Publicado

2023-04-01

Factors associated with mortality in COVID-19 patients admitted to an intensive care unit in Medellín, Colombia. March-December 2020

Factores asociados a la mortalidad en pacientes con COVID-19 admitidos en una unidad de cuidados intensivos de Medellín, Colombia. Marzo-diciembre 2020

Palabras clave:

Coronavirus Infections, Intensive Care Unit, Respiratory Distress Syndrome, Acute, Ventilation, Mechanical, Mortality (en)
Infecciones por coronavirus, Unidad de cuidados intensivos, Síndrome de dificultad respiratoria aguda, Ventilación mecánica, Mortalidad (es)

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Introduction: COVID-19 is mild in 80% of cases; however, it progresses to severe disease in 5% of patients, thus requiring intensive care unit (ICU) admission.

Objective: To identify demographic, clinical, and treatment-related factors associated with mortality in patients with COVID-19 treated at the ICU of a quaternary care hospital in Medellín, Colombia.

Materials and methods: Retrospective cohort study. The medical records of 182 patients admitted to the ICU between March and December 2020 due to COVID-19 were analyzed. Bivariate analyses (chi-square, Fisher's exact, unpaired Student's t test, or Mann-Whitney U test) were performed to evaluate the association between demographic characteristics, presence of coexisting diseases, laboratory results, therapeutic interventions, ventilatory and hemodynamic support requirement, and mortality. In addition, a multivariate analysis was performed, in which simple and multiple binary logistic regressions were used, calculating crude and adjusted relative risks (RR). A significance level of p<0.05 was considered.

Results: Mortality was reported in 47.80% of patients. In the multivariate analysis model, the following factors were protective factors: age <60 years (aRR: 0.154, 95%CI: 0.059-0.401; p=0.000), use of vasopressors (aRR: 0.082, 95%CI: 0.021-0.319; p<0.001), and use of renal replacement therapy (aRR: 0.205 95%CI 0.059 - 0.716; p=0.013). On the other hand, not performing tracheostomy was an independent protective factor for mortality (aRR: 14.959, 95%CI: 4.865-45.998; p<0.001). A lower platelet count during the ICU stay had a neutral effect, although it was a significantly associated quantitative variable (aRR: 0.999, 95%CI: 0.990-0.999; p=0.003).

Conclusions: In the present study, age <60 years, the use of vasopressors, and renal replacement therapy were protective factors, while not performing tracheostomy was a risk factor for mortality. Furthermore, a lower platelet count during ICU stay was a significantly associated quantitative variable.

Introducción. La COVID-19 se manifiesta en el 80% de los casos de forma leve; sin embargo, en el 5% progresa a enfermedad severa con necesidad de manejo en unidad de cuidados intensivos (UCI).

Objetivo. Identificar los factores demográficos, clínicos y de tratamiento asociados a la mortalidad en pacientes con COVID-19 atendidos en la UCI de un hospital de cuarto nivel de atención de Medellín, Colombia.

Materiales y métodos. Estudio de cohorte retrospectivo. Se analizaron las historias clínicas de 182 pacientes admitidos a UCI por COVID-19 entre marzo y diciembre de 2020. Se realizaron análisis bivariados (pruebas de chi-cuadrado, exacta de Fisher, t-Student no pareada o U de Mann-Whitney) para evaluar la asociación entre, por un lado, características demográficas, presencia de enfermedades coexistentes, resultados de laboratorio, intervenciones terapéuticas, requerimiento de soporte ventilatorio y hemodinámico, y, por otro, mortalidad. Además, se realizó un análisis multivariado en el que se construyeron regresiones logísticas binarias simples y múltiples, calculando riesgos relativos (RR) crudos y ajustados. Se consideró un nivel de significancia de p<0.05.

Resultados. La mortalidad fue de 47.80%. En el análisis multivariado, los siguientes factores se comportaron como protectores para mortalidad: edad <60 años (RRa: 0.154, IC95%: 0.059-0.401; p=0.000), uso de vasopresores (RRa 0.082, IC95%: 0.021-0.319; p<0.001) y uso de terapia de remplazo renal (RRa: 0.205, IC95%: 0.059-0.716; p=0.013). La realización de traqueostomía se comportó como un factor protector independiente para mortalidad (RRa: 0.073, IC95%: 0.012-0.827; p<0.001). El conteo más bajo de plaquetas registrado durante la estancia en UCI tuvo un efecto neutro, aunque fue una variable cuantitativa significativamente asociada (RRa: 0.999, IC95%: 0.990-0.999; p=0.003).

Conclusiones. En el presente estudio, la edad <60 años y el uso de vasopresores y de terapia de remplazo renal se comportaron como factores protectores, mientras que la no realización de traqueostomía se comportó como factor de riesgo para mortalidad. Además, el conteo más bajo de plaquetas registrado durante la estancia en UCI fue una variable cuantitativa significativamente asociada.

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