Factores asociados a ingreso a UCI en pacientes con IRAG por SARS CoV-2 durante la pandemia en hospitales colombianos

Abstract

Introducción: Los pacientes con COVID-19 presentan un espectro clínico variable y su severidad está influenciada por factores de riesgo individuales. Identificarlos de manera oportuna permite predecir formas graves de la enfermedad. Objetivo: Determinar los factores asociados al ingreso a unidad de cuidados intensivos (UCI) en pacientes hospitalizados por COVID-19 durante las primeras 2 olas de la epidemia en Colombia. Materiales y métodos: Estudio de cohorte multicéntrico, retrospectivo en pacientes hospitalizados por COVID-19 en instituciones prestadoras de salud de Bogotá y Girardot, Colombia. Se incluyeron adultos con diagnóstico confirmado de marzo de 2020 a enero de 2021. Se describieron las características sociodemográficas clínicas y paraclínicas de la población y se establecieron las variables independientes que predecían el ingreso a la UCI mediante un modelo de regresión logística multivariada. Resultados: Se incluyeron 1160 pacientes con una edad media de 55 años, 59.7% fueron hombres y 426 pacientes (37.7%) ingresaron a UCI. Los factores asociados a ingreso a UCI fueron edad (OR 1,25, 95%IC: 1,14-1,37 por cada década de vida), sobrepeso (OR 2,82, 95%IC: 1,98-4,02) y obesidad (OR 2,97, 95%IC: 2,03-4,37), antecedente cardiovascular valvular (OR 6,46, 95%IC: 1,84-27,48) hipotensión (OR 2,35, 95%IC: 1,40-3,97), presencia de SIRS (OR 2,03, 95%IC: 1,50-2,74), disnea (OR 1,52, 95%IC:1,09-2.14), requerimiento de oxígeno (OR 2,64, 95%IC: 1,67-4,30 por cada incremento 1% de FiO2), neutrofilia (OR 1,09, 95%IC: 1,05-1,13 por cada 1000 cel/ml), elevación del dímero D (OR: 1,09, 95%IC: 1,03-1,18 por cada 1000 ng/ml), compromiso multilobar (OR 2,19, 95%IC: 1,58-3,07) y consolidación pulmonar (OR 1,52, 95%IC: 1,13-2,04). La mortalidad intrahospitalaria fue de 14,4% (166 pacientes). Conclusión: En esta cohorte de pacientes hospitalizados por COVID-19, el 36,72% ingresaron a UCI, encontrando como principales predictores la edad, obesidad, antecedente de valvulopatía, hipotensión, presencia de SIRS y compromiso pulmonar multilobar. (Texto tomado de la fuente)

Background: Patients with COVID-19 present a variable clinical spectrum and its severity is influenced by the presence of risk factors. Identifying them in a timely manner makes it possible to predict severe forms of the disease. Aim: To determine the factors associated with ICU admission in patients hospitalized for COVID-19 during the first 2 waves of the epidemic in Colombia Material and method: Retrospective multicenter cohort study in patients hospitalized for COVID-19 in health care institutions in Bogotá and Girardot, Colombia. Adults with a confirmed diagnosis from March 2020 to January 2021 were included. The clinical and paraclinical sociodemographic characteristics of the population were described and the independent variables that predicted admission to the ICU were obtained using a multivariate logistic regression model. Results: 1160 patients were included: mean age was 55 years, 59,7% were men, and 436 patients (36,7%) were admitted to the ICU. The factors associated with admission to the ICU were age (OR 1,25, 95%CI: 1,14-1,37 for each decade of life), overweight (OR 2,82, 95%CI: 1,98-4,02) and obesity (OR 2,97, 95%CI: 2,03-4,37), antecedent valvular cardiovascular disease (OR 6.46, 95%CI: 1.84-27.48), hypotension (OR 2,35, 95%CI: 1,40-3,97), presence of SIRS (OR 2,03, 95%CI: 1,50-2,74), dyspnea (OR 1,52, 95%CI: 1,09-2,14), oxygen requirement (OR 2,64, 95%CI: 1,67-4,30 for each 1% increase in FiO2), neutrophilia (OR 1,09, 95%CI: 1,05-1,13 for each 1000 cells/ml), elevated D-dimer (OR 1,09, 95%CI: 1,03 - 1,18 per 1000 ng/ml) multilobar involvement (OR 2,19, 95%CI: 1,58-3,07) and pulmonary consolidation (OR 1,52, 95%CI: 1,13-2,04). In-hospital mortality was 14,4% (166 patients). Conclusion: In this cohort of patients hospitalized for COVID-19, 36,72% were admitted to the ICU, finding age, obesity, a history of valve disease, hypotension, presence of SIRS, and multilobar pulmonary involvement as the main predictors.