Factors associated with mortality in critically ill patients with COVID-19 / Fatores associados à mortalidade em pacientes críticos com COVID-19 / Factores asociados a la mortalidad en pacientes críticos con COVID-19

Background and objectives: COVID-19 is a life-threatening disease. Recognizing the main characteristics of the disease and its main complications will help future interventions, care, and management of health services since territorial and population diversities directly influence health outcomes. Our main objective is to describe the clinical characteristics, outcomes, and factors associated with mortality of patients with COVID-19 admitted to the intensive care unit of a public and tertiary hospital. Methods: Cohort study, conducted from March 1 to September 30, 2020. Poisson regression was performed to investigate the variables of hospital treatment as potential risk factors for in-hospital mortality. Results: Of the 283 eligible patients in this study, the hospital mortality rate was of 41.7% (n=118). The most common outcomes were acute respiratory distress syndrome, nosocomial infection, and septic shock. Factors independently associated with increased risk of death were age greater than 51 years old (RR=1.7, 95%CI=1.0-2.8), especially over 70 years old (RR=2.9, 95%CI=1.7-2.8), current smoker (RR=1.8, 95%CI=1.1-2.9), requiring the use of inotrope (RR=1.4, 95%CI=1.0-2.0), and presenting potassium greater than 5.0 mEq/l on admission (RR=1.3, 95%CI=1.0-1.7). Conclusion: Mortality was associated with older age, being a current smoker, inotrope use, and presenting potassium greater than 5.0 on hospital admission.(AU)

Justificativa e objetivos: A COVID-19 é uma doença ameaçadora à vida. Reconhecer as características da doença e suas principais complicações nesta população auxiliará em futuras intervenções, cuidados e gestão dos serviços de saúde, uma vez que a diversidade territorial e populacional influencia diretamente nos resultados de saúde. O objetivo principal do presente estudo é descrever as características clínicas, desfechos e fatores associados à mortalidade de pacientes com COVID-19 internados na unidade de terapia intensiva de um hospital público e terciário. Métodos: Estudo de coorte, realizado de 1º de março a 30 de setembro de 2020. Foi realizada regressão de Poisson para investigar variáveis de apresentação hospitalar como potenciais fatores de risco para mortalidade intra-hospitalar. Resultados: Dos 283 pacientes elegíveis neste estudo, o dado de mortalidade hospitalar foi de 41,7% (n=118). Os desfechos mais comuns foram síndrome do desconforto respiratório agudo, infecção hospitalar e choque séptico. Os fatores independentemente associados ao aumento do risco de morte foram idade superior a 51 anos (RR=1,7, IC 95%=1,0-2,8), principalmente acima de 70 anos (RR=2,9, IC 95%=1,7-2,8), tabagismo atual (RR=1,8, IC 95%=1,1-2,9), necessidade de inotrópico (RR=1,4, IC 95%=1,0-2,0) e potássio maior que 5,0 mEq/l (RR=1,3, IC 95%=1,0- 1.7) na admissão. Conclusão: A mortalidade esteve associada à idade avançada, tabagismo atual, uso de inotrópicos e potássio maior que 5,0 na admissão hospitalar.(AU)

Justificación y objetivos: La COVID-19 es una enfermedad potencialmente mortal. Reconocer las características de la enfermedad y sus principales complicaciones en esta población ayudará a futuras intervenciones, atención y gestión de los servicios de salud, ya que las diversidades territoriales y poblacionales influyen directamente en los resultados de salud. El objetivo principal de este estudio es describir las características clínicas, los resultados y los factores asociados a la mortalidad de los pacientes con COVID-19 ingresados en la unidad de cuidados intensivos de un hospital público y de tercer nivel. Métodos: Estudio de cohorte, realizado del 1 de marzo al 30 de septiembre de 2020. Se realizó regresión de Poisson para investigar variables en la presentación hospitalaria como potenciales factores de riesgo para la mortalidad intrahospitalaria. Resultados: De los 283 pacientes elegibles en este estudio, el 41,7% (n=118) tuvo mortalidad hospitalaria. Los desenlaces más comunes fueron síndrome de dificultad respiratoria aguda, infección nosocomial y shock séptico. Los factores independientemente asociados a mayor riesgo de muerte fueron edad mayor de 51 años (RR=1,7, IC95%=1,0-2,8), especialmente mayores de 70 años (RR=2,9, IC95%=1,7-2,8), tabaquismo actual (RR=1,8, IC95%=1,1-2,9), necesidad de inotrópico (RR=1,4, IC95%=1,0-2,0) y potasio mayor que 5,0 mEq/l (RR=1,3, IC95%=1,0-1,7). Conclusión: La mortalidad estuvo asociada a la edad avanzada, tabaquismo actual, uso de inotrópico y potasio mayor a 5,0 en la admisión hospitalaria.(AU)

Adult patients admitted to a tertiary hospital for COVID-19 and risk factors associated with severity: a retrospective cohort study

