Perfil epidemiológico e laboratorial de pacientes confirmados com Covid-19 e admitidos em um hospital de referência

Autores

DOI:

https://doi.org/10.33448/rsd-v10i15.23067

Palavras-chave:

D-dímero; Unidade de Tratamento Intensivo; Lactato desidrogenase; Aspartato aminotransferase; SARS-CoV-2; Síndrome respiratória aguda.

Resumo

O novo coronavírus, SARS-CoV-2, que causa o COVID-19, é facilmente transmitido de pessoa para pessoa. Cerca de 15% desenvolvem pneumonia grave e, destes, 6% evoluem para síndrome respiratória aguda grave (SARS) e falência de múltiplos órgãos. Identificar biomarcadores que podem prever quais indivíduos são susceptíveis de serem afetados por doenças graves e estão em risco de morte é crucial. No entanto, a fisiopatologia da doença não está completamente elucidada e a caracterização do perfil clínico das pessoas infectadas com SARS-CoV-2 permanece obscura. Portanto, o objetivo deste estudo foi avaliar o perfil epidemiológico e laboratorial de pacientes confirmados com COVID-19 e internados no Hospital Universitário Lauro Wanderley, com base na correlação dos exames laboratoriais com a evolução da doença, determinação das mais influentes variáveis no agravamento da doença. Os dados consistiram em hemograma completo e análises bioquímicas séricas. Ao todo, 74 pacientes atenderam a todos os critérios deste estudo e foram incluídos, 40 da Unidade de Terapia Intensiva (UTI) e 34 da Enfermaria de Doenças Infecciosas (PDI), ambas exclusivamente para pacientes com COVID-19. Com base nesses achados, os pacientes com contagem elevada de leucócitos, ALT, AST e LDH devem ser monitorados de perto, pois esses fatores predizem admissão na UTI e mortalidade. Entre outros parâmetros laboratoriais, os pacientes internados na UTI apresentam níveis mais elevados de dímero-D em comparação com os pacientes IDI. Os resultados sugerem que níveis mais elevados de dímero-D na admissão estão relacionados a um pior prognóstico da doença.

Referências

Ai, J., Gong, J., Xing, L., He, R., Tian, F., Wang, J., Wang, J., Pei, S., Chen, D., Huang, G., Zhang, M., Qu, G., Fan, W., Lin, H., Li, D., & Pei, B. (2020). Analysis of factors associated early diagnosis in coronavirus disease 2019 (COVID-19). MedRxiv. https://doi.org/10.1101/2020.04.09.20059352

Badawi, A., & Ryoo, S. G. (2016). Prevalence of comorbidities in the Middle East respiratory syndrome coronavirus (MERS-CoV): a systematic review and meta-analysis. International Journal of Infectious Diseases, 49. https://doi.org/10.1016/j.ijid.2016.06.015

Chai, X., Hu, L., Zhang, Y., Han, W., Lu, Z., Ke, A., Zhou, J., Shi, G., Fang, N., Fan, J., Cai, J., Fan, J., & Lan, F. (2020). Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection. BioRxiv. https://doi.org/10.1101/2020.02.03.931766

Chen, G., Wu, D., Guo, W., Cao, Y., Huang, D., Wang, H., Wang, T., Zhang, X., Chen, H., Yu, H., Zhang, X., Zhang, M., Wu, S., Song, J., Chen, T., Han, M., Li, S., Luo, X., Zhao, J., & Ning, Q. (2020). Clinical and immunological features of severe and moderate coronavirus disease 2019. Journal of Clinical Investigation, 130(5). https://doi.org/10.1172/JCI137244

Chen, N., Zhou, M., Dong, X., Qu, J., Gong, F., Han, Y., Qiu, Y., Wang, J., Liu, Y., Wei, Y., Xia, J., Yu, T., Zhang, X., & Zhang, L. (2020). Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet, 395(10223). https://doi.org/10.1016/S0140-6736(20)30211-7

Chen, X., Yang, Y., Huang, M., Liu, L., Zhang, X., Xu, J., Geng, S., Han, B., Xiao, J., & Wan, Y. (2020). Differences between COVID‐19 and suspected then confirmed SARS‐CoV‐2‐negative pneumonia: A retrospective study from a single center. Journal of Medical Virology, 92(9). https://doi.org/10.1002/jmv.25810

Cheng, Y., Luo, R., Wang, K., Zhang, M., Wang, Z., Dong, L., Li, J., Yao, Y., Ge, S., & Xu, G. (2020). Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney International, 97(5). https://doi.org/10.1016/j.kint.2020.03.005

Ding, J., Karp, J. E., & Emadi, A. (2017). Elevated lactate dehydrogenase (LDH) can be a marker of immune suppression in cancer: Interplay between hematologic and solid neoplastic clones and their microenvironments. Cancer Biomarkers, 19(4). https://doi.org/10.3233/CBM-160336

Ferrari, D., Motta, A., Strollo, M., Banfi, G., & Locatelli, M. (2020). Routine blood tests as a potential diagnostic tool for COVID-19. Clinical Chemistry and Laboratory Medicine (CCLM), 58(7). https://doi.org/10.1515/cclm-2020-0398

