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Tavares CDAM, de Azevedo LCP, Rea-Neto Á, Campos NS, Amendola CP, Bergo RR, Kozesinski-Nakatani AC, David-João PG, Westphal GA, Guimarães Júnior MRR, Lobo SMA, Tavares MS, Dracoulakis MDA, de Souza GM, de Almeida GMB, Gebara OCE, Tomba PO, Albuquerque CSN, Silva MCR, Pereira AJ, Damiani LP, Corrêa TD, Serpa-Neto A, Berwanger O, Zampieri FG. Dapagliflozin in patients with critical illness: rationale and design of the DEFENDER study. Crit Care Sci 2023; 35:256-265. [PMID: 38133155 PMCID: PMC10734800 DOI: 10.5935/2965-2774.20230129-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/09/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Critical illness is a major ongoing health care burden worldwide and is associated with high mortality rates. Sodium-glucose cotransporter-2 inhibitors have consistently shown benefits in cardiovascular and renal outcomes. The effects of sodium-glucose cotransporter-2 inhibitors in acute illness have not been properly investigated. METHODS DEFENDER is an investigator-initiated, multicenter, randomized, open-label trial designed to evaluate the efficacy and safety of dapagliflozin in 500 adult participants with acute organ dysfunction who are hospitalized in the intensive care unit. Eligible participants will be randomized 1:1 to receive dapagliflozin 10mg plus standard of care for up to 14 days or standard of care alone. The primary outcome is a hierarchical composite of hospital mortality, initiation of kidney replacement therapy, and intensive care unit length of stay, up to 28 days. Safety will be strictly monitored throughout the study. CONCLUSION DEFENDER is the first study designed to investigate the use of a sodium-glucose cotransporter-2 inhibitor in general intensive care unit patients with acute organ dysfunction. It will provide relevant information on the use of drugs of this promising class in critically ill patients. CLINICALTRIALS.GOV REGISTRY NCT05558098.
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Affiliation(s)
| | | | - Álvaro Rea-Neto
- Centro de Estudos e de Pesquisas em Terapia Intensiva - Curitiba
(PR), Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ary Serpa-Neto
- Hospital Israelita Albert Einstein - São Paulo (SP),
Brazil
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2
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Glir JRZ, Bernardelli RS, Kozesinski-Nakatani AC, Deucher RADO, de Oliveira MC, Réa-Neto Á. Accuracy of the persistent AKI risk index in predicting acute kidney injury in patients admitted to the intensive care unit for acute respiratory failure. Crit Care Sci 2023; 35:302-310. [PMID: 38133160 PMCID: PMC10734811 DOI: 10.5935/2965-2774.20230141-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/11/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To evaluate the accuracy of the persistent AKI risk index (PARI) in predicting acute kidney injury within 72 hours after admission to the intensive care unit, persistent acute kidney injury, renal replacement therapy, and death within 7 days in patients hospitalized due to acute respiratory failure. METHODS This study was done in a cohort of diagnoses of consecutive adult patients admitted to the intensive care unit of eight hospitals in Curitiba, Brazil, between March and September 2020 due to acute respiratory failure secondary to suspected COVID-19. The COVID-19 diagnosis was confirmed or refuted by RT-PCR for the detection of SARS-CoV-2. The ability of PARI to predict acute kidney injury at 72 hours, persistent acute kidney injury, renal replacement therapy, and death within 7 days was analyzed by ROC curves in comparison to delta creatinine, SOFA, and APACHE II. RESULTS Of the 1,001 patients in the cohort, 538 were included in the analysis. The mean age was 62 ± 17 years, 54.8% were men, and the median APACHE II score was 12. At admission, the median SOFA score was 3, and 83.3% had no renal dysfunction. After admission to the intensive care unit, 17.1% had acute kidney injury within 72 hours, and through 7 days, 19.5% had persistent acute kidney injury, 5% underwent renal replacement therapy, and 17.1% died. The PARI had an area under the ROC curve of 0.75 (0.696 - 0.807) for the prediction of acute kidney injury at 72 hours, 0.71 (0.613 - 0.807) for renal replacement therapy, and 0.64 (0.565 - 0.710) for death. CONCLUSION The PARI has acceptable accuracy in predicting acute kidney injury within 72 hours and renal replacement therapy within 7 days of admission to the intensive care unit, but it is not significantly better than the other scores.
