Banca de QUALIFICAÇÃO: André Luiz Araújo Branquinho

Uma banca de QUALIFICAÇÃO de DOUTORADO foi cadastrada pelo programa.
STUDENT : André Luiz Araújo Branquinho
DATE: 27/11/2023
TIME: 08:30
LOCAL: Plataforma Teams
TITLE:

Multicenter observational study in patients hospitalized for Severe Acute Respiratory Syndrome in an Intensive Care Unit during the COVID-19 pandemic

KEY WORDS:

COVID-19; Intensive care unit; Severe Acute Respiratory Syndrome

PAGES: 55
BIG AREA: Ciências da Saúde
AREA: Medicina
SUMMARY:

SARS in Brazil is called Severe Acute Respiratory Syndrome (SARS). The etiology of SARS is quite broad, ranging from primary pulmonary or secondary involvement to extrapulmonary processes. This could be due to bacterial infections, viruses and fungi. In Brazil, the cause of death from diseases of the respiratory system occupies the top five positions in the ranking. An important, emerging and pandemic cause of SARS with evolution is the disease caused by the new coronavirus (SARS-CoV-2): COVID-19. According to the WHO, around 3% to 5% of patients with COVID 19 needed intensive care beds and generally had prolonged hospitalization. On average, the length of stay for a patient in an ICU in a public hospital is around 6.5 days. In the case of patients with COVID-19, they may stay for an average of 14 days. Understand risk factors that contribute to the outcome of death in patients with COVID-19 admitted to an intensive care unit during the pandemic, as well as understand the independent risks through multivariate analysis. Methodology Data were collected in four field hospitals in the Federal District, Brazil, focusing on patient demographics, clinical results and outcome. There were 1584 patients admitted to the ICU, hospitalized in Field Hospitals (Military Police Field Hospital (HCPM), Santa Maria Field Hospital (HCSM), Ceilândia Field Hospital (HCC), Base Campanha Hospital (HCBDF)) during the period from November 2020 to June 2021. The collected variables consist of demographic data, comorbidities, Simplified Acute Physiology Score (SAPS 3), at the time of ICU admission, Sequential Organ Failure Assessment (SOFA) at the time of ICU admission, Charlson Comorbidity Index, Modified Frailty Index ( MFI), use of resources and supportive therapy (vasopressors, non-invasive ventilation, high-flow nasal catheter – HFNC –, mechanical ventilation and extracorporeal membrane oxygenation – ECMO), during ICU admission, destination after hospital discharge, length of stay in ICU and hospital and ICU and in-hospital mortality. Survival curves were estimated by Kaplan-Meier and the non-parametric logrank test was used to confirm the existence of statistically significant differences between the survival curves. P < 0.05 was considered significant. The statistical analysis consisted of adjusting Cox regression models with the objective of determining demographic, clinical and laboratory risk factors associated with mortality from COVID 19 using the risk ratio (HR) and their respective confidence intervals as a measure of effect. The time in days until death occurred was considered the dependent variable. The analysis took place in two stages: bivariate and multiple, in both, risk ratios and their respective 95% confidence intervals were calculated. Initially, simple Cox regression models were fitted for each variable. Those in which the p value was less than 0.25 were included in the multiple Cox regression analysis. These variables were subsequently adjusted through a process of removing/inclusion of variables (stepwise). Only those variables with p < 0.05 remained in the final model. At the end, risk ratios (HR) and their respective 95% confidence intervals were calculated. Multicollinearity between the independent variables was assessed. It considered the limit of the presence of multicollinearity if the tolerance indicator assumes values greater than 0.60. The assumption of proportional risks was verified by introducing time-dependent explanatory variables into the model. P < 0.05 was considered significant. The analyzes were conducted using the SAS 9.4 program. Partial results The majority of patients, 53.41%, were aged 60 or over and 56.44% were male. The vast majority, 70.08%, had sepsis and shock, 89.14% had a low risk for comorbidity and 60.80% were independent regarding their health status. Upon admission, 91.22% had respiratory failure, 69.81% required mechanical ventilation and 20.14% had renal failure. 20.60% were tachycardiac and 27.50% had Glasgow greater than nine on admission. Regarding laboratory parameters upon admission, 55.34% had leukocytosis, 1.42% platelets less than or equal to 50 and 10.31% creatinine greater than or equal to 5. The vast majority 76.61% had paO2 greater than 60 and 40, 19% had paCO2 greater than 45. At the end of follow-up, 63.61% of patients died. Conclusion/Perspective In the bivariate analysis adjustment, only the variables gender, BMI, paO2 on admission and lung exchange presented a p value > 0.25 and were not included in the multivariate model. From the adjustment of the multivariate Cox regression model, using the stepwise variable selection process, the variables age, vasopressor on admission, platelets on admission, creatinine on admission and paCO2 on admission showed a significant association (p < 0.05) with time until death from COVID occurs and, therefore, considered risk factors for death in patients with COVID 19.

COMMITTEE MEMBERS:
Presidente - ***.432.421-** - ALEXANDRE ANDERSON DE SOUSA MUNHOZ SOARES - UNICAMP
Externo à Instituição - FABIO FERREIRA AMORIM - ESCS
Interno - ***.583.131-** - LUIZ SÉRGIO FERNANDES DE CARVALHO - UNICAMP
Interno - 2376346 - OTAVIO DE TOLEDO NOBREGA