Giannitsis, E., Mair, J., Christersson, C., Siegbahn, A., Huber, K., Jaffe, A. S., Peacock, W. F., Plebani, M., Thygesen, K., Möckel, M., Mueller, C., & Lindahl, B. (2017). How to use D-dimer in acute cardiovascular care. European Heart Journal: Acute Cardiovascular Care, 6(1). https://doi.org/10.1177/2048872615610870

Guan, W., Ni, Z., Hu, Y., Liang, W., Ou, C., He, J., Liu, L., Shan, H., Lei, C., Hui, D. S. C., Du, B., Li, L., Zeng, G., Yuen, K.-Y., Chen, R., Tang, C., Wang, T., Chen, P., Xiang, J., … Zhong, N. (2020). Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine, 382(18). https://doi.org/10.1056/NEJMoa2002032

Han, Y., Zhang, H., Mu, S., Wei, W., Jin, C., Xue, Y., Tong, C., Zha, Y., Song, Z., & Gu, G. (2020). Lactate dehydrogenase, a Risk Factor of Severe COVID-19 Patients: A Retrospective and Observational Study. MedRxiv. https://doi.org/10.1101/2020.03.24.20040162

Hsih, W.-H., Cheng, M.-Y., Ho, M.-W., Chou, C.-H., Lin, P.-C., Chi, C.-Y., Liao, W.-C., Chen, C.-Y., Leong, L.-Y., Tien, N., Lai, H.-C., Lai, Y.-C., & Lu, M.-C. (2020). Featuring COVID-19 cases via screening symptomatic patients with epidemiologic link during flu season in a medical center of central Taiwan. Journal of Microbiology, Immunology and Infection, 53(3). https://doi.org/10.1016/j.jmii.2020.03.008

Jaillon, S., Berthenet, K., & Garlanda, C. (2019). Sexual Dimorphism in Innate Immunity. Clinical Reviews in Allergy & Immunology, 56(3). https://doi.org/10.1007/s12016-017-8648-x

Ji, H.-L., Zhao, R., Matalon, S., & Matthay, M. A. (2020). Elevated Plasmin(ogen) as a Common Risk Factor for COVID-19 Susceptibility. Physiological Reviews, 100(3). https://doi.org/10.1152/physrev.00013.2020

Keski, H. (2021). Hematological and Inflammatory Parameters to Predict the Prognosis in COVID-19. Indian Journal of Hematology and Blood Transfusion, 37(4). https://doi.org/10.1007/s12288-021-01407-y

Kuang, Z., Yang, Y., Wei, W., Wang, J., Long, X., Li, K., Tong, C., Sun, Z., & Song, Z. (2020). Clinical characteristics and prognosis of community-acquired pneumonia in autoimmune disease-induced immunocompromised host: A retrospective observational study. World Journal of Emergency Medicine, 11(3). https://doi.org/10.5847/wjem.j.1920-8642.2020.03.003

Liang, W., Liang, H., Ou, L., Chen, B., Chen, A., Li, C., Li, Y., Guan, W., Sang, L., Lu, J., Xu, Y., Chen, G., Guo, H., Guo, J., Chen, Z., Zhao, Y., Li, S., Zhang, N., Zhong, N., & He, J. (2020). Development and Validation of a Clinical Risk Score to Predict the Occurrence of Critical Illness in Hospitalized Patients With COVID-19. JAMA Internal Medicine, 180(8). https://doi.org/10.1001/jamainternmed.2020.2033

Liao, Y.-C., Liang, W.-G., Chen, F.-W., Hsu, J.-H., Yang, J.-J., & Chang, M.-S. (2002). IL-19 Induces Production of IL-6 and TNF-α and Results in Cell Apoptosis Through TNF-α. The Journal of Immunology, 169(8). https://doi.org/10.4049/jimmunol.169.8.4288

Lippi, G., & Plebani, M. (2020). Laboratory abnormalities in patients with COVID-2019 infection. Clinical Chemistry and Laboratory Medicine (CCLM), 58(7). https://doi.org/10.1515/cclm-2020-0198

Mardani, R., Ahmadi Vasmehjani, A., Zali, F., Gholami, A., Mousavi Nasab, S. D., Kaghazian, H., Kaviani, M., & Ahmadi, N. (2020). Laboratory Parameters in Detection of COVID-19 Patients with Positive RT-PCR; a Diagnostic Accuracy Study. Archives of Academic Emergency Medicine, 8(1).