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Affiliation(s)
| | | | | | | | | | - Álvaro Réa-Neto
- Centro de Estudos e Pesquisa em Terapia Intensiva - Curitiba (PR),
Brazil
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3
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Trott G, Scolari FL, Rover MM, da Silva MMD, de Souza D, dos Santos RDRM, Schardosim RFDC, Rech GS, de Mesquita J, Estivalete GP, Freitas HJM, Itaqui CR, Kozesinski-Nakatani AC, Biolo A, Marcolino MS, Barreto BB, Schvartzman PR, Antonio ACP, Robinson CC, Falavigna M, Polanczyk CA, Rosa RG. Long-term Health-Related Quality of Life and Outcomes after Hospitalization for COVID-19 in Brazil: Post-COVID Brazil 1 Study Protocol. Arq Bras Cardiol 2023; 120:e20230378. [PMID: 37991122 PMCID: PMC10697686 DOI: 10.36660/abc.20230378] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/01/2023] [Accepted: 08/16/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND The long-term impact of hospitalization for COVID-19 on patients' physical, mental, and cognitive health still needs further assessment. OBJECTIVES This study aims to evaluate factors associated with quality of life and cardiovascular and non-cardiovascular outcomes 12 months after hospitalization for COVID-19. METHODS This prospective multicenter study intends to enroll 611 patients hospitalized due to COVID-19 (NCT05165979). Centralized telephone interviews are scheduled to occur at three, six, nine, and 12 months after hospital discharge. The primary endpoint is defined as the health-related quality-of-life utility score assessed by the EuroQol-5D-3L (EQ-5D-3L) questionnaire at 12 months. Secondary endpoints are defined as the EQ-5D-3L at three, six and nine months, return to work or education, persistent symptoms, new disabilities in instrumental activities of daily living, cognitive impairment, anxiety, depression, and post-traumatic stress symptoms, major cardiovascular events, rehospitalization, as well as all-cause mortality at 3, 6, 9, and 12 months after SARS-CoV-2 infection. A p-value <0.05 will be assumed as statistically significant for all analyses. RESULTS The primary endpoint will be presented as the frequency of the EQ-5D-3L score 12 months after COVID-19 hospitalization. A sub-analysis to identify possible associations of independent variables with study outcomes will be presented. CONCLUSIONS This study will determine the impact of COVID-19 on the quality of life and cardiovascular and non-cardiovascular outcomes of hospitalized patients 12 months after discharge providing insights to the public health system in Brazil.
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Affiliation(s)
- Geraldine Trott
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Fernando Luis Scolari
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
- Divisão de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasil Divisão de Cardiologia do Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Marciane Maria Rover
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
- Divisão de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasil Divisão de Cardiologia do Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Mariana Motta Dias da Silva
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Denise de Souza
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Rosa da Rosa Minho dos Santos
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Raíne Fogliati de Carli Schardosim
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Gabriela Soares Rech
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Juliana de Mesquita
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Gabriel Pozza Estivalete
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Hellen Jordan Martins Freitas
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Carolina Rothmann Itaqui
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Amanda Christina Kozesinski-Nakatani
- Unidade de Terapia IntensivaHospital Santa Casa de CuritibaCuritibaPRBrasil Unidade de Terapia Intensiva – Hospital Santa Casa de Curitiba , Curitiba , PR – Brasil
| | - Andreia Biolo
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
- Divisão de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasil Divisão de Cardiologia do Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
- Instituto Nacional de Avaliação de Tecnologias em SaúdeUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasil Instituto Nacional de Avaliação de Tecnologias em Saúde – Universidade Federal do Rio Grande do Sul , Porto Alegre , RS – Brasil
| | - Milena Soriano Marcolino
- Departamento de Medicina InternaFaculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasil Departamento de Medicina Interna da Faculdade de Medicina da Universidade Federal de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Bruna Brandão Barreto
