Variables asociadas a la severidad en pacientes con COVID-19.
Barra lateral del artículo
Detalles del artículo
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
La publicación es gratuita y sus contenidos se distribuyen con la licencia Creative Commons Atribución-NoComercial-SinDerivadas 4.0 Internacional (CC BY-NC-ND 4.0) . Los derechos de las obras publicadas en esta revista son propiedad del autor y este es libre de distribuir y difundir las mismas fuentes siempre y cuando cite correctamente la fuente de publicación, estos actos no sean con fines comerciales y no se generen obras derivadas.
Contenido principal del artículo
Resumen
En la COVID-19 un porcentaje de los enfermos desarrolla cuadros severos, con una elevada mortalidad, siendo necesario el estudio de sus características con el objetivo de frenar la progresión de la enfermedad. Se realizó un estudio retrospectivo en una cohorte de 150 pacientes adultos atendidos en el hospital Manuel Fajardo de Villa Clara, Cuba, en el período de marzo a junio de 2020. Se analizaron variables demográficas, clínicas, de laboratorio, gasométricas y radiológicas medidas al ingreso hospitalario; definiéndose dos grupos de pacientes según la evolución clínica: severos y no severos. Para la comparación de los grupos se realizó un análisis bivariado con el objetivo de determinar aquellas variables con asociación significativa a la severidad. Del total de pacientes, 26 (17,3%) evolucionaron a la severidad y 124 (83.7%), evolucionó satisfactoriamente. Los pacientes severos se caracterizaron por tener edad avanzada (media: 83 años) y presentar comorbilidades; siendo las más significativas: hipertensión arterial, diabetes mellitus, cardiopatía, enfermedad renal crónica y cáncer (p<0.0001). La polipnea y diarrea fueron las manifestaciones clínicas con mayor asociación a la severidad (p<0.0001), seguido por la fiebre (p=0.0157). La escala pronóstica quick SOFA mostró ser un instrumento útil para evaluar a los pacientes al ingreso. Las variables de laboratorio: neutrófilos, linfocitos, índice neutrófilos/linfocitos, hemoglobina. y lactato deshidrogenasa fueron las que mayor asociación tuvieron con la severidad (p<0.0001). Los leucocitos, lactato, dímero D, proteína C reactiva, glicemia y calcio también mostraron resultados significativos (p< 0.05). De las variables gasométricas, la presión y saturación arterial de oxígeno fueron las más significativamente asociadas a la severidad; así como la presencia de infiltrados o consolidación pulmonar en la radiografía de tórax (p <0.0001). El estudio permitió identificar variables al ingreso hospitalario, asociadas a progresión hacia formas severas de la enfermedad.
Citas
Angus, DC., Alexander, BM., Berry, S., Buxton, M., Lewis, R., Paoloni, M., et al. (2019) Adaptive platform trials: defnition, design, conduct and reporting considerations. Nat Rev Drug Discov, 18(10): 797-807 https://go.gale.com/ps/i.do?id=GALE%7CA601353038&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=14741776&p=HRCA&sw=w
Argenziano, MG., Bruce, SL., Slater, CL., Tiao, JR., Baldwin, MR,, Barr, RG., et al. (2020) Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series. BMJ, 369: m1996. https://www.bmj.com/content/369/bmj.m1996.long
Berlin, DA., Gulick, RM. & Martinez, FG. (2020) Severe Covid-19. N Engl J Med, 383(25): 2451-2460. https://www.nejm.org/doi/full/10.1056/NEJMcp2009575
Bonafè, M., Prattichizzo, F., Giuliani, A., Storci, G., Sabbatinelli, J. & Olivieri F. (2020) Inflammaging: Why older menare the most susceptible to SARS-CoV-2 complicated outcomes. Cytokine Growth Factor Rev, 53: 33-37 https://www.sciencedirect.com/science/article/pii/S1359610120300848
Chen, G., Wu, D., Guo, W., Cao, Y., Huang, D., Wang, H., et al. (2020) Clinical and immunologic features in severe and moderate coronavirus disease 2019. J Clin Invest , 130(5): 2620-2629 https://www.jci.org/articles/view/137244?fbclid=IwAR0HcF1DebxTN_FfVIL-V3AJFz2xixrR4zIzsi8_xDeIHGjuyofdhnCydh0
