Clinical parameters related to morbidity and mortality in patients with COVID-19 on hospital admission in a tertiary hospital

Authors

DOI:

https://doi.org/10.15448/1980-6108.2023.1.44593

Keywords:

inflammation, intensive care units, nutritional status, renal insufficiency, SARS-CoV-2.

Abstract

Objective: to identify the relationship between morbimortality, nutritional status and biochemical markers at hospital admission and stay in hospitalized COVID-19 patients. Methods: retrospective stud whose data were collected from the medical records of patients admitted with a diagnosis of COVID-19, confirmed by the reverse transcription polymerase chain reaction testing, who were hospitalized between April and November 2020 at a tertiary hospital in the state of Pernambuco, in Northeast Brazil. Results: 217 medical records were included, of which 71.9% were from older adults. 70% of patients had peripheral oxygen saturation below 95% at admission, and 47.5% were admitted to the intensive care unit. Being an older adult (OR 1.9, 95% CI 1.0 to 3.5, p = 0.035), having diabetes (OR 2.2, 95% CI 1.2 to 3.8, p = 0.007) and combined diabetes and hypertension (OR 1.9, 95% CI 1.1 to 3.5, p = 0.023) were associated with intensive care unit stay, as well as lymphopenia and renal function impairment in the first day of hospital stay. The prevalence of overweight and obesity was 21.2% and 20.7%. There was a difference in body mass index between adults and older adults (30.61 ± 6.29 kg/m2 vs. 27.53 ± 4.83 kg/m2, p < 0.001). There was 43.8% mortality, which was associated with advanced age, lower peripheral oxygen saturation, body mass index, and albumin values, and increased of urea, creatinine, C-reactive protein, lactate dehydrogenase, troponin T, and dimer values. Conclusion: Older adults were at a higher risk of intensive care unit stay and mortality and had lower body mass index. Patients with lower peripheral oxygen saturation values at admission died. Renal dysfunction, coagulation disorders, and increased inflammatory markers led to a greater risk of intensive care unit stay and mortality.

Downloads

Download data is not yet available.

Author Biographies

Laura Mata de Lima Silva, Professor Agamenon Magalhães Regional Hospital (Hospital Regional Professor Agamenon Magalhães [HOSPAM]), Serra Talhada, PE, Brazil

Master’s Degree in Nutrition by the Federal University of Pernambuco (UFPE), Recife, PE, Brazil. Currently, she is a member of the nutrition service of a regional public hospital in the Northeast of Brazil.

Ermínia Luzia da Silva Marinho, Federal University of Alagoas (UFAL), Maceio, AL, Brazil.

Graduated in Nutrition from the Federal University of Alagoas (UFAL), Maceio, AL, Brazil; Postgraduate from the Residency Program in Clinical Nutrition at the Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE, Brazil, with emphasis on care for patients with Chronic Kidney Disease (dialysis and post-transplant treatment).

Joseilma de Lima Silva, Federal University of Pernambuco (UFPE), Department of Physical Education and Sport Sciences, Vitoria de Santo Antão, PE, Brazil.

Bachelor of Nursing from the Federal University of Pernambuco - Academic Center of Vitória (UFPE-CAV), Vitória de Santo Antão, PE, Brazil. Member of the research group on Cardiorespiratory Control and Phenotypic Plasticity.

Joao Henrique da Costa Silva, Federal University of Pernambuco (UFPE), Department of Physical Education and Sport Sciences, Vitoria de Santo Antão, PE, Brazil.

PhD in Physiology from the University of São Paulo (USP), Ribeirão Preto, SP, Brazil. Currently, he is Associate Professor II of Federal University of Pernambuco (UFPE), Vitória de Santo Antão, PE, Brazil, and Enseignant / Chercheur Invité dans lUniversité Claude Bernard Lyon 1-UCBL1, Lyon, France.