- Departamento de Medicina Interna e Apoio DiagnósticoFaculdade de Medicina da BahiaUniversidade Federal da BahiaSalvadorBABrasil Departamento de Medicina Interna e Apoio Diagnóstico , Faculdade de Medicina da Bahia , Universidade Federal da Bahia , Salvador , BA – Brasil
- Unidade de Terapia IntensivaHospital da Mulher – Maria Luzia Costa dos SantosSalvadorBABrasil Unidade de Terapia Intensiva – Hospital da Mulher – Maria Luzia Costa dos Santos , Salvador , BA – Brasil
| | - Paulo Roberto Schvartzman
- Divisão de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasil Divisão de Cardiologia do Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Ana Carolina Peçanha Antonio
- Unidade de Terapia IntensivaHospital de Clínicas de Porto AlegrePorto AlegreRSBrasil Unidade de Terapia Intensiva – Hospital de Clínicas de Porto Alegre , Porto Alegre , RS – Brasil
| | - Caroline Cabral Robinson
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
| | - Maicon Falavigna
- Instituto Nacional de Avaliação de Tecnologias em SaúdeUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasil Instituto Nacional de Avaliação de Tecnologias em Saúde – Universidade Federal do Rio Grande do Sul , Porto Alegre , RS – Brasil
- Unidade de PesquisaInova MedicalPorto AlegreRSBrasil Unidade de Pesquisa – Inova Medical , Porto Alegre , RS – Brasil
| | - Carisi Anne Polanczyk
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
- Divisão de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasil Divisão de Cardiologia do Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
- Instituto Nacional de Avaliação de Tecnologias em SaúdeUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasil Instituto Nacional de Avaliação de Tecnologias em Saúde – Universidade Federal do Rio Grande do Sul , Porto Alegre , RS – Brasil
| | - Regis Goulart Rosa
- Escritório de Projetos de PesquisaHospital Moinhos de VentoPorto AlegreRSBrasil Escritório de Projetos de Pesquisa – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
- Serviço de Medicina InternaHospital Moinhos de VentoPorto AlegreRSBrasil Serviço de Medicina Interna – Hospital Moinhos de Vento , Porto Alegre , RS – Brasil
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Réa-Neto Á, Bernardelli RS, de Oliveira MC, David-João PG, Kozesinski-Nakatani AC, Falcão ALE, Kurtz PMP, Teive HAG. Epidemiology and disease burden of patients requiring neurocritical care: a Brazilian multicentre cohort study. Sci Rep 2023; 13:18595. [PMID: 37903826 PMCID: PMC10616165 DOI: 10.1038/s41598-023-44261-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/05/2023] [Indexed: 11/01/2023] Open
Abstract
Acute neurological emergencies are highly prevalent in intensive care units (ICUs) and impose a substantial burden on patients. This study aims to describe the epidemiology of patients requiring neurocritical care in Brazil, and their differences based on primary acute neurological diagnoses and to identify predictors of mortality and unfavourable outcomes, along with the disease burden of each condition at intensive care unit admission. This prospective cohort study included patients requiring neurocritical care admitted to 36 ICUs in four Brazilian regions who were followed for 30 days or until ICU discharge (Aug-Sep in 2018, 1 month). Of 4245 patients admitted to the participating ICUs, 1194 (28.1%) were patients with acute neurological disorders requiring neurocritical care and were included. Patients requiring neurocritical care had a mean mortality rate 1.7 times higher than ICU patients not requiring neurocritical care (17.21% versus 10.1%, respectively). Older age, emergency admission, higher number of potential secondary injuries, and worse APACHE II, SAPS III, SOFA, and Glasgow coma scale scores on ICU admission are independent predictors of mortality and poor outcome among patients with acute neurological diagnoses. The estimated total DALYs were 4482.94 in the overall cohort, and the diagnosis with the highest DALYs was traumatic brain injury (1634.42). Clinical, epidemiological, treatment, and ICU outcome characteristics vary according to the primary neurologic diagnosis. Advanced age, a lower GCS score and a higher number of potential secondary injuries are independent predictors of mortality and unfavourable outcomes in patients requiring neurocritical care. The findings of this study are essential to guide education policies, prevention, and treatment of severe acute neurocritical diseases.
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Affiliation(s)
- Álvaro Réa-Neto
- Center for Studies and Research in Intensive Care Medicine (CEPETI), Curitiba, Brazil.
- Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil.
