Complicações associadas a paciente com COVID-19 grave: uma coorte retrospectiva

Abstract

Introduction: COVID-19 is a highly contagious infection that can lead to severe complications and death. Emerging in December 2019 in China, it spread globally. Comorbidities such as hypertension and diabetes are predictors of unfavorable outcomes in severe cases. However, there is a gap in the literature regarding the specific influence of clinical and laboratory variables on unfavorable outcomes in hospitalized patients in regions with high mortality rates from the disease. This study aims to fill this gap and provide valuable information for clinical practice.

Objective: To identify comorbidities and complications of patients with severe COVID-19 hospitalized in Manaus, Amazonas, analyze the influence of clinical and laboratory variables on the outcome with and without complications, and create a multivariate regression model to predict death and complications.

Method: A retrospective cohort study approved by the Ethics Committee (CAAE: 52104121.9.0000.0042/ approval: 5.112.830). Analyzed electronic medical records of patients hospitalized with severe COVID-19 between March 2020 and March 2022. We used multivariate regression models and survival analysis (Kaplan-Meier and Cox model) with R software version 3.2.2. Figures were generated in Jamovi version 2.3.24.

Results: We analyzed the medical records of 13,372 patients, of whom 1,155 were eligible for the study. The most frequent comorbidities were hypertension and diabetes. The most common complications included shock, severe hypoxia, multiple organ dysfunction, and elevated inflammatory markers. We identified that advanced age, hypertension, diabetes, multiple comorbidities, oxygen saturation <90%, and elevated markers such as D-dimer, LDH, and CPK were significant predictors of unfavorable outcomes, and the presence of complications impacted patient survival (HR = 8.24; 95% CI: 3.84-17.69). The multivariate regression models demonstrated good predictive performance, with 85% sensitivity and 90% specificity for death, and 80% sensitivity and 85% specificity for complications.

Conclusion: Hypertension and diabetes were the most frequent comorbidities among hospitalized patients with severe COVID-19, and shock, severe hypoxia, multiple organ dysfunction, and elevated inflammatory markers were the main complications. The presence of complications reduced patient survival. Elevated levels of D-dimer, LDH, and CPK were predictors of unfavorable outcomes. Identifying these variables may enable the implementation of personalized approaches and early interventions, which are crucial for improving patient prognosis.