Churpek, MM., Snyder, A., Han, X., Sokol, S., Pettit, N., Howell, MD., et al. (2017) Quick Sepsis-related Organ Failure Assessment Systemic Inflammatory Response Syndrome, and Early Warning Scores for Detecting Clinical Deterioration in Infected Patients outside the Intensive Care Unit. Am J Respir Crit Care Med, 195(7): 906–11. https://www.atsjournals.org/doi/abs/10.1164/rccm.201604-0854OC
Cummings, J., Baldwin, M., Abrams, D., Jacobson, SD., Meyer, BJ., Balough, EM., et al. (2020) Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet, 395(10239): 1763-1770 https://www.sciencedirect.com/science/article/pii/S0140673620311892
Du, R., Liang, L., Yang, C., Wang, W., Cao, T., Li, M., et al. (2020) Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J, 55(5): 2000524. https://erj.ersjournals.com/content/55/5/2000524.short
Ferrucci, L. & Fabbri, E. Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty. (2018) Nat Rev Cardiol, 15:505–522. https://doi.org/10.1038/s41569-018-0064-2
Guan, W., Ni, Z., Hu, Y., Liang, W., Ou, C,. He, J., et al. (2020) Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med, 382(18): 1708–1720 https://www.nejm.org/doi/full/10.1056/neJMoa2002032
Han, Y., Zhang, H., Mu, S., Wei, W., Jin, C., Xue, Y., et al. (2020) Lactate Dehydrogenase, a Risk Factor of Severe COVID-19 Patients. Aging, 12(12): 11245-11258. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7343511/pdf/aging-12-103372.pdf
Hu, X., Xing, Y., Jia, J., Ni, W., Liang, J., Zhao D., et al. (2020) Factors associated with negative conversion of viral RNA in patients hospitalized with COVID-19. Sci Total Environ, 728:138812. https://www.sciencedirect.com/science/article/pii/S0048969720323299
Huang, Z., Fu, Z., Huang, W. & Huang, K. (2020) Prognostic value of neutrophil-to-lymphocyte ratio in sepsis: a meta-analysis. Am J Emerg Med, 38(3): 641-647. https://www.sciencedirect.com/science/article/pii/S0735675719306710
Imam, Z., Odish, F-, Gill, I-, O’Connor, D-, Armstrong, J-, Vanood, A-, Ibironke, O-, Hanna, A., Ranski, A. & Halalau, A. (2020) Older age and comorbidity are independent mortality predictors in a large cohort of 1305 COVID-19 patients in Michigan, United States (Rapid Communication). J Intern Med, 288: 469–476. https://doi.org/10.1111/joim.13119
Ji, D., Zhang, D., Xu, J., Chen, Z., Yang, T., Zhao, P., Chen, G., Cheng, G., Wang, Y., Bi, J., Tan, L., Lau, G., & Qin, E. (2020). Prediction for Progression Risk in Patients With COVID-19 Pneumonia: The CALL Score. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 71(6): 1393–1399. https://doi.org/10.1093/cid/ciaa414
Ji, K. & In J. (2020) Age-Related Morbidity and Mortality among Patients with COVID-19.Infect Chemother, 52(2):154-164. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335648/
Lalueza, A., Lora, J, de la Calle, C., Sayas, J., Arrieta, E., Maestro, G. & Lumbreras, C. (2020) Utilidad de las escalas de sepsis para predecir el fallo respiratorio y la muerte en pacientes con COVID-19 fuera de las Unidades de Cuidados Intensivos. Rev Clin Esp, 2021. https://www.sciencedirect.com/science/article/pii/S0014256520302800
Leung, C. (2020) Risk factors for predicting mortality in elderly patients with COVID-19: a review of clinical data in China. Mech Ageing Dev, 188: 111255. https://www.sciencedirect.com/science/article/pii/S0047637420300518
Liu, F., Li, L., Xu, M., Wu, J., Luo, D., Zhu, Y., et al. (2020) Prognostic value of interleukin-6, C reactive protein, and procalcitonin in patients with COVID-19. J Clin Virol, 127: 104370. https://www.sciencedirect.com/science/article/pii/S1386653220301128
Liu, Y., Du, X., Chen, J., Jin, Y., Peng, L., Wang, H., et al. (2020) Neutrophil to lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect, 81(1): e6-e12. https://www.sciencedirect.com/science/article/pii/S0163445320302085
Paudel, SS. (2020) A meta-analysis of 2019 novel coronavirus patient clinical characteristics and comorbidities. Res Square, https://www.researchsquare.com/article/rs-21831/v1.