- Neurological Institute of Curitiba Hospital, Curitiba, Paraná, Brazil.
| | - Rafaella Stradiotto Bernardelli
- Center for Studies and Research in Intensive Care Medicine (CEPETI), Curitiba, Brazil
- School of Medicine and Life Sciences, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
| | - Mirella Cristine de Oliveira
- Center for Studies and Research in Intensive Care Medicine (CEPETI), Curitiba, Brazil
- Complexo Hospitalar do Trabalhador (CHT), Curitiba, Paraná, Brazil
| | - Paula Geraldes David-João
- Center for Studies and Research in Intensive Care Medicine (CEPETI), Curitiba, Brazil
- Department of Critical Patients, Hospital Municipal Dr Moysés Deutsch, São Paulo, São Paulo, Brazil
| | | | - Antônio Luís Eiras Falcão
- Medical School, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Head of the Intensive Care Unit, Hospital de Clínicas de Campinas, Campinas, São Paulo, Brazil
| | - Pedro Martins Pereira Kurtz
- D'Or Institute of Research and Education, Rio de Janeiro, Rio de Janeiro, Brazil
- Hospital Copa Star, Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Hélio Afonso Ghizoni Teive
- Neurology Service, Movement Disorders Unit, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil
- Postgraduate Program in Internal Medicine, Neurological Diseases Group, Federal University of Paraná, Curitiba, Paraná, Brazil
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5
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de Oliveira MC, Bernardelli RS, Kozesinski-Nakatani AC, Turnes J, Reese FB, Pozzo LC, Deucher RADO, Rossi CU, Tannous LA, Réa-Neto Á. Typical phenotypes of patients with acute respiratory failure with and without COVID-19 and their relationship with outcomes: a cohort study. Crit Care Sci 2023; 35:355-366. [PMID: 38265317 PMCID: PMC10802779 DOI: 10.5935/2965-2774.20230015-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 09/09/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To compare, within a cohort of patients with acute respiratory failure, the phenotypes of patients with and without COVID-19 in the context of the pandemic and evaluate whether COVID-19 is an independent predictor of intensive care unit mortality. METHODS This historical cohort study evaluated 1001 acute respiratory failure patients with suspected COVID-19 admitted to the intensive care unit of 8 hospitals. Patients were classified as COVID-19 cases and non-COVID-19 cases according to real-time polymerase chain reaction results. Data on clinical and demographic characteristics were collected on intensive care unit admission, as well as daily clinical and laboratory data and intensive care unit outcomes. RESULTS Although the groups did not differ in terms of APACHE II or SOFA scores at admission, the COVID-19 group had more initial symptoms of fever, myalgia and diarrhea, had a longer duration of symptoms, and had a higher prevalence of obesity. They also had a lower PaO2/FiO2 ratio, lower platelet levels than non-COVID-19 patients, and more metabolic changes, such as higher levels of blood glucose, C-reactive protein, and lactic dehydrogenase. Patients with non-COVID-19 acute respiratory failure had a higher prevalence of chronic obstructive pulmonary disease/asthma and cardiopathy. Patients with COVID-19 stayed in the hospital longer and had more complications, such as acute kidney failure, severe acute respiratory distress syndrome and severe infection. The all-cause mortality rate was also higher in this group (43.7% in the COVID-19 group versus 27.4% in the non-COVID-19 group). The diagnosis of COVID-19 was a predictor of intensive care unit mortality (odds ratio, 2.77; 95%CI, 1.89 - 4.07; p < 0.001), regardless of age or Charlson Comorbidity Index score. CONCLUSION In a prospective cohort of patients admitted with acute respiratory failure, patients with COVID-19 had a clearly different phenotype and a higher mortality than non-COVID-19 patients. This may help to outline more accurate screening and appropriate and timely treatment for these patients.
