Predictores de mortalidad en pacientes con COVID-19 grave: Experiencia de la unidad de cuidados intensivos en un centro de referencia colombiano
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Fecha
2024
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Ediciones Universidad Simón Bolívar
Facultad de Ciencias de la Salud
Facultad de Ciencias de la Salud
Resumen
Introducción: Los pacientes con COVID-19 grave que ingresan a la unidad de
cuidados intensivos tienen un mayor riesgo de mortalidad. La falta de información
local y el desconocimiento de espectro de los predictores de mortalidad temprano
complican el curso clínico.
Objetivos: Identificar los predictores de mortalidad en pacientes con COVID‑19
grave en una unidad de cuidados intensivos de un centro de referencia colombiano
durante el año 2021-2022.
Materiales y métodos: Estudio retrospectivo, descriptivo y de corte transversal en
pacientes adultos con neumonía grave por SARS-CoV-2 que ingresaron a unidad
de cuidados intensivos de una clínica de referencia de Barranquilla. Se aplicaron
medidas de tendencia central. Dos análisis multivariados fue realizado a través de
modelos de regresión para identificar los predictores de mortalidad.
Resultados: El 59.9% de los 232 pacientes fallecieron. Los predictores
relacionados con la mortalidad en el análisis multivariado fueron shock (OR: 9.63),
síndrome de disfunción orgánica múltiple (OR: 13.77), ventilación mecánica invasiva
(OR: 111.9), uso de relajante (OR: 9.14), agentes vasoactivos ≥2 (OR: 32.77),
niveles de nitrógeno ureico ≥30 mg/dl (OR: 3.86), lactato deshidrogenasa ≥600 U/l
(OR: 3.40) y ferritina ≥1,000 ng/ml (OR: 1.83).
Conclusiones: La presencia de shock, síndrome de disfunción orgánica múltiple,
la ventilación mecánica invasiva, uso de relajante y agentes vasoactivos ≥2,
parámetros de laboratorio como niveles de nitrógeno ureico ≥30 mg/dl, lactato
deshidrogenasa ≥600 U/l y ferritina ≥1,000 ng/ml fueron predictores de mortalidad.
Introduction: Patients with severe COVID-19 admitted to the intensive care unit have an increased risk of mortality. The lack of local information and ignorance of the spectrum of early mortality predictors complicate the clinical course. Objectives: Identify the predictors of mortality in patients with severe COVID-19 in an intensive care unit of a Colombian reference center during the year 2021-2022. Materials and Methods: Retrospective, descriptive and cross-sectional study in adult patients with severe SARS-CoV-2 pneumonia who were admitted to the intensive care unit of a reference clinic in Barranquilla. Measures of central tendency were applied. Two multivariate analyzes were performed through regression models to identify predictors of mortality. Results: 59.9% of the 232 patients died. The predictors related to mortality in the multivariate analysis were shock (OR: 9.63), multiple organ dysfunction syndrome (OR: 13.77), invasive mechanical ventilation (OR: 111.9), use of relaxant (OR: 9.14), vasoactive agents ≥ 2 (OR: 32.77), urea nitrogen levels ≥30 mg/dl (OR: 3.86), lactate dehydrogenase ≥600 U/l (OR: 3.40) and ferritin ≥1,000 ng/ml (OR: 1.83). Conclusions: The presence of shock, multiple organ dysfunction syndrome, invasive mechanical ventilation, use of relaxant and vasoactive agents ≥2, laboratory parameters such as urea nitrogen levels ≥30 mg/dl, lactate dehydrogenase ≥600 U/l and ferritin ≥ 1,000 ng/ml were predictors of mortality.
Introduction: Patients with severe COVID-19 admitted to the intensive care unit have an increased risk of mortality. The lack of local information and ignorance of the spectrum of early mortality predictors complicate the clinical course. Objectives: Identify the predictors of mortality in patients with severe COVID-19 in an intensive care unit of a Colombian reference center during the year 2021-2022. Materials and Methods: Retrospective, descriptive and cross-sectional study in adult patients with severe SARS-CoV-2 pneumonia who were admitted to the intensive care unit of a reference clinic in Barranquilla. Measures of central tendency were applied. Two multivariate analyzes were performed through regression models to identify predictors of mortality. Results: 59.9% of the 232 patients died. The predictors related to mortality in the multivariate analysis were shock (OR: 9.63), multiple organ dysfunction syndrome (OR: 13.77), invasive mechanical ventilation (OR: 111.9), use of relaxant (OR: 9.14), vasoactive agents ≥ 2 (OR: 32.77), urea nitrogen levels ≥30 mg/dl (OR: 3.86), lactate dehydrogenase ≥600 U/l (OR: 3.40) and ferritin ≥1,000 ng/ml (OR: 1.83). Conclusions: The presence of shock, multiple organ dysfunction syndrome, invasive mechanical ventilation, use of relaxant and vasoactive agents ≥2, laboratory parameters such as urea nitrogen levels ≥30 mg/dl, lactate dehydrogenase ≥600 U/l and ferritin ≥ 1,000 ng/ml were predictors of mortality.
Descripción
Palabras clave
COVID-19, Unidad de cuidados intensivos, Agentes vasoactivos, Mortalidad
