations of the disease have been poorly characterized in our region.
Objective: to study the clinical presentation, progression, and mortality in patients admitted to the Intensive Care Unit (ICU) of a COVID-19 Reference Center.
Patients and methods: clinical, prospective, observational study of SARS-CoV-2 during the early stages of the pandemic in Uruguay. ICU mortality was defined as the primary outcome.
Results: in 274 patients, the median age was 65 years (IQR 54-73), male gender accounted for 57%, and the Charlson Index was 3 (IQR 2-5). ICU mortality was 59.9%. The main causes of death were refractory hypoxemia, multiple organ dysfunction, and refractory shock. Age (Odds Ratio (OR) = 1.06; 95% CI 1.03 - 1.09), bed occupancy (OR= 1.04, 95% CI: 1.02 -1.07), male gender (OR= 2.14, 95% CI 0.93 - 5.06), invasive mechanical ventilation (OR= 51.7, 95% CI 16.5 - 208.6), coinfection at admission (OR= 2.34, 95% CI 0.88 - 6.77), and pre-existing chronic kidney disease (OR= 13.1, 95% CI 2.29 - 129.2) were independent predictors of mortality. The first wave of the pandemic was driven by the circulation of the P.6 and P.1 variants of the coronavirus in a population with a very low vaccination percentage (8%).
Conclusions: these results in critical patients provide a detailed description of the impact of the SARS-CoV-2 pandemic in a reference center and serve as a foundation for addressing future epidemic events.

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