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Affiliation(s)
| | | | | | - Joelle Turnes
- Centro de Estudos e de Pesquisas em Terapia Intensiva - Curitiba
(PR), Brazil
| | | | | | | | | | | | - Álvaro Réa-Neto
- Centro de Estudos e de Pesquisas em Terapia Intensiva - Curitiba
(PR), Brazil
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6
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Rover MM, Trott G, Scolari FL, da Silva MMD, de Souza D, dos Santos RDRM, Dagnino APA, de Mesquita J, Estivalete GP, Kozesinski-Nakatani AC, Marcolino MS, Barreto BB, Schvartzman PR, Antonio ACP, Robinson CC, Falavigna M, Biolo A, Polanczyk CA, Rosa RG. Health-Related Quality of Life and Long-Term Outcomes after Mildly Symptomatic COVID-19: The Post-COVID Brazil Study 2 Protocol. Arq Bras Cardiol 2023; 120:e20220835. [PMID: 37851732 PMCID: PMC10547435 DOI: 10.36660/abc.20220835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/30/2023] [Accepted: 07/17/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The long-term effects of mild COVID-19 on physical, cognitive, and mental health are not yet well understood. OBJECTIVE The purpose of this paper is to describe the protocol for the ongoing "Post-COVID Brazil" study 2, which aims to evaluate the factors associated with health-related quality of life and long-term cardiovascular and non-cardiovascular outcomes one year after a mild episode of symptomatic COVID-19. METHODS The "Post-COVID Brazil" study 2 is a prospective multicenter study that plans to enroll 1047 patients (NCT05197647). Centralized, structured telephone interviews are conducted at 1, 3, 6, 9, and 12 months after COVID-19 diagnosis. The primary outcome is the health-related quality-of-life utility score, assessed using the EuroQol-5D-3L (EQ-5D-3L) questionnaire at 12 months. Secondary endpoints include the EQ-5D-3L at 3, 6, and 9 months, as well as all-cause mortality, major cardiovascular events, hospitalization, return to work or education, persistent symptoms, new disabilities in instrumental activities of daily living, cognitive impairment, anxiety, depression, and post-traumatic stress symptoms at 3, 6, 9, and 12 months after SARS-CoV-2 infection. A p-value < 0.05 will be considered statistically significant for all analyses. RESULTS The primary endpoint will be presented as the overall frequency of the EQ-5D-3L domains 12 months after SARS-CoV-2 infection. Main analysis will explore the association of independent variables with the study outcomes. CONCLUSION The "Post-COVID Brazil" study 2 aims to clarify the impact of long COVID on the quality of life and cardiovascular and non-cardiovascular outcomes of Brazilian patients who have had mild COVID-19.
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Affiliation(s)
- Marciane Maria Rover
- Hospital Moinhos de VentoPorto AlegreRSBrasilProjetos de Pesquisa – Hospital Moinhos de Vento, Porto Alegre, RS – Brasil
- Divisão de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasilDivisão de Cardiologia – Hospital Moinhos de Vento, Porto Alegre, RS – Brasil
| | - Geraldine Trott
- Divisão de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasilDivisão de Cardiologia – Hospital Moinhos de Vento, Porto Alegre, RS – Brasil
| | - Fernando Luís Scolari
- Hospital Moinhos de VentoPorto AlegreRSBrasilProjetos de Pesquisa – Hospital Moinhos de Vento, Porto Alegre, RS – Brasil
- Divisão de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasilDivisão de Cardiologia – Hospital Moinhos de Vento, Porto Alegre, RS – Brasil
| | - Mariana Motta Dias da Silva
- Hospital Moinhos de VentoPorto AlegreRSBrasilProjetos de Pesquisa – Hospital Moinhos de Vento, Porto Alegre, RS – Brasil
| | - Denise de Souza
- Hospital Moinhos de VentoPorto AlegreRSBrasilProjetos de Pesquisa – Hospital Moinhos de Vento, Porto Alegre, RS – Brasil
| | - Rosa da Rosa Minho dos Santos
- Hospital Moinhos de VentoPorto AlegreRSBrasilProjetos de Pesquisa – Hospital Moinhos de Vento, Porto Alegre, RS – Brasil
| | - Ana Paula Aquistapase Dagnino
- Hospital Moinhos de VentoPorto AlegreRSBrasilProjetos de Pesquisa – Hospital Moinhos de Vento, Porto Alegre, RS – Brasil
| | - Juliana de Mesquita
- Hospital Moinhos de VentoPorto AlegreRSBrasilProjetos de Pesquisa – Hospital Moinhos de Vento, Porto Alegre, RS – Brasil
| | - Gabriel Pozza Estivalete
- Hospital Moinhos de VentoPorto AlegreRSBrasilProjetos de Pesquisa – Hospital Moinhos de Vento, Porto Alegre, RS – Brasil
| | - Amanda Christina Kozesinski-Nakatani
- Unidade de Terapia IntensivaHospital Santa Casa de CuritibaCuritibaPRBrasilUnidade de Terapia Intensiva – Hospital Santa Casa de Curitiba, Curitiba, PR – Brasil
| | - Milena Soriano Marcolino
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilMedicina Interna – Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Bruna Brandão Barreto
- Departamento de Medicina Interna e Apoio DiagnósticoFaculdade de Medicina da BahiaUniversidade Federal da BahiaSalvadorBABrasilDepartamento de Medicina Interna e Apoio Diagnóstico – Faculdade de Medicina da Bahia – Universidade Federal da Bahia Salvador, BA – Brasil
