Complicações vasculares em pacientes graves com COVID-19: coorte prospectiva
Data
2023-03-03
Autores
Correia, Rebeca Mangabeira 
Orientadores
Nakano, Luis Carlos Uta
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: Embora tenha sido feita uma associação entre a doença do coronavírus 2019 (COVID-19) e doença microvascular, dados sobre complicações vasculares são escassos. A principal manifestação da doença é a insuficiência respiratória, mas também pode estar relacionada a doenças vasculares, como trombose venosa profunda (TVP), oclusão arterial aguda, coagulação intravascular disseminada (CIVD), acrocianose, necrose de extremidades e rabdomiólise. Pessoas com COVID-19 que desenvolvem complicações vasculares tem pior prognóstico. Objetivo: Investigar as complicações vasculares em pacientes graves internados com COVID-19 e sua associação com a mortalidade por todas as causas. Métodos: Estudo de coorte prospectiva realizada na Universidade Federal de São Paulo, Brasil. Todos os 305 pacientes que foram internados consecutivamente em unidade de terapia intensiva (UTI) diagnosticados com COVID-19 entre 2 de abril a 17 de julho de 2021 foram incluídos e acompanhados por 30 dias. Resultados: Dos 305 pacientes incluídos no estudo, 193 (63,3%) eram do sexo masculino e a idade média foi de 59,9 anos (desvio padrão = 14,34). Todos apresentavam ao menos uma comorbidade, sendo a hipertensão arterial sistêmica (RR 1,78) e a doença renal crônica (RR 1,89) as duas mais prevalentes entre os não sobreviventes, após correção para idade e sexo. A taxa de mortalidade foi de 56,3% (172 pacientes) e 23,6% (72 pacientes) desenvolveram pelo menos uma complicação vascular durante o período de acompanhamento. Complicações vasculares foram mais prevalentes no grupo dos não-sobreviventes (28,5%) do que entre os sobreviventes (17,3%). As complicações vasculares estudadas foram a CIVD (10,8%), TVP (8,2%), acrocianose (7,5%) e necrose das extremidades (2%). CIVD (RRajustado 2,30, intervalo de confiança 1,01-5,24, P =0,046) e acrocianose (RRa 5,21, 95% IC 1,48-18,27, P = 0,009) foram significativamente mais prevalentes nos não-sobreviventes do que nos sobreviventes. O uso de heparina foi associado com menor incidência de complicações vasculares (RR 0,46, IC= 0,22-0,98, P= 0,043). Conclusão: Complicações vasculares em pacientes críticos com COVID-19 são comuns (23,6%) e podem estar estreitamente relacionadas com a taxa de mortalidade (56,3%) em até 30 dias após a admissão na UTI. Complicações macrovasculares têm implicações diretas na mortalidade, que é o principal resultado da gestão da COVID-19 em pacientes críticos.
Backgroung: Although an association has been made between coronavirus disease 2019 (COVID-19) and microvascular disease, data on vascular complications are sparse. The main manifestation of the disease is respiratory failure, but it can also be related to vascular diseases, such as deep vein thrombosis (DVT), acute arterial occlusion, disseminated intravascular coagulation (DIC). acrocyanosis, necrosis of extremities and rhabdomyolysis. Patients with COVID-19 who develop vascular complications has a worst prognosis. Objective: To investigate vascular complications in critically ill patients hospitalized with COVID-19 and their association with all-cause mortality. Methods: This prospective cohort study conducted at the Federal University of São Paulo, Brazil. All 305 patients who were consecutively admitted to the intensive care unit (ICU) diagnosed with COVID-19 between April 2 and July 17, 2021 were included and followed for 30 days. Results: Of these, 193 (63.3%) were male and the mean age was 59.9 years (standard deviation = 14.34). All of them had at least one comorbidity, with systemic arterial hypertension (OR 1.78) and chronic kidney disease (OD 1.89) being the two most prevalent among non-survivors, after correcting for age and sex. The mortality rate was 56.3% (172 patients) and 23.6% (72 patients) developed at least one vascular complication during the follow-up period. Vascular complications were more prevalent in the non-survivor group (28.5%) than among survivors (17.3%). The vascular complications studied were DIC (10.8%), DVT (8.2%), acrocyanosis (7.5%) and necrosis of the extremities (2%). DIC (aOR 2.30, confidence interval 1.01-5.24, P=0.046) and acrocyanosis (adjusted OR 5.21, 95% CI 1.48-18.27, P=0.009) were significantly more prevalent in non-survivors than in survivors. The use of heparin was associated with a lower incidence of vascular complications (OD 0.46, CI= 0.22-0.98, P= 0.043). Conclusion: Vascular complications in critically ill patients with COVID-19 are common (23.6%) and may be closely related to the mortality rate (56.3%) until 30 days after ICU admission. Macrovascular complications have direct implications for mortality, which is the main outcome of management COVID-19.
Backgroung: Although an association has been made between coronavirus disease 2019 (COVID-19) and microvascular disease, data on vascular complications are sparse. The main manifestation of the disease is respiratory failure, but it can also be related to vascular diseases, such as deep vein thrombosis (DVT), acute arterial occlusion, disseminated intravascular coagulation (DIC). acrocyanosis, necrosis of extremities and rhabdomyolysis. Patients with COVID-19 who develop vascular complications has a worst prognosis. Objective: To investigate vascular complications in critically ill patients hospitalized with COVID-19 and their association with all-cause mortality. Methods: This prospective cohort study conducted at the Federal University of São Paulo, Brazil. All 305 patients who were consecutively admitted to the intensive care unit (ICU) diagnosed with COVID-19 between April 2 and July 17, 2021 were included and followed for 30 days. Results: Of these, 193 (63.3%) were male and the mean age was 59.9 years (standard deviation = 14.34). All of them had at least one comorbidity, with systemic arterial hypertension (OR 1.78) and chronic kidney disease (OD 1.89) being the two most prevalent among non-survivors, after correcting for age and sex. The mortality rate was 56.3% (172 patients) and 23.6% (72 patients) developed at least one vascular complication during the follow-up period. Vascular complications were more prevalent in the non-survivor group (28.5%) than among survivors (17.3%). The vascular complications studied were DIC (10.8%), DVT (8.2%), acrocyanosis (7.5%) and necrosis of the extremities (2%). DIC (aOR 2.30, confidence interval 1.01-5.24, P=0.046) and acrocyanosis (adjusted OR 5.21, 95% CI 1.48-18.27, P=0.009) were significantly more prevalent in non-survivors than in survivors. The use of heparin was associated with a lower incidence of vascular complications (OD 0.46, CI= 0.22-0.98, P= 0.043). Conclusion: Vascular complications in critically ill patients with COVID-19 are common (23.6%) and may be closely related to the mortality rate (56.3%) until 30 days after ICU admission. Macrovascular complications have direct implications for mortality, which is the main outcome of management COVID-19.
Descrição
Citação
CORREIA, Rebeca Mangabeira. Complicações vasculares em pacientes graves com COVID-19: coorte prospectiva. 2023. 77 f. Dissertação (Mestrado em Ciência Cirúrgica Interdisciplinar) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2023.