Obesity and the obesity paradox in patients with severe COVID-19 / Obesidad y paradoja de la obesidad en pacientes con COVID-19 severo: Resultados de dos cohortes prospectivas

Objective: To test the presence of the obesity paradox in two cohorts of patients hospitalized for COVID-19. Design: Two multicenter prospective cohorts. Setting: Three fourth level institutions. Patients: Adults hospitalized in the general ward for confirmed COVID-19 in the three institutions and those admitted to one of the 9 critical care units of one of the institutions. Interventions: None. Main variables of interest: Categorized weight and its relationship with admission to the ICU in hospitalized patients and death in the ICU. Result: Of 402 hospitalized patients, 30.1% were obese. Of these, 36.1% were admitted to the ICU vs. 27.1% of non-obese patients. Of the 302 ICU patients, 46.4% were obese. Of these, mortality was 45.0% vs. 52.5% for non-obese. The requirement to transfer hospitalized patients to the ICU admission get a HR of 1.47 (95%CI 0.87–2.51, p = 0.154) in the multivariate analysis. In intensive care patients, an HR of 0.99 (95%CI: 0.92–1.07, p = 0.806) was obtained to the association of obesity with mortality. Conclusions: The present study does not demonstrate an association between obesity and risk of inpatient transfer to intensive care or death of intensive care patients due to COVID-19 therefore, the presence of an obesity paradox is not confirmed. (AU)

Objetivo: Comprobar la presencia la paradoja de la obesidad en dos cohortes de pacientes hospitalizados por COVID-19. Diseño: Dos cohortes prospectivas multicéntricas. Ámbito: Tres instituciones de cuarto nivel. Pacientes: Adultos hospitalizados en pabellón general por COVID-19 confirmado en las tres instituciones y aquellos internados en alguna de las 9 unidades de cuidado crítico de una de las instituciones. Intervenciones: Ninguna. Variables de interés principales: El peso categorizado y su relación con el ingreso a UCI en hospitalizados y de muerte en UCI. Resultado: Entre 402 hospitalizados 30.1% fueron obesos, de los que 36.1% ingresaron a UCI vs. 27.1% en los no obesos. De los 302 pacientes en UCI, el 46.4% fueron obesos, entre ellos la mortalidad fue de 45.0% vs. 52.5% en los no obesos. En hospitalizados el análisis multivariado obtuvo HR de 1.47 (IC95% 0.87–2.51, p = 0.154) para traslado a UCI. En UCI se obtuvo un OR de 0.99 (IC95%: 0.92–1.07, p = 0.806) para la muerte. Conclusiones: El presente estudio no demuestran una asociación entre la obesidad y el riesgo de traslados a cuidados intensivos en pacientes hospitalizados ni con la muerte en pacientes en cuidados intensivos por COVID-19 por lo que no se confirma la presencia de una paradoja de la obesidad. (AU)

Obesity and the obesity paradox in patients with severe COVID-19.

OBJECTIVE: To test the presence of the obesity paradox in two cohorts of patients hospitalized for COVID-19. DESIGN: Two multicenter prospective cohorts. SETTING: Three fourth level institutions. PATIENTS: Adults hospitalized in the general ward for confirmed COVID-19 in the three institutions and those admitted to one of the 9 critical care units of one of the institutions. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Categorized weight and its relationship with admission to the ICU in hospitalized patients and death in the ICU. RESULT: Of 402 hospitalized patients, 30.1% were obese. Of these, 36.1% were admitted to the ICU vs. 27.1% of non-obese patients. Of the 302 ICU patients, 46.4% were obese. Of these, mortality was 45.0% vs. 52.5% for non-obese. The requirement to transfer hospitalized patients to the ICU admission get a HR of 1.47 (95%CI 0.87-2.51, p = 0.154) in the multivariate analysis. In intensive care patients, an HR of 0.99 (95%CI: 0.92-1.07, p = 0.806) was obtained to the association of obesity with mortality. CONCLUSIONS: The present study does not demonstrate an association between obesity and risk of inpatient transfer to intensive care or death of intensive care patients due to COVID-19 therefore, the presence of an obesity paradox is not confirmed.

Early warning scores to identify the risk of clinical worsening or death in patients hospitalized for COVID-19

Background: identifying patients at risk for negative outcomes is key for performing a timely triage and adapting the care intensity for patients with COVID-19. Early warning scores are rules that alert to the risk of adverse outcomes during hospitalization. We sought to validate the modified NEWS, NEWS-2 and COVID-19 Severity Index (CSI). Methods: a prospective observational multicenter study of patients hospitalized for CO VID-19 at three quaternary care hospitals in Bogotá, Colombia, between April and November 2020. The operating characteristics and areas under the ROC curve were calculated. Results: 711 patients were included, in whom the AUC for death was 0.68, 0.58 and 0.68, and for ICU admission was 0.61, 0.63 and 0.66 for mNEWS, NEWS-2 and CSI, respectively. The CSI had the greatest sensitivity for ICU admission or death (87.6 and 90.0%) and NEWS-2 had the greatest specificity (76.8 and 75.5%). Conclusions: the three early warning scores had a low to moderate performance in pre dicting ICU admission or death in patients hospitalized for COVID-19. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2225).

