Fatores associados à presença de sequela na alta hospitalar de pacientes infectados pela COVID-19 grave

Abstract

Introduction: the coronavirus – 2 pandemic presented a different distribution of infection between countries. In Brazil, Coronavirus Disease 2019 (COVID-19) caused specific epidemic curves of the disease depending on the region of the country and these curves were influenced by socioeconomic factors and the presence of comorbidities in the population. Coronavirus-19 infection has different clinical presentations, from mild symptoms to Severe Acute Respiratory Syndrome (SARS). Objective: to investigate the factors associated with the presence of sequelae at hospital discharge of patients infected with severe COVID-19 coronavirus, in southern Brazil. Material and methods: an analytical and retrospective observational study was carried out in a University Hospital that is a reference for coronavirus treatment. Medical records of individuals over 18 years of age who tested positive for COVID-19 and who, at some point during hospitalization, underwent orotracheal intubation, characterizing a serious infection, were included. The medical records of adults who were hospitalized from January 2021 to April 2022 and who were discharged were selected. The presence of sequelae was defined as the presence of some change in the health condition, not present at the time of hospital admission, indicating special needs at home. The following were identified as sequelae: need for oxygen, pressure injury, change in renal function, use of tracheostomy, use of a tube, presence of sign or symptom, limb amputation and restriction to bed. Data collection was carried out from August 2022 to April 2023, using the Tasy® electronic medical record. Statistical analyzes were performed using the Student 's t test, Fisher's exact test and the logistic regression model, with the odds ratio. All regulations of resolution 466/2012 of the National Health Council, in relation to ethical aspects, were respected. Results: 238 medical records were included in the study, from 1172 patients hospitalized in the selected period. The average age of the patients was 53 years. The main symptoms on admission were shortness of breath (78.9%), cough (47.4%) and fatigue (23.1%). The most prevalent comorbidities were hypertension (49.5%), obesity (29.4%) and diabetes mellitus (29.1%). The presence of sequelae was observed in 120 patients (50.4%) and was statistically different from the group that did not present sequelae in several aspects. Respiratory sequelae (38%) at hospital discharge were the most frequent, followed by neurological changes (30,8%). Age and acute kidney injury were factors associated with the presence of sequelae at hospital discharge. Conclusion: Acute kidney injury and age, during hospitalization for severe COVID-19 infection, were shown to be factors associated with sequelae at hospital discharge. The chance of developing some change in health condition at hospital discharge was observed to be 3 times higher in the presence of acute kidney injury and 1x higher for older patients.