Epidemiologia dos pacientes atendidos com quadro respiratório durante a COVID-19
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Data
2024-04-09
Autores
Freitas, Victor Muniz de [UNIFESP]
Orientadores
Rangel, Érika Bevilaqua [UNIFESP]
Tipo
Dissertação de mestrado
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Resumo
A pandemia de COVID-19 foi marcada por sua rápida disseminação e elevada morbimortalidade em seu período inicial. Precedendo o surgimento de vacinas, esta pandemia acumulou 7 milhões de óbitos globalmente e 700 mil óbitos no Brasil até fevereiro de 2024.
A morbimortalidade da COVID-19 concentra-se no sexo masculino e em faixas etárias elevadas, além de acometer desproporcionalmente aqueles com alguma comorbidade. Fora o grande número de mortes atreladas à doença, a pandemia foi marcada por grave comprometimento respiratório, com necessidade de ventilação mecânica superando as capacidades dos sistemas de saúde, e comprometimento renal, necessitando de terapia renal substitutiva. A análise retrospectiva de 7336 pacientes de COVID-19 de março a julho de 2020 no Hospital São Paulo revelou a predileção por sexo masculino (56,7%) e média de idade de 59,3 ± 16,1 anos, sendo que pacientes hipertensos tiveram chance 1,58 (IC 1,01-2,48) vezes maior de óbito, enquanto pacientes previamente doentes renais crônicos tiveram chance 5,6 (IC 2,93-10,29) vezes maior de necessidade de hemodiálise durante a internação.
A análise laboratorial evidenciou que alterações em pH, bicarbonato, lactato e glicemia em gasometria arterial são preditores de desfechos negativos, bem como a elevação de proteína C reativa. O comprometimento de função renal, marcado por elevação dos valores de ureia e creatinina séricas, com consequente redução da TFGe (taxa de filtração glomerular estimada), também foi um preditor de maior
morbimortalidade geral.
O entendimento dos fatores de risco demográficos, complementado pela presença de comorbidades e avaliação laboratorial dirigida, permite identificar os pacientes com risco elevado de complicações da COVID-19, com chances aumentadas de necessitar de suporte ventilatório, suporte de terapia intensiva e hemodiálise, além de maior risco de óbito. Desta forma, foi possível estratificar os pacientes com maior risco de morbimortalidade pela COVID-19, contribuindo para definição de políticas públicas e alocação de recursos.
The COVID-19 pandemic was marked by its rapid spread and high morbimortality in its initial period. Prior to the emergence of vaccines, this pandemic has accumulated seven million deaths globally and 700,000 deaths in Brazil until February 2024. The morbimortality of COVID-19 concentrates in males and older age groups, as well as disproportionately affecting those with some comorbidities. Besides the large number of deaths linked to the disease, the pandemic was marked by severe respiratory impairment, with the need for mechanical ventilation exceeding the capabilities of health systems, and renal impairment, requiring renal replacement therapy. The retrospective analysis of 7336 patients of COVID-19 from March to July 2020, at Hospital São Paulo revealed a predilection for males (56.7%) and a mean age of 59.3 ± 16.1 years, with hypertensive patients having a 1. 58 (CI 1.01-2.48) times greater chance of death, while previously chronic kidney disease patients had a 5.6 (IC 2.93-10.29) times greater chance of needing hemodialysis during hospitalization. Laboratory analyses showed that changes in pH, bicarbonate, lactate, and blood glucose in arterial blood gases are predictors of negative outcomes, along with an increased C-reactive protein. Impairment of renal function, marked by an increase in serum urea and creatinine values, with a consequent reduction in eGFR (estimated glomerular filtration rate), was also a predictor of greater morbidity and mortality overall. Understanding demographic risk factors, complemented by the presence of comorbidities and targeted laboratory assessment, allows us to determine patients at high risk of complications from COVID-19, with increased chances of needing ventilatory support, intensive care support, and hemodialysis, in addition to a greater risk of death. In this way, it was possible to stratify patients at higher risk of morbidity and mortality from COVID-19, contributing to defining public policies and resource allocation.
The COVID-19 pandemic was marked by its rapid spread and high morbimortality in its initial period. Prior to the emergence of vaccines, this pandemic has accumulated seven million deaths globally and 700,000 deaths in Brazil until February 2024. The morbimortality of COVID-19 concentrates in males and older age groups, as well as disproportionately affecting those with some comorbidities. Besides the large number of deaths linked to the disease, the pandemic was marked by severe respiratory impairment, with the need for mechanical ventilation exceeding the capabilities of health systems, and renal impairment, requiring renal replacement therapy. The retrospective analysis of 7336 patients of COVID-19 from March to July 2020, at Hospital São Paulo revealed a predilection for males (56.7%) and a mean age of 59.3 ± 16.1 years, with hypertensive patients having a 1. 58 (CI 1.01-2.48) times greater chance of death, while previously chronic kidney disease patients had a 5.6 (IC 2.93-10.29) times greater chance of needing hemodialysis during hospitalization. Laboratory analyses showed that changes in pH, bicarbonate, lactate, and blood glucose in arterial blood gases are predictors of negative outcomes, along with an increased C-reactive protein. Impairment of renal function, marked by an increase in serum urea and creatinine values, with a consequent reduction in eGFR (estimated glomerular filtration rate), was also a predictor of greater morbidity and mortality overall. Understanding demographic risk factors, complemented by the presence of comorbidities and targeted laboratory assessment, allows us to determine patients at high risk of complications from COVID-19, with increased chances of needing ventilatory support, intensive care support, and hemodialysis, in addition to a greater risk of death. In this way, it was possible to stratify patients at higher risk of morbidity and mortality from COVID-19, contributing to defining public policies and resource allocation.
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Citação
FREITAS, Victor Muniz de. Epidemiologia dos pacientes atendidos com quadro respiratório durante a COVID-19. 2024. 102 f. Dissertação (Mestrado em Nefrologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo, 2024.