Fatores associados à mortalidade de pacientes com Covid-19 internados em unidade de terapia intensiva: estudo de coorte

Abstract

Introduction: COVID-19 can cause acute respiratory disorders that range from mild symptoms to serious conditions. The high hospitalization rate and lethality of the disease, together with the lack of beds in Intensive Care Units (ICU), show the importance of identifying risk factors, allowing the promotion of better therapeutic and management strategies in the hospital environment. Objective: To identify factors associated with mortality in patients with COVID-19 admitted to the ICU. Subjects and Method: This is a retrospective cohort study with patients admitted to the ICU with COVID-19 admitted to the Hospital Casa de Caridade Nossa Senhora do Perpétuo Socorro de Alfenas - MG. The information analyzed was: sociodemographic variables, previous comorbidities, vaccination history, laboratory and imaging tests, length of stay, orotracheal intubation (OTI) and tracheostomy (TQT), invasive mechanical ventilation (IMV) and its parameters, oxygen therapy, mechanical ventilation non-invasive (NIMV), use of vasoactive drugs, prone position, extracorporeal membrane oxygenation (ECMO), 4C Mortality Score and death. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20.0 software. Data distribution was examined using the Kolmogorov-Smirnov test. The central tendency and dispersion measures used were mean and standard deviation. In all cases, p values ≤ 0.05 were considered significant. Results: There was a negative and significant correlation between mortality and immunization against COVID-19 (r= -0.194), pH (r= -0.127), SpO2 (r= 0.136) and P/F ratio (r=0.250) in arterial blood gas analysis at the end of hospitalization, systolic blood pressure (SBP) (r= -0.153) and diastolic blood pressure (DBP) (r= -0.159), SpO2 (pulse oximetry) (r= -0.213) and the Coma Scale score of Glasgow (r= -0.402), in the final period of hospitalization. A positive and significant correlation was identified between mortality and aging (r= 0.146), use of IMV (r= 0.231), time on IMV (r=0.156) 4C Mortality Score initial (r=0.151) and final (r =0.250), leukocytes (r=0.106) and d-dimer (r=0.194) at the beginning of hospitalization, lactate (r=0.122), C-reactive protein (r=0.167), PaCO2 (r=0.184) and heart rate (HR) (r=0.110) at the end of hospital stay. The prolonged length of stay in the hospital environment and the ICU was influenced by the need for IOT and TQT, as well as the prone position and the greater frequency of repetitions of the maneuver. Conclusion: The factors associated with the mortality of patients with COVID-19 admitted to the ICU were age, lack of immunization against the disease, need for IMV and time on IMV, in addition to the 4C Mortality Score at the beginning and end of hospitalization. In relation to laboratory tests, those associated with mortality were leukocytes, d-dimer, lactate, C-reactive protein and in the arterial blood gas analysis, respiratory acidosis and high concentration of CO2 were associated with death, as well as low P/F ratio. Regarding vital signs, only HR, SBP, DBP, peripheral saturation and level of consciousness on the Glasgow Coma Scale recorded at the end of hospitalization were associated with mortality.