- Unidade de Terapia IntensivaHospital da Mulher – Maria Luzia Costa dos SantosSalvadorBABrasilUnidade de Terapia Intensiva – Hospital da Mulher – Maria Luzia Costa dos Santos, Salvador, BA – Brasil
| | - Paulo Roberto Schvartzman
- Divisão de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasilDivisão de Cardiologia – Hospital Moinhos de Vento, Porto Alegre, RS – Brasil
| | - Ana Carolina Peçanha Antonio
- Unidade de Terapia IntensivaHospital de Clínicas de Porto AlegrePorto AlegreRSBrasilUnidade de Terapia Intensiva – Hospital de Clínicas de Porto Alegre, Porto Alegre, RS – Brasil
| | - Caroline Cabral Robinson
- Hospital Moinhos de VentoPorto AlegreRSBrasilProjetos de Pesquisa – Hospital Moinhos de Vento, Porto Alegre, RS – Brasil
| | - Maicon Falavigna
- Unidade de PesquisaInova MedicalPorto AlegreRSBrasilUnidade de Pesquisa – Inova Medical, Porto Alegre, RS – Brasil
- Instituto Nacional de Avaliação de Tecnologias em SaúdeUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasilInstituto Nacional de Avaliação de Tecnologias em Saúde – Universidade Federal do Rio Grande do Sul, Porto Alegre, RS – Brasil
| | - Andreia Biolo
- Divisão de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasilDivisão de Cardiologia – Hospital Moinhos de Vento, Porto Alegre, RS – Brasil
- Faculdade de MedicinaUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasilFaculdade de Medicina – Universidade Federal do Rio Grande do Sul, Porto Alegre, RS – Brasil
| | - Carisi Anne Polanczyk
- Hospital Moinhos de VentoPorto AlegreRSBrasilProjetos de Pesquisa – Hospital Moinhos de Vento, Porto Alegre, RS – Brasil
- Divisão de CardiologiaHospital Moinhos de VentoPorto AlegreRSBrasilDivisão de Cardiologia – Hospital Moinhos de Vento, Porto Alegre, RS – Brasil
- Faculdade de MedicinaUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasilFaculdade de Medicina – Universidade Federal do Rio Grande do Sul, Porto Alegre, RS – Brasil
| | - Regis Goulart Rosa
- Hospital Moinhos de VentoPorto AlegreRSBrasilProjetos de Pesquisa – Hospital Moinhos de Vento, Porto Alegre, RS – Brasil
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Réa RR, Bernardelli RS, Kozesinski-Nakatani AC, Olandoski M, Martins-Junior MJ, Oliveira MC, Réa-Neto Á. Dysglycemias in patients admitted to ICUs with severe acute respiratory syndrome due to COVID-19 versus other causes - a cohort study. BMC Pulm Med 2023; 23:173. [PMID: 37193970 DOI: 10.1186/s12890-023-02439-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/17/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Dysglycemias have been associated with worse prognosis in critically ill patients with COVID-19, but data on the association of dysglycemia with COVID-19 in comparison with other forms of severe acute respiratory syndrome are lacking. This study aimed to compare the occurrence of different glycemic abnormalities in patients with severe acute respiratory syndrome and COVID-19 admitted to intensive care units versus glycemic abnormalities in patients with severe acute respiratory syndrome from other causes, to evaluate the adjusted attributable risk associated with COVID-19 and dysglycemia and to assess the influence of these dysglycemias on mortality. METHODS We conducted a retrospective cohort of consecutive patients with severe acute respiratory syndrome and suspected COVID-19 hospitalized in intensive care units between March 11 and September 13, 2020, across eight hospitals in Curitiba-Brazil. The primary outcome was the influence of COVID-19 on the variation of the following parameters of dysglycemia: highest glucose level at admission, mean and highest glucose levels during ICU stay, mean glucose variability, percentage of days with hyperglycemia, and hypoglycemia during ICU stay. The secondary outcome was the influence of COVID-19 and each of the six parameters of dysglycemia on hospital mortality within 30 days from ICU admission. RESULTS The sample consisted of 841 patients, of whom 703 with and 138 without COVID-19. Comparing patients with and without COVID-19, those with COVID-19 had significantly higher glucose peaks at admission (165 mg/dL vs. 146 mg/dL; p = 0.002) and during ICU stay (242 mg/dL vs. 187md/dL; p < 0.001); higher mean daily glucose (149.7 mg/dL vs. 132.6 mg/dL; p < 0.001); higher percentage of days with hyperglycemia during ICU stay (42.9% vs. 11.1%; p < 0.001); and greater mean glucose variability (28.1 mg/dL vs. 25.0 mg/dL; p = 0.013). However, these associations were no longer statistically significant after adjustment for Acute Physiology and Chronic Health Evaluation II scores, Sequential Organ Failure Assessment scores, and C-reactive protein level, corticosteroid use and nosocomial infection. Dysglycemia and COVID-19 were each independent risk factors for mortality. The occurrence of hypoglycemia (< 70 mg/dL) during ICU stay was not associated with COVID-19. CONCLUSION Patients with severe acute respiratory syndrome due to COVID-19 had higher mortality and more frequent dysglycemia than patients with severe acute respiratory syndrome due to other causes. However, this association did not seem to be directly related to the SARS-CoV-2 infection.