References

Lana RM, Coelho FC, Gomes MFC, Cruz OG, Bastos LS, Villela DAM, et al. Emergência do novo coronavírus (SARS-CoV-2) e o papel de uma vigilância nacional em saúde oportuna e efetiva. Cad. Saúde Pública. 2020;36(3):1-5. https://doi.org/10.1590/0102-311X00019620

Chaoqun MA, Jiawei GU, Pan H, Liang Z, Yuan B, Zhifu G, et al. Incidence, clinical characteristics and prognostic factor of patients with COVID-19: a systematic review and meta-analysis. medRxiv. 2020. Preprint. https://doi.org/10.1101/2020.03.17.20037572

Figueiredo Neto JA, Braga FGM, Moura LZ, Figueiredo AMS, Figueiredo VMS, Mourilhe-Rocha R, et al. Doença de coronavírus-19 e o miocárdio. Arq. Bras. Cardiol. 2020;114(6):1051-7. https://doi.org/10.36660/abc.20200373

Mehta S. Nutritional status and COVID-19: an opportunity for lasting change? Clin Med. 2020; 20(3):270-3. https://doi.org/10.7861/clinmed.2020-0187

Zhao X, Li Y, Ge Y, Shi Y, Lv P, Zhang J, et al. Evaluation of nutrition risk and its association with mortality risk in severely and critically ill COVID-19 patients. JPEN J Parenter Enteral Nutr. 2021;45(1):32-42. https://doi.org/10.1002/jpen.1953

Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus- 2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity (Silver Spring). 2020;28(7):1195-9. https://doi.org/10.1002/oby.22831

Dietz W, Santos-Burgoa C. Obesity and its implications for COVID-19 mortality. obesity (silver spring). 2020;28(6):1005. https://doi.org/10.1002/oby.22818

Piovacari SMF, Santos GFCG, Santana GA, Scacchetti T, Castro MG. Fluxo de assistência nutricional para pacientes admitidos com COVID-19 e SCOVID-19 em unidade hospitalar. Braspen J. 2020;35(1):6-8. https://66b28c71-9a36-4ddb-9739-12f146d519be.usrfiles.com/ugd/66b28c_2f5d298499184d22b2655dff908f58c9.pdf

Laviano A, Koverech A, Zanetti M. Nutrition support in the time of SARS-CoV-2 (COVID-19). Nutrition. 2020;74: 110834. https://doi.org/10.1016/j.nut.2020.110834

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054-62. https://doi.org/10.1016/S0140-6736(20)30566-3

Lino K, Guimaraes GMC, Alves SL, Oliveira AC, Faustino R, Fernandes CS, et al. Serum ferritin at admission in hospitalized COVID-19 patients as a predictor of mortality. Braz. J Infect Dis. 2021;25(2):101569. https://doi.org/10.1016/j.bjid.2021.101569

World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. Geneva: World Health Organization; 2000. https://apps.who.int/iris/handle/10665/42330

Lipschitz DA. Screening for nutritional status in the elderly. Prim Care. 1994; 21(1):55-67. https://doi.org/10.1016/S0095-4543(21)00452-8

Thapa K, Verma N, Singh TG, Grewal AK, Kanojia N, Rani L. COVID-19-associated acute respiratory distress syndrome (CARDS): mechanistic insights on therapeutic intervention and emerging trends. Int Immunopharmacol. 2021;101:108328. https://doi.org/10.1016/j.intimp.2021.108328

Baggio JAO, Exel AL, Calles ACN, Minatel V. Síndrome respiratória aguda grave (SRAG) causada por COVID-19: um fator regional. Arq Bras Cardiol. 2021;117(5):976-7. https://doi.org/10.36660/abc.20210803

Pfortmueller CA, Spinetti T, Urman RD, Luedi MM, Schefold JC. COVID-19-associated acute respiratory distress syndrome (CARDS): Current knowledge on pathophysiology and ICU treatment – a narrative review. Best Pract Res Clin Anaesthesiol. 2021;35(3):351-68. https://doi.org/10.1016/j.bpa.2020.12.011

Liao D, Zhou F, Luo L, Xu M, Wang H, Xia J, et al. Haematological characteristics and risk factors in the classification and prognosis evaluation of COVID-19: a retrospective cohort study. Lancet Haematol. 2020;7(9):671-8. https://doi.org/10.1016/S2352-3026(20)30217-9

Grasseli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy. JAMA. 2020;323(16):1574-81. https://doi.org/10.1001/jama.2020.5394

