O comportamento dos sinais vitais nos primeiros dias da hospitalização está associado aos desfechos clínicos em pacientes com COVID-19? Um estudo retrospectivo
Is the behavior of vital signs in the first days of hospitalization associated with clinical outcomes in patients with COVID-19? A retrospective study
Viviane Castello-Simões, Mariana Brasil da Cunha Martino Pereira, Adriano Petrolini Mateus, Naiara Tais Leonardi, Cássia da Luz Goulart, Débora Mayumi de Oliveira Kawakami, Nayara Cristina Romão Cruz, Nikolly Struziatto Duarte, Audrey Borghi-Silva, Renata Gonçalves Mendes
Resumo
Introdução: A trajetória dos sinais vitais, principalmente no início da hospitalização, pode resultar em respostas sobre desfechos clínicos. Objetivo: Avaliar o comportamento dos sinais vitais/variáveis derivadas e da variabilidade da pressão arterial (VPA) durante a fase precoce de hospitalização por COVID-19 e sua associação com desfechos clínicos, além de identificar o ponto de corte dos sinais vitais/variáveis derivadas para prever desfechos clínicos. Métodos: Análise retrospectiva de 100 pacientes hospitalizados por COVID-19, alocados em: grupo desfechos negativos (GD-; n=56) e grupo desfecho positivo (GD+; n=44). Sinais vitais [frequência cardíaca (FC), pressão arterial sistólica (PAS), diastólica e média (PAM), temperatura, frequência respiratória (FR) e saturação periférica de oxigênio]/variáveis derivadas [pressão de pulso (PP) e duplo produto (DP)] e VPA foram avaliadas nos primeiros cinco dias de hospitalização. Curvas ROC foram utilizadas para identificar pontos de corte na predição dos desfechos clínicos. Resultados: Comparado ao 1.º dia de internação, o GD+ apresentou redução na PP no 3.º e 5.º dias, FR a partir do 3.º dia, DP a partir do 4.º dia e PAS no 5.º dia (p<0,05). Adicionalmente, o GD+ apresentou menor PP no 2.º e 4.º dias, menor FR no 4.º dia e menor VPA (PAS e PAM) em relação ao GD- (p<0,05). A curva ROC foi capaz de predizer desfechos negativos quando PP ≥ 40 mmHg no 5.º dia de internação (AUC: 0,63; p=0,02). Conclusão: Pacientes com desfecho clínico positivo apresentaram melhor comportamento dos sinais vitais/variáveis derivadas e da VPA na fase precoce de hospitalização. Adicionalmente, PP ≥ 40 mmHg no 5º dia de hospitalização foi considerada como ponto de corte para prever desfechos negativos.
Palavras-chave
Abstract
Background: The trajectory of vital signs, especially at the beginning of hospitalization, can result in answers about clinical outcomes. Aim: To evaluate the behavior of vital signs/derived variables and blood pressure variability (BPV) during the early phase of hospitalization for COVID-19 and its association with clinical outcomes, in addition to identify the cut-off point for these vital signs/derived variables to predict clinical outcomes. Methods: Retrospective analysis of 100 patients hospitalized for COVID-19, allocated into: negative outcome group (NOG; n=56) and positive outcome group (POG; n=44). Vital signs [heart rate, systolic (SBP), diastolic and mean blood pressure (MAP), temperature, respiratory rate (RR) and peripheral oxygen saturation]/derived variables [pulse pressure (PP) and double product (DP)] and VPA were assessed in the first five days of hospitalization. ROC curves were used to identify cut-off points for predicting clinical outcomes. Results: Compared to the 1st day of hospitalization, POG showed a reduction in PP on the 3rd and 5th days, RR from the 3rd day, DP from the 4th day and SBP on the 5th day (p<0.05). Additionally, POG presented lower PP on the 2nd and 4th days (p<0.05), lower RR on the 4th day and lower variability of SBP and MAP (p<0.05) in relation to NOP. The ROC curve was able to predict negative outcomes when PP ≥ 40 mmHg on the 5th day of hospitalization (AUC: 0.63; p=0.02). Conclusion: Patients with a positive clinical evolution showed better behavior of signs/derived variables and BPV in the early phase of hospitalization. Furthermore, PP ≥ 40 mmHg on the 5th day of hospitalization was considered as a cut-off point to predict negative results.
DOI da versão traduzida: | https://doi.org/10.47066/2966-4837.2024.0002en
Keywords
Referências
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Submetido em:
01/12/2023
Aceito em:
03/09/2024
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