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Affiliation(s)
- Rosângela Roginski Réa
- Internal Medicine Department, Endocrine Division (SEMPR), Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Rafaella Stradiotto Bernardelli
- Center for Studies and Research in Intensive Care Medicine (CEPETI), 366 Monte Castelo Street, Curitiba, Paraná, 82590-300, Brazil
- School of Medicine and Life Sciences, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
| | - Amanda Christina Kozesinski-Nakatani
- Center for Studies and Research in Intensive Care Medicine (CEPETI), 366 Monte Castelo Street, Curitiba, Paraná, 82590-300, Brazil
- ICU Department, Hospital Santa Casa de Curitiba, Curitiba, Paraná, Brazil
| | - Marcia Olandoski
- School of Medicine and Life Sciences, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
| | - Marcelo José Martins-Junior
- Center for Studies and Research in Intensive Care Medicine (CEPETI), 366 Monte Castelo Street, Curitiba, Paraná, 82590-300, Brazil
| | - Mirella Cristine Oliveira
- Center for Studies and Research in Intensive Care Medicine (CEPETI), 366 Monte Castelo Street, Curitiba, Paraná, 82590-300, Brazil
- ICU Department, Complexo Hospitalar do Trabalhador (CHT), Curitiba, Paraná, Brazil
| | - Álvaro Réa-Neto
- Internal Medicine Department, Endocrine Division (SEMPR), Federal University of Paraná, Curitiba, Paraná, Brazil.
- Center for Studies and Research in Intensive Care Medicine (CEPETI), 366 Monte Castelo Street, Curitiba, Paraná, 82590-300, Brazil.
- Internal Medicine Department, Federal University of Paraná, Curitiba, Paraná, Brazil.
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Oliveira MC, Scharan KO, Thomés BI, Bernardelli RS, Reese FB, Kozesinski-Nakatani AC, Martins CC, Lobo SMA, Réa-Neto Á. Diagnostic accuracy of a set of clinical and radiological criteria for screening of COVID-19 using RT-PCR as the reference standard. BMC Pulm Med 2023; 23:81. [PMID: 36894945 PMCID: PMC9997428 DOI: 10.1186/s12890-023-02369-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/22/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND The gold-standard method for establishing a microbiological diagnosis of COVID-19 is reverse-transcriptase polymerase chain reaction (RT-PCR). This study aimed to evaluate the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a set of clinical-radiological criteria for COVID-19 screening in patients with severe acute respiratory failure (SARF) admitted to intensive care units (ICUs), using reverse-transcriptase polymerase chain reaction (RT-PCR) as the reference standard. METHODS Diagnostic accuracy study including a historical cohort of 1009 patients consecutively admitted to ICUs across six hospitals in Curitiba (Brazil) from March to September, 2020. The sample was stratified into groups by the strength of suspicion for COVID-19 (strong versus weak) using parameters based on three clinical and radiological (chest computed tomography) criteria. The diagnosis of COVID-19 was confirmed by RT-PCR (referent). RESULTS With respect to RT-PCR, the proposed criteria had 98.5% (95% confidence interval [95% CI] 97.5-99.5%) sensitivity, 70% (95% CI 65.8-74.2%) specificity, 85.5% (95% CI 83.4-87.7%) accuracy, PPV of 79.7% (95% CI 76.6-82.7%) and NPV of 97.6% (95% CI 95.9-99.2%). Similar performance was observed when evaluated in the subgroups of patients admitted with mild/moderate respiratory disfunction, and severe respiratory disfunction. CONCLUSION The proposed set of clinical-radiological criteria were accurate in identifying patients with strong versus weak suspicion for COVID-19 and had high sensitivity and considerable specificity with respect to RT-PCR. These criteria may be useful for screening COVID-19 in patients presenting with SARF.