García-Posada M, Aruachan-Vesga S, Mestra D, Humanéz K, Serrano-Coll H, Cabrales H, et al. Clinical outcomes of patients hospitalized for COVID-19 and evidence-based on the pharmacological management reduce mortality in a region of the Colombian Caribbean. J Infect Public Health. 2021;14(6):696-701. https://doi.org/10.1016/j.jiph.2021.02.013

Perrotta F, Corbi G, Mazzeo G, Boccia M, Aronne L, D’Agnano V, et al. COVID-19 and the elderly: insights into pathogenesis and clinical decision-making. Aging Clin Exp Res. 2020;32(8):1599-1608. https://doi.org/10.1007/s40520-020-01631-y

Mejía F, Medina C, Cornejo E, Morello E, Vásquez S, Avale J, et al. Oxygen saturation as a predictor of mortality in hospitalized adult patients with COVID-19 in a public hospital in Lima, Peru. PLoS ONE. 2020;15(12):0244171. https://doi.org/10.1371/journal.pone.0244171

Dhont S, Derom E, Braeckel EV, Depuydt P, Lambrecht BN. The pathophysiology of ‘happy’ hypoxemia in COVID-19. Respir Res. 2020;21:198. https://doi.org/10.1186/s12931-020-01462-5

Lim S, Bae JH, Kwon HS, Nauck MA. COVID-19 and diabetes mellitus: from pathophysiology to clinical management. Nat Rev Endocrinol. 2021;17(1):11-30. https://doi.org/10.1038/s41574-020-00435-4

Palaiodimos L, Kokkinidis DG, Li W, Karamanis D, Ognibene J, Arora S, et al. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metabolism. 2020;108:154-262. https://doi.org/10.1016/j.metabol.2020.154262

Hendren NS, Lemos JAD, Ayers C, Das SR, Rao A, Carter S, et al. Association of body mass index and age with morbidity and mortality in patients hospitalized with COVID-19. Circulation. 2021;143(2):135-44. https://doi.org/10.1161/circulationaha.120.051936

Smati S, Tramunt B, Wargny M, Caussy C, Gaborit B, Vatier C, et al. Relationship between obesity and severe COVID‐19 outcomes in patients with type 2 diabetes: results from the CORONADO study. Diabetes Obes Metab. 2021;23(2):391-403. https://doi.org/10.1111/dom.14228

Legrand M, Bell S, Forni L, Joannidis M, Koyner JL, Liu K, et al. Pathophysiology of COVID-19 associated acute kidney injury. Nat Rev Nephrol. 2021;17(11):751-64. https://doi.org/10.1038/s41581-021-00452-0

Henry BM, Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med. 2020;58(7):1021-8. https://doi.org/10.1515/cclm-2020-0369

Xu Y, Yang H, Wang J, Li X, Xue C, Niu C, et al. Serum albumin levels are a predictor of COVID-19 patient prognosis: evidence from a single cohort in Chongqing, China. Int J Gen Med. 2021;14:2785-97. https://doi.org/10.2147/IJGM.S312521

Poudel A, Poudel Y, Adhikari A, Aryal BB, Dangol D, Bajracharya T, et al. D-dimer as a biomarker for assessment of COVID-19 prognosis: D-dimer levels on admission and its role in predicting disease outcome in hospitalized patients with COVID-19. PLoS ONE. 2021;16(8):e0256744. https://doi.org/10.1371/journal.pone.0256744

Hosseinzadeh M, Pouladzadeh M, Eftekhar A, Choghakabodi PM, Sokooti A. Avaliação do D-dímero como preditor de gravidade, grau de envolvimento pulmonar e mortalidade em pacientes com COVID-19. Sci Med. 2022;32(1):e43281. https://doi.org/10.15448/1980-6108.2022.1.43281

Downloads

Published

2023-10-17

How to Cite

Mata de Lima Silva, L., da Silva Marinho, E. L., de Lima Silva, J., & da Costa Silva, J. H. (2023). Clinical parameters related to morbidity and mortality in patients with COVID-19 on hospital admission in a tertiary hospital. Scientia Medica, 33(1), e44593. https://doi.org/10.15448/1980-6108.2023.1.44593