Fatores prognósticos clínicos e laboratoriais associado ao espectro crítico da COVID-19: um estudo de coorte retrospectivo

Abstract

Introduction: The infection caused by the severe acute respiratory syndrome coronavirus 2, SARS- CoV-2, which emerged in Wuhan, China, in late December 2019, as an outbreak of pneumonia and after a few months became a pandemic affecting worldwide. Although a higher proportion of asymptomatic individuals predominate, COVID-19 is a disease that presents several clinical spectrums, of which critical is the most worrisome, leading to high lethality and, especially, when associated with prognostic factors that favor the outcome death. Objective: The aim of this study was to investigate the epidemiological, clinical and laboratory prognostic factors associated with the outcome death in patients with the critical spectrum of COVID-19, through survival analysis. Methodology: This is an observational retrospective cohort study, composed of a randomized sample of 155 patients who died from October 2020 to October 2021 at adult intensive care unit (ICU) of Clinics Hospital, Federal University of Uberlândia. The sample was divided into 2 groups, being the criterion the survival time ≤ 5 days and > 5 days. The association among variables was analyzed using the binomial test, while the logistic regression model was used to evaluate the combined probability among factors. Survival analysis was conducted using Kaplan-Meier curves and Cox proportional hazards regression model. Results: There was an association between smoking (p=0.0313), alcoholism (p=0.0002) and obesity (p=0.0001) with the survival group < 5 days after ICU admission. C-reactive protein (p=0.7461) and D-dimer (p=0.9048) showed no differences between the medians when comparing patients with survival time ≤ 5 and > 5 days. The factors, alcohol use, obesity and the presence of altered WBC counts in combination, led to an 80.19% chance of the patient dying during the first 5 days after hospitalization. The survival curves showed poor prognosis in the presence of the factors obesity (Log Rank, p<0.0001; Breslow, p<0.0001; Tarone-Ware, p<0.0001), alcoholism (Log Rank, p<0.0001; Breslow, p<0.0001; Tarone-Ware, p<0.0001), heart rate >100bpm (Log Rank, p=0.003; Breslow, p=0.002; Tarone-Ware, p=0.003), respiratory rate >24irpm (Log Rank, p=0.001; Breslow, p<0.001; Tarone-Ware, p<0.00), oxygen saturation <94% (Log Rank, p=0.038; Breslow, p=0.047; Tarone-Ware, p=0.030), altered WBC values (Log Rank, p=0.010; Breslow, p=0.001; Tarone-Ware, p= 0.002) and among others. In Cox regression, in a multivariate model, only alcoholism (HR=2.31), obesity (HR=2.66), respiratory rate >24rpm (HR=1.50) and altered WBC count (HR=2.20) influenced the outcome death with significant proportional hazards. Conclusion: Our findings pointed to alcoholism, obesity, respiratory rate>24rpm and altered white blood cell count as the main factors associated with shorter survival of patients hospitalized with COVID-19 in its critical form. Such factors are important criteria in the development of risk stratification and prognostic protocols during admission to the adult ICU capable of predicting the outcome of patients and implementing high-cost therapies for cases of high chance of poor prognosis.