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Affiliation(s)
- Mirella Cristine Oliveira
- Center for Studies and Research in Intensive Care Medicine - CEPETI, Monte Castelo Street, 366, Curitiba, Paraná, 82590-300, Brazil.,Complexo Hospitalar do Trabalhador (CHT), República Argentina Street, 4406, Curitiba, Paraná, 81050-000, Brazil
| | - Karoleen Oswald Scharan
- Center for Studies and Research in Intensive Care Medicine - CEPETI, Monte Castelo Street, 366, Curitiba, Paraná, 82590-300, Brazil
| | - Bruna Isadora Thomés
- Center for Studies and Research in Intensive Care Medicine - CEPETI, Monte Castelo Street, 366, Curitiba, Paraná, 82590-300, Brazil
| | - Rafaella Stradiotto Bernardelli
- Center for Studies and Research in Intensive Care Medicine - CEPETI, Monte Castelo Street, 366, Curitiba, Paraná, 82590-300, Brazil.,School of Medicine and Life Sciences, Pontifical Catholic University of Paraná, Imaculada Conceição Street, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Fernanda Baeumle Reese
- Center for Studies and Research in Intensive Care Medicine - CEPETI, Monte Castelo Street, 366, Curitiba, Paraná, 82590-300, Brazil.,Complexo Hospitalar do Trabalhador (CHT), República Argentina Street, 4406, Curitiba, Paraná, 81050-000, Brazil
| | - Amanda Christina Kozesinski-Nakatani
- Center for Studies and Research in Intensive Care Medicine - CEPETI, Monte Castelo Street, 366, Curitiba, Paraná, 82590-300, Brazil.,Hospital Santa Casa de Curitiba, Praça Rui Barbosa, 694, Curitiba, Paraná, 80010-030, Brazil
| | - Cintia Cristina Martins
- Center for Studies and Research in Intensive Care Medicine - CEPETI, Monte Castelo Street, 366, Curitiba, Paraná, 82590-300, Brazil.,Complexo Hospitalar do Trabalhador (CHT), República Argentina Street, 4406, Curitiba, Paraná, 81050-000, Brazil
| | - Suzana Margareth Ajeje Lobo
- Departament of Medicine, São José do Rio Preto Medical School, Brigadeiro Faria Lima avenue, 5416, São José do Rio Preto, São Paulo, 15090-000, Brazil
| | - Álvaro Réa-Neto
- Center for Studies and Research in Intensive Care Medicine - CEPETI, Monte Castelo Street, 366, Curitiba, Paraná, 82590-300, Brazil. .,Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, General Carneiro Street, 181, Curitiba, Paraná, 80060-900, Brazil.
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Réa-Neto Á, da Silva Júnior ED, Hassler G, Dos Santos VB, Bernardelli RS, Kozesinski-Nakatani AC, Martins-Junior MJ, Reese FB, Cosentino MB, Oliveira MC, Teive HAG. Epidemiological and clinical characteristics predictive of ICU mortality of patients with traumatic brain injury treated at a trauma referral hospital - a cohort study. BMC Neurol 2023; 23:101. [PMID: 36890473 PMCID: PMC9993710 DOI: 10.1186/s12883-023-03145-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/27/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) has substantial physical, psychological, social and economic impacts, with high rates of morbidity and mortality. Considering its high incidence, the aim of this study was to identify epidemiological and clinical characteristics that predict mortality in patients hospitalized for TBI in intensive care units (ICUs). METHODS A retrospective cohort study was carried out with patients over 18 years old with TBI admitted to an ICU of a Brazilian trauma referral hospital between January 2012 and August 2019. TBI was compared with other traumas in terms of clinical characteristics of ICU admission and outcome. Univariate and multivariate analyses were used to estimate the odds ratio for mortality. RESULTS Of the 4816 patients included, 1114 had TBI, with a predominance of males (85.1%). Compared with patients with other traumas, patients with