Análise de sobrevivência e fatores prognósticos associados à mortalidade em pacientes com SRAG por Covid-19 hospitalizados em UTI na Paraíba

Abstract

Since the first epidemiological weeks in 2020, the pandemic for the new coronavirus has caused overload in the health system, since many affected patients require hospitalization due to the progression to acute respiratory distress syndrome (ARDS), heart failure, acute kidney injury and shock, the condition of which may lead to death. In this scenario, the present study aimed to analyze the survival and prognostic factors associated with mortality in patients with SRAG by COVID-19 who required ICU admission in the State of Paraiba. This is a longitudinal, observational, analytical and descriptive study, using secondary data from the individual records of hospitalized SRAG cases included in the database of the State Department of Health, containing socio-demographic, clinical and epidemiological data of each patient. Logistic regression was used to evaluate the final model that best explains the probability of the individual evolving to the outcome death. Survival functions were calculated using the Kaplan Meier method. To evaluate the factors associated with death, the hazard ratio-HR was calculated following cox's proportional risk model. The length of hospital stay until the outcome was also evaluated. A total of 2,084 observations were included. At the end of the follow-up, 479 censure (23%) and 1,605 deaths (77%) were observed. In the logistic regression stage, they were significant (at the level of 10%) in relation to the increase in the risk of death: age group over 60 (odds ratio -OR- 4.78), need for invasive ventilatory support (OR 4.17), oxygen saturation < 95% (OR 1.25), having been hospitalized in the 3rd macroregion of Paraiba (OR 1.63) and presence of immunodepression (OR 1.72). They were associated with a lower risk of death: living in a periurban area (OR 0.20) and not requiring invasive ventilatory support (0.16). The probability of survival by Kaplan-Meier was 72.1% in 5 days and 49.6% in 10 days of hospitalization. The mean length of ICU stay until death was 8.9 days. After adjustments of the variables in the Cox model, they were significant (at the level of 10%) in relation to the increase in the risk of death: age over 60 (HR 1.29), need for invasive ventilatory support (HR 1.60), oxygen saturation <95% (HR 1.10), presence of chronic liver disease (HR 1.66) and having been hospitalized in the 3rd macro-region of Paraiba (HR 1.32). Living in rural areas (HR 0.83) and having been hospitalized in the metropolitan region of the State (HR 0.84) were associated with a lower risk of death. The results described here reinforce the importance of identifying clinical and socio-demographic characteristics that may impact the prognosis of patients with SARS by COVID-19 admitted to the ICU in Paraiba, in addition to providing data capable of supporting the decision-making of health professionals and managers involved in directing resources and planning about the hospital structure needed to meet the increased demand generated by the Covid-19 outbreak.