Factores de riesgo asociados a ingreso a Unidad de Cuidados Intensivos en pacientes con COVID-19 en hospitales colombianos, estudio de cohorte / Risk factors associated with admission in the Intensive Care Unit among patients with COVID-19 in Colombian hospitals, a cohort study

RESUMEN

INTRODUCCIÓN: Los pacientes hospitalizados con COVID-19 presentan un espectro clínico variable y su gravedad puede ser predicha por la presencia de factores de riesgo. OBJETIVO: Determinar los factores asociados al ingreso a UCI en pacientes internados por COVID-19 en Colombia. PACIENTES Y MÉTODOS: Estudio de cohorte multicéntrico, retrospectivo, en pacientes adultos hospitalizados por COVID-19 en Colombia, desde marzo de 2020 a enero de 2021. Se describieron las características de los pacientes y se establecieron predictores de ingreso a la UCI mediante un modelo de regresión logística. RESULTADOS: Se incluyeron 1.160 pacientes, edad media de 55 años, 59,7% fueron hombres y 426 pacientes (36,7%) ingresaron a UCI. Los factores asociados al ingreso a UCI fueron edad (OR 1,25; IC 95% 1,14-1,37), sobrepeso (OR 2,82; IC 95% 1,98-4,02) y obesidad (OR 2,97; IC 95% 2,03-4,37), antecedente de cardiopatía valvular (OR 6,46; IC 95% 1,84-27,48), hipotensión arterial al ingreso (OR 2,35; IC 95% 1,40-3,97), SIRS (OR 2,03; IC 95% 1,50-2,74), disnea (OR 1,52; IC 95% 1,09-2.14), requerimiento de oxígeno (OR 2,64; IC 95% 1,67-4,30), neutrofilia (OR1,09; IC 95% 1,05-1,13), elevación de dímero D (OR 1,09; IC 95% 1,03-1,18), compromiso multilobar (OR 2,19; IC 95% 1,58-3,07) y consolidación pulmonar (OR1,52; IC 95% 1,13-2,04). La mortalidad intrahospitalaria fue de 14,4% (166 pacientes), 2,3% entre los que no ingresaron a la UCI y 35,2% entre los que sí lo hicieron. CONCLUSIÓN: El 36,7% de pacientes hospitalizados por COVID-19 ingresó a UCI, identificándose predictores clínicos y de laboratorio asociados con este desenlace. La elaboración de modelos predictores con estos parámetros podría mejorar el pronóstico de los pacientes con COVID-19 que se hospitalizan.

ABSTRACT

BACKGROUND: Hospitalized patients with COVID-19 present a variable clinical spectrum and its severity might be predicted by the presence of risk factors. AIM: To determine the factors associated with ICU admission in patients hospitalized for COVID-19 in Colombia. METHOD: Retrospective multicenter cohort study, in adult patients hospitalized for COVID-19 in Colombia, from March 2020 to January 2021. Population characteristics were described and ICU admission predictors were established using a logistic regression model. RESULTS: 1,160 patients were included, mean age 55 years, 59.7% were men and 426 patients (36.7%) were admitted to the ICU. The associated factors were age (OR 1.25, 95% CI 1.14-1.37), overweight (OR 2.82, 95% CI 1.98-4.02) and obesity (OR 2.97, 95% CI 2.03-4.37), valvular heart disease (OR 6.46, 95% CI 1.84-27.48) hypotension at admission (OR 2.35, 95% CI 1.40-3, 97), SIRS (OR 2.03, 95% CI 1.50-2.74), dyspnea (OR 1.52, 95% CI 1.09-2.14), oxygen requirement (OR 2.64, 95% CI 1.67-4.30), neutrophilia (OR 1.09, 95% CI 1.05-1.13), elevated D-dimer (OR 1.09, 95% CI 1.03-1.18), multilobar lung involvement (OR 2.19, 95% CI 1.58-3.07) and pulmonary consolidation (OR 1.52, 95% CI 1.13-2.04). In-hospital mortality was 14.4% (166 patients), 2.3% among those that did not enter to the ICU and 35.2% among those who did. CONCLUSION: 36.7% of patients hospitalized for COVID-19 were admitted to the ICU. We identified clinical predictors associated with this outcome. Predictive models using these parameters could improve the prognostic of those patients with COVID-19 that are hospitalized.