Antecedentes: la identificación de los pacientes con riesgo de desenlaces negativos es clave para realizar un triage oportuno y adecuar la intensidad de los cuidados en los pacientes con COVID-19. Las puntuaciones de alerta temprana son reglas para advertir el riesgo de desenlaces adversos durante la hospitalización. Buscamos validar el NEWS modificado, NEWS-2 y COVID-19 Severity Index. Metodología: estudio observacional, prospectivo, multicéntrico con pacientes hospitalizados por COVID-19 en tres hospitales de cuarto nivel en Bogotá (Colombia), entre abril y noviembre de 2020. Se calcularon las características operativas y áreas bajo la curva ROC. Resultados: se contó con 711 pacientes entre los cuales el AUC para muerte fue 0.68, 0.58 y 0.68, y para ingreso a UCI de 0.61, 0.63 y 0.66 para NEWSm, NEWS-2 y CSI respectivamente. El CSI alcanzó la mayor sensibilidad para ingreso a UCI o muerte (87.6 y 90.0%) y la mayor especificidad fue el NEWS-2 (76.8 y 75.5%). Conclusiones: las tres puntuaciones de alerta temprana mostraron un desempeño bajo a moderado para la predicción del ingreso a UCI o muerte en pacientes hospitalizados por COVID-19. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2225).

Epidemiological and clinical characterization of patients hospitalized for decompensated heart failure with reduced ejection fraction / Caracterización clínico epidemiológica de pacientes hospitalizados con diagnóstico de falla cardiaca descompensada con fracción de eyección reducida

Abstract Objective: to describe the clinical and biochemical characteristics and treatment of patients with decompensated heart failure with reduced ejection fraction hospitalized during 2015 at the Hospital Militar Central in Bogotá. Methods: a descriptive study reviewing the clinical records of patients over the age of 18 who were hospitalized due to decompensated heart failure with reduced ejection fraction during 2015. Clinical, biochemical, echocardiographic and treatment variables were recorded. A univariate analysis was performed reporting percentages for qualitative variables, measures of central tendency for quantitative variables, and medians and first and third quartiles for variables with a non-normal distribution. Results: the medical records of 114 patients were analyzed (average age 74.8 years; 69.3% males). The etiology of the heart failure was hypertension in 66.7% and ischemia in 60.5%. Noncompliance was the main precipitating factor for decompensation. High adherence to management guidelines was seen on discharge, with medications at suboptimal doses and ambulatory titration in 32% of patients; 38% were readmitted at least once during the first 30 days. Altogether, 25.4% required ICU care, with a mortality rate of 18%; there was a 16% mortality rate for early readmissions and 3% for patients with late admissions. Conclusion: the clinical profile in this study is similar to what is reported in other research. Adherence to management guidelines is adequate, but at suboptimal doses. There is a high percentage of recorded readmissions and hospital mortality.(Acta Med Colomb 2020; 45. DOI: https://doi.org/10.36104/amc.2020.1233).

Resumen Objetivo: describir las características clínicas, bioquímicas y tratamiento de pacientes con falla cardiaca descompensada con fracción de eyección reducida hospitalizados en el año 2015 en el Hospital Militar Central de Bogotá. Metodología: estudio descriptivo en el que se revisaron registros clínicos de pacientes mayores de 18 años hospitalizados por falla cardiaca descompensada con fracción de eyección reducida en el año 2015. Se registraron variables clínicas, bioquímicas, ecocardiográficas y de tratamiento. Se realizó análisis univariado, reportando para variables cualitativas proporciones, para variables cuantitativas medidas de tendencia central y para variables que no siguen distribución normal, medianas y cuartiles 1 y 3. Resultados: se analizaron registros de 114 pacientes, con edad promedio de 74.8 años, 69.3% hombres. La etiología de la falla cardiaca fue hipertensiva 66.7% e isquémica 60.5%, la no adherencia al tratamiento fue el principal factor precipitante de descompensación, se encontró alta adherencia a guías de manejo al egreso con medicación en dosis subóptimas, y titulación ambulatoria en 32% de los pacientes, el 38% reingresaron al menos una vez dentro de los primeros 30 días. Un 25.4% requirió manejo en UCI con mortalidad de 18% y para reingresos tempranos de 16%, siendo de 3% para pacientes con ingresos tardíos. Conclusión: en este estudio el perfil clínico es semejante a los reportados en otras series. La adherencia a guías de manejo es adecuada pero en dosis subóptimas. Existe un alto porcentaje de reingreso registrados y de mortalidad intrahospitalaria.(Acta Med Colomb 2020; 45. DOI: https://doi.org/10.36104/amc.2020.1233).