Análise longitudinal dos parâmetros ventilatórios e escore SOFA de pacientes com covid-19 hospitalizados em uma UTI no Sul do Brasil

Abstract

While COVID-19 is best known for causing substantial respiratory pathology, the virus can also result in a variety of extrapulmonary manifestations, particularly in critical care wards. In view of this, the use of the SOFA score has become an alternative for the assessment of organ failure and in-hospital complications of critically ill patients in the ICU. Considering this context, this study intends to analyze the ventilatory parameters and SOFA score of patients with COVID-19 in an ICU in southern Brazil and the main complications caused. A retrospective cohort study was carried out that analyzed medical records of patients diagnosed with COVID-19 in the ICU of Hospital Nossa Senhora da Conceição, Tubarão/SC, between March 2020 and December 2021. A mean (±SD) of 448 patients was included aged 58.5 (±15.1) years, median (p25-p75) hospital stay of 15 (9-24) days and mean (±SD) of mechanical ventilation of 15 (±8.7) days, evolving to death 63.3%. During hospitalization, 86.4% of people suffered complications, among the most prevalent AKI (46.8%) followed by VAP (41.9%) and septic shock (22%). Advanced age, hypertension, diabetes, heart disease, occurrence of complications and need for invasive mechanical ventilation were associated with death. In the clinical evolution, the SOFA score and the PaO2/FiO2 ratio were factors of unfavorable outcome in the three weeks of hospitalization, with SOFA ≥ 5 and PaO2/FiO2 ratio < 200. In addition, 3 of the 6 SOFA components (renal, respiratory and coagulation) were related to the occurrence of complications. Factors associated with greater sensitivity for detecting COVID-19 severity were older age, diabetes, and high SOFA score, with the area under the curve of 0.796 for the multivariate model and 0.742 for the SOFA.