ABSTRACT
Objetivo : Estimar la mortalidad relacionada a hidroxicloroquina y azitromicina en pacientes con Covid-19 en ventilación mecánica de una unidad de cuidados intensivos. Material y métodos : Cohorte analítica retrospectiva. Se incluyeron 105 pacientes con Covid-19 en ventilación mecánica invasiva que ingresaron con el diagnóstico de Insuficiencia Respiratoria Aguda a la unidad de cuidados intensivos del Hospital Cayetano Heredia durante el año 2020. Resultados : La mortalidad global fue 38 %; el 79 % fueron varones, la edad media fue 50±13 años, el 65 % no tuvo comorbilidades; al ingreso la puntuación en la escala APACHE II fue 12±6 puntos y en la escala SOFA 5±3 puntos; el 30 % recibió hidroxicloroquina, el 32 % azitromicina y 32 % la combinación de los mismos. La mortalidad fue significativamente mayor en pacientes que recibieron hidroxicloroquina (p=0.001), azitromicina (p=0.03), y la combinación hidroxicloroquina más azitromicina (p=0.001). Sin embargo, en la regresión de Cox se evidenció que los pacientes que fallecieron tuvieron mayor probabilidad de exposición a hidroxicloroquina (p=0.001) (HR: 21, IC: 3.4-131.3), no ocurrió lo mismo con azitromicina (p=0.22) (HR: 0.43, IC: 0.11-1.6). Conclusión : La mortalidad en los pacientes con Covid-19 en ventilación mecánica invasiva fue significadamente mayor en pacientes que recibieron hidroxicloroquina.
Objective : To estimate mortality rates associated with hydroxichloroquine and azithromycin use in Covid-19 patients undergoing mechanical ventilation in an intensive care unit in Lima. Material and methods : This is a retrospective analytical cohort. One hundred and five patients with Covid-19 undergoing invasive mechanical ventilation who were admitted with a diagnosis of acute respiratory insufficiency to the intensive care unit of Cayetano Heredia Hospital in Lima during 2020. Results : The overall mortality rate was 38%. Most patients (79%) were male, their mean age was 50 ± 13 years, two thirds (65%) did not have comorbidities; APACHE II and SOFA scores were 12 ± 6 points and 5 ± 3 points, respectively. Thirty percent of all patients received hydroxichloroquine, 32% received azithromycin, and 32% received both drugs. Mortality was significantly higher in those patients who received hydroxichloroquine (p= 0.001), azithromycin (p= 0.03), and the combination of hydroxichloroquine and azithromycin (p= 0.001). However, when a Cox regression analysis was performed, it was evidenced that deceased patients were more likely to have been exposed to hydroxichloroquine (p= 0.001) (HR: 21, CI: 3.4-131.3), but this was not the case with azithromycin (p= 0.22) (HR: 0.43, CI: 0.11-1.6). Conclusion : Mortality in Covid-19 patients undergoing invasive mechanical ventilation was higher in those who received hydroxichloroquine.
ABSTRACT
INTRODUÇÃO: Os derivados das 4-aminoquinolonas vêm sendo utilizados desde sua industrialização na terapêutica da malária, das doenças reumatológicas e dermatológicas. Essas drogas apresentam reações adversas sistêmicas e oculares. As reações adversas sistêmicas afetam o sistema gastrointestinal, sistema nervoso, sistema muscular esquelético e a pele, e as oculares são: fotofobia, córnea verticilata, poliose, catarata, paralisia dos músculos extraoculares, uveíte anterior, maculopatia tóxica, neurite óptica. OBJETIVO: Revisão bibliográfica das complicações do uso de cloroquina e derivados. Analisar evolução e estágio atual da propedêutica. Sugerir conduta prática no mapeamento precoce dos sinais de toxicidade. MÉTODOS: Revisão bibliográfica através da pesquisa no banco de dados MEDLINE, PUBMED, LILACS e SciELO. DISCUSSÃO: São descritos todos os exames que podem ser utilizados para mapeamento das reações adversas oculares, tais quais: exame oftalmológico completo, com ênfase na biomicroscopia e oftalmoscopia binocular indireta, campo visual computadorizado, tela de Amsler, visão de cores, exames eletrofisiológicos, polarimetria e tomografia de coerência óptica. É feita a descrição do quadro de maculopatia enfocando epidemiologia, fatores de risco, histopatologia e propedêutica. É descrita a estrutura química e as diferenças entre os derivados das 4-aminoquinolonas. CONCLUSÃO: Todo paciente em uso de cloroquina e seus derivados devem ser acompanhados e documentados desde seu início e até atingir a dose cumulativa acima de 100 gramas. Quanto maior a dose cumulativa, maior deve ser a nossa preocupação com o seguimento desse paciente.
INTRODUCTION: Byproducts of 4-aminoquinolones are being used since its industrialization in the treatment of malaria, rheumatic and dermatologic diseases. These drugs present systemic and ocular adverse events. Systemic adverse reactions affect the gastrointestinal, nervous and skeletal muscular systems and the skin. Ocular adverse reactions are: photophobia, cornea verticillata, poliosis, cataract, extraocular muscle palsy, anterior uveitis, toxic maculopathy and optical neuritis. PURPOSE: Bibliography review of complications due to the use of chloroquine and its derivatives. To analyze the current practice and propedeutics' evolution. To suggest practical managements for early toxicity signs. METHODS: Bibliographic review through research on MEDLINE, PUBMED, LILACS and SciELO database. DISCUSSION: All exams that can be used to screen ocular adverse reactions are described, such as: complete ophthalmologic exam, with emphasis on biomicroscopy and indirect binocular ophthalmoscopy, computerized visual field, Amsler grid testing and color vision testing, electrophysiological exams, polarimetry and optical coherence tomography. A description of maculopathy is presented, focusing on epidemiology, risk factors, histopathology and propedeutics. Chemical structure and the differences between 4-aminoquinolone derivatives are described. CONCLUSION: All patients using chloroquine and its derivatives must be followed-up and documented since the beginning of the therapy until they reach a cumulative dose above 100 grams. The higher the cumulative dose, the more we must be concerned with patient follow-up.