Parra, ML., Buitrago, G., Grau, M. & Arenaza, G. (2020) Aspectos radiológicos de la neumonía COVID-19: evolución y complicaciones torácicas. Radiología, 63 (1): 74-88 https://www.sciencedirect.com/science/article/pii/S0033833820301661
Ponti, G., Maccaferri, M., Ruini, C., Tomasi, A. & Ozben, T. (2020) Biomarkers associated with COVID-19 disease progression. Crit Rev Clin Lab Sci, 57(6): 389-399. https://www.tandfonline.com/doi/abs/10.1080/10408363.2020.1770685
Qin, C., Zhou, L., Hu, Z., Zhang, S., Yang, S., Tao, Y., et al. (2020) Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis, 71(15): https://pubmed.ncbi.nlm.nih.gov/32161940/
Qiurong, R., Kun, Y., Wenxia, W., Lingyu, J. & Jianxin, S. (2020) Clinical predictors of mortality due to COVID‑19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med, 46(5): 846-848. https://link.springer.com/article/10.1007/s00134-020-05991-x
Singer, M., Deutschman, CS., Seymour, CV., Shankar, Hari, M., Annane, D., Bauer M., et al. (2016) The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 315(8): 801–10. https://jamanetwork.com/journals/jama/article-abstract/2492881
Tan, L., Wang, Q., Zhang, D., Ding, J., Huang, Q., Tang, YQ., et al. (2020) Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study. Signal Transduc Target Ther, 5:33. https://www.nature.com/articles/s41392-020-0148-4?report=reader
Tang, N., Li, D., Wang, X. & Sun, Z. (2020) Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost, 18(4): 844–847. https://onlinelibrary.wiley.com/doi/abs/10.1111/jth.14768
Tay, MZ., Poh, CM., Rénia, L., Mac Ary PA. & Ng PFL. (2020) The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol, 20(6): 363-374 https://www.nature.com/articles/s41577-020-0311-8?fbclid=IwAR006BPp8mRx8nAxiOljiN8dlYJjNncQ4zj4N8mvi1VN9gMFrcSRuIpnTWk
Tompson, BC., Chambers, RT. & Liu KD. (2017) Acute respiratory distress syndrome. N Engl J Med, 307(23): 562–572 https://jamanetwork.com/journals/jama/article-abstract/1160659
World Health Organization. (2020) Novel Coronavirus (2019-nCoV). Situation Report—9 Geneva: WHO. https://apps.who.int/iris/bitstream/handle/10665/330762/nCoVsitrep23Jan2020-eng.pdf
Wu, Z. & McGoogan, J. (2020) Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA, 323(13): 1239-1242 https://jamanetwork.com/journals/jama/article-abstract/2762130
Xia, X., Wen, M., Zhan, S., He J. & Chen W. (2020) An increased neutrophil/lymphocyte ratio is an early warning signal of severe COVID-19. J South Med Univ, 40: 333–336. https://pubmed.ncbi.nlm.nih.gov/32376581/
Yang, X., Yu, Y., Xu, J., Shu, H., Xia, J., Liu, H., Wu, Y., Zhang, L., Yu, Z., Fang, M., Yu, T., Wang, Y., Pan, S., Zou, X., Yuan, S., & Shang, Y. (2020). Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet. Resp Med, 8(5): 475–481. https://doi.org/10.1016/S2213-2600(20)30079-5
Zhang, G., Zhang, J., Wang, B., Zhu, X., Wang, Q. & Qiu, S. (2020) Analysis of clinical characteristics and laboratory findings of 95 cases of2019 novel coronavirus pneumonia in Wuhan, China: a retrospective analysis. Respir Res, 21(1): 74. https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-020-01338-8?utm_source=other&utm_medium=other&utm_content=null&utm_campaign=BSCN_2_DD01_CN_bmcso_article_paid_XMOL
Zheng, YY., Ma YT., Zhang JY. & Xie, X. (2020) COVID-19 and the cardiovascular system. Nat Rev Cardiol, 17(5): 259–60. https://www.nature.com/articles/s41569-020-0360-5?fbclid=IwAR3TjvxiEtYQqNkpsPuEuuef94Gp2m4a89YFxubY2pw2FtOxsSpxGZ18TmI
Zhu, N., Zhang, D., Wang, W., Li X., Yang B., Song J., et al. (2020) A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med, 382: 727–733 https://www.nejm.org/doi/full/10.1056/nejmoa2001017