ABSTRACT COVID-19 is a disease whose knowledge is still under construction, high transmissibility, with no consensual treatment available to everyone. Therefore, the identification of patients at higher risk of evolving to the critical form of the disease is fundamental. The study aimed to determine risk factors associated with the severity of COVID-19 in adults patients. This is an observational, retrospective study from a cohort of adult patients with COVID-19 admitted to a public hospital from March to August 2020, whose medical records were evaluated. For the association of possible severity predictors, a Poisson regression was used. The primary outcome was the critical form of the disease (need for admission to the Intensive Care Unit and/or invasive mechanical ventilation). We included 565 patients: mostly men; 55.5% of those who progressed to the critical form of the disease were over sixty years old. Hypertension, diabetes mellitus and obesity were the most frequent comorbidities. There were 39.8% of patients who progressed to the critical form of the disease. The hospital mortality rate was 22.1%, and that of critical patients was 46.7%. The independent factors associated with the severity of the disease were obesity [RR = 1.33 (95% CI 1.07 to 1.66; p = 0.011)], SpO2/FiO2 ratio ≤ 315 [RR = 2.20 (95% CI 1.79 to 2.71; p = 0.000)], C-reactive protein > 100 mg/L [RR = 1.65 (95% CI 1.33 to 2.06; p = 0.000)], and lymphocytes < 1,000/µL [RR = 1.44 (95% CI 1.18 to 1.75; p = 0.000)]. Advanced age and comorbidities were dependent factors strongly associated with the critical form of the disease.

Knowledge about diabetes in patients hospitalized for heart disease: a descriptive research

Aim: To assess the knowledge of patients hospitalized for cardiovascular co-morbidities in diabetes mellitus (DM), and its relationship to the confrontation and attitudes towards the disease. Method: This was a prospective cross-sectional study, conducted in the inpatient unit with cardiac patients affected by DM. Their level of knowledge about diabetes was assessed using the Diabetes Knowledge Scale (DKN-A) and the psychological and emotional aspects were assessed by use of the Diabetes Attitudes Questionnaire (ATT-19). Results: We included 220 patients with 63.0 ± 9.4 years, of which 119 (54.1%) were male. The punctuation of the scores ≥ eight in DKN-A was found in 55 patients (25%), and a score ≥ 60 on ATT-19 occurred in 37 patients (17.7%). Discussion: The patients who presented with relatively good knowledge about DM had a score of ≥ eight; those individuals who had a score ≥ 60 on the scale ATT-19 had an appropriate response to the disease. Conclusion: The patients generally had a low level of knowledge of DM and had difficulty in coping with the disease.

Fatores de risco para doença arterial coronariana em pacientes admitidos em unidade de hemodinâmica / Factores de riesgo para enfermedad arterial coronaria en pacientes de una unidad de hemodinamia / Risk factors for coronary artery disease in patients admitted in hemodynamics unit

O estudo transversal objetivou identificar os fatores de risco (FR) para doença arterial coronariana (DAC) em pacientes submetidos a procedimentos cardíacos em unidade hemodinâmica. Incluíram-se 302 pacientes com idade de 62±11 anos, predominantemente brancos 270 (89%) e do sexo masculino 172 (57%). O FR de maior prevalência foi o sedentarismo 227 (75%), seguido de hipertensão 220 (73%), dislipidemia 150 (50,5%), obesidade 87 (29%), diabetes mellitus 81 (27%), tabagismo 77 (25,5%), consumo de álcool 67 (22%) e alimentação pobre em frutas e verduras 15 (5%). A correlação entre o número de FR e as variáveis - escolaridade, renda, idade, estado civil, atividade profissional e sexo -, além do número de procedimentos a que foram submetidos, comparado àqueles que apresentavam número superior a cinco FR para DAC, não foi significativa; no entanto, existe uma associação positiva, reforçando a importância de estratégias que visem à diminuição ou eliminação dos FR modificáveis.

Estudio transversal cuyo objetivo fue evaluar la prevalencia de factores de riesgo (FR) para enfermedad arterial coronaria (EAC) en pacientes sometidos a procedimientos cardíacos en una unidad de hemodinamia. Se incluyeron 302 pacientes de 62±11 años, predominantemente blancos (270, 89%) y de sexo masculino (172, 57%). Los FR más prevalentes fueronsedentarismo (227, 75%), seguido de la hipertensión (220, 73%), dislipidemia (150, 50.5%), obesidad (87, 29%), diabetes mellitus (81, 27%), tabaquismo (77, 25.5%), consumo de alcohol (67, 22%) y alimentación pobre en frutas y verduras (15, 5%). La correlación entre el número de FR y las variables analizadas (escolaridad, sueldo mínimo, edad, estado civil, actividad profesional y sexo, además del número de procedimientos a los que fueron sometidos) comparados con aquellos que presentaban más que cinco FR para EAC, no fue significativo; sin embargo, existe una asociación positiva, reforzando la importancia de estrategias que visen disminuir o eliminar los FR modificables.

Transversal study aiming to evaluate the predominance of risk factor (RF) regarding to coronary artery disease (CAD) in patients submitted to cardiac procedures in hemodynamic unit. The study encloses 302 patients of 62±11 years old, 270 (89%) predominantly white and 172 (57%) male. The most prevalent RF was 227 (75%) sedentism, followed by 220 (73%)arterial hypertension, 150 (50,5%) dyslipidemia, 87 (29%) obesity, 81 (27%) diabetes mellitus, 77 (25,5%) smoking, 67 (22%) alcohol and 15 (5%) diet poor of fruits and vegetables. The correlation was not relevant between the quantity of RF and its variables: scholarship, income, age, marital status, professional activity and gender, in addition to the quantity ofprocedures submitted, comparing those with five or more RF for CAD; however, there is a positive connection that reinforces the importance of strategies towards to reduce or remove modifiable RF.