Miao, C., Zhuang, J., Jin, M., Xiong, H., Huang, P., Zhao, Q., Miao, L., Du, J., Yang, X., Huang, P., & Hong, J. (2020). A comparative multicenter study on the clinical and imaging features of confirmed and unconfirmed patients with COVID19. MedRxiv. https://doi.org/10.1101/2020.03.22.20040782

Pan, Y., Ye, G., Zeng, X., Liu, G., Zeng, X., Jiang, X., Zhao, J., Chen, L., Guo, S., Deng, Q., Hong, X., Yang, Y., Li, Y., & Wang, X. (2020). Can routine laboratory tests discriminate SARS‐CoV‐2‐infected pneumonia from other causes of community‐acquired pneumonia? Clinical and Translational Medicine, 10(1). https://doi.org/10.1002/ctm2.23

Rodrigues, T. S., de Sá, K. S. G., Ishimoto, A. Y., Becerra, A., Oliveira, S., Almeida, L., Gonçalves, A. v., Perucello, D. B., Andrade, W. A., Castro, R., Veras, F. P., Toller-Kawahisa, J. E., Nascimento, D. C., de Lima, M. H. F., Silva, C. M. S., Caetite, D. B., Martins, R. B., Castro, I. A., Pontelli, M. C., … Zamboni, D. S. (2021). Inflammasomes are activated in response to SARS-CoV-2 infection and are associated with COVID-19 severity in patients. Journal of Experimental Medicine, 218(3). https://doi.org/10.1084/jem.20201707

Rojas, M., Rodríguez, Y., Monsalve, D. M., Acosta-Ampudia, Y., Camacho, B., Gallo, J. E., Rojas-Villarraga, A., Ramírez-Santana, C., Díaz-Coronado, J. C., Manrique, R., Mantilla, R. D., Shoenfeld, Y., & Anaya, J.-M. (2020). Convalescent plasma in Covid-19: Possible mechanisms of action. Autoimmunity Reviews, 19(7). https://doi.org/10.1016/j.autrev.2020.102554

Tan, L., Wang, Q., Zhang, D. et al. Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study. Sig Transduct Target Ther 5, 33 (2020). https://doi.org/10.1038/s41392-020-0148-4

Tian, W., Jiang, W., Yao, J., Nicholson, C. J., Li, R. H., Sigurslid, H. H., Wooster, L., Rotter, J. I., Guo, X., & Malhotra, R. (2020). Predictors of mortality in hospitalized COVID‐19 patients: A systematic review and meta‐analysis. Journal of Medical Virology, 92(10). https://doi.org/10.1002/jmv.26050

Wang, D., Hu, B., Hu, C., Zhu, F., Liu, X., Zhang, J., Wang, B., Xiang, H., Cheng, Z., Xiong, Y., Zhao, Y., Li, Y., Wang, X., & Peng, Z. (2020). Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA, 323(11). https://doi.org/10.1001/jama.2020.1585

Wang, Z. F., Su, F., Lin, X. J., Dai, B., Kong, L. F., Zhao, H. W., & Kang, J. (2011). Serum D-dimer changes and prognostic implication in 2009 novel influenza A(H1N1). Thrombosis Research, 127(3). https://doi.org/10.1016/j.thromres.2010.11.032

WORLD HEALTH ORGANIZATION (WHO). (2021). Coronavirus.

Xu, H., Zhong, L., Deng, J., Peng, J., Dan, H., Zeng, X., Li, T., & Chen, Q. (2020). High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. International Journal of Oral Science, 12(1). https://doi.org/10.1038/s41368-020-0074-x

Zhang, J. J. Y., Lee, K. S., Ang, L. W., Leo, Y. S., & Young, B. E. (2020). Risk Factors for Severe Disease and Efficacy of Treatment in Patients Infected With COVID-19: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis. Clinical Infectious Diseases, 71(16). https://doi.org/10.1093/cid/ciaa576

Zhang, Y., Zheng, L., Liu, L., Zhao, M., Xiao, J., & Zhao, Q. (2020). Liver impairment in COVID‐19 patients: A retrospective analysis of 115 cases from a single centre in Wuhan city, China. Liver International, 40(9). https://doi.org/10.1111/liv.14455

Zhao, D., Yao, F., Wang, L., Zheng, L., Gao, Y., Ye, J., Guo, F., Zhao, H., & Gao, R. (2020). A Comparative Study on the Clinical Features of Coronavirus 2019 (COVID-19) Pneumonia With Other Pneumonias. Clinical Infectious Diseases, 71(15). https://doi.org/10.1093/cid/ciaa247

Zhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z., Xiang, J., Wang, Y., Song, B., Gu, X., Guan, L., Wei, Y., Li, H., Wu, X., Xu, J., Tu, S., Zhang, Y., Chen, H., & Cao, B. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet, 395(10229). https://doi.org/10.1016/S0140-6736(20)30566-3

Zhu, W., Xie, K., Lu, H., Xu, L., Zhou, S., & Fang, S. (2020). Initial clinical features of suspected coronavirus disease 2019 in two emergency departments outside of Hubei, China. Journal of Medical Virology, 92(9). https://doi.org/10.1002/jmv.25763

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Publicado

29/11/2021

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ARAGÃO NETO, H. de C.; COSTA, C. M. .; PITA, J. C. L. R. .; CASTRO, R. D. de .; VASCONCELOS, I. R. A. .; BENEDITO, R. B. . Perfil epidemiológico e laboratorial de pacientes confirmados com Covid-19 e admitidos em um hospital de referência. Research, Society and Development, [S. l.], v. 10, n. 15, p. e421101523067, 2021. DOI: 10.33448/rsd-v10i15.23067. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/23067. Acesso em: 6 jul. 2024.

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