Aspectos epidemiológicos de pacientes críticos com Covid-19: estudo de coorte não concorrente

Abstract

ABSTRACT The Coronavirus Disease 2019 - COVID-19 pandemic has shown exponential growth in several countries. Consequently, there is a worldwide concern about the emergence of new variants due to the transmissibility and virulence of the Severe Acute Respiratory Syndrome Coronavirus 2 - SARS-CoV-2. Thousands of people infected with the virus evolved with the severe form of the disease, requiring oxygen support and hospitalization in Intensive Care Units, which put pressure on the health system worldwide. Thus, considering the seriousness of the repercussions that Covid-19 causes in the patient and the gaps present in the scientific literature, this research was carried out, which aimed to: analyze the epidemiological aspects and factors associated with the survival of critically ill patients diagnosed with Covid -19; compare the profile of patients who survived or not; identify the association between clinical variables of patients and hospitalization outcomes and estimate predictors of mortality in critically ill patients diagnosed with Covid -19. This is a non-concurrent cohort study, based on documentary analysis of data available in the medical records of critically ill patients diagnosed with Covid-19 admitted to an Intensive Care Unit. For data collection, an eight-month period was established (May to December 2020). Descriptive and inferential analysis was performed using Cox regression. The incidence rate of COVID-19 among critically ill patients was 60.3% (205/340). The mortality rate of COVID-19 was 46.8% (96/205). There was a predominance of elderly patients with a median of 66 years (Q1:57 – Q3:73), male (132 – 64,4%), with any comorbidity (190 – 92,7%). In the multivariate analysis from Cox regression, the highest score on the Simplified Acute Physiology Score III was found to be factors associated with higher mortality (HR 1,021; I.C.95% 1,003-1,039), the presence of altered level of consciousness (HR 2,135; I.C.95% 1,013-4,499); the use of a Central Venous Catheter (CVC) (HR 3,023; I.C.95% 1,109-8,238), the need for cardiopulmonary resuscitation (HR 2,281; I.C.95% 1,463-3,558) and the shortest ventilation time Invasive Mechanics (HR 0,857; I.C.95% 0,822-0,893). In addition, it was found that patients who received oxygen therapy by nasal catheter at some period during their hospitalization had a longer survival (HR 0,176; I.C.95% 0,107-0,289). Therefore, this study contributes for researchers, managers, nurses, and other healthcare professionals to know the epidemiological aspects of critically ill patients diagnosed with Covid-19 and thus be able to design work methodologies that contribute to minimize the worsening of the disease, as well as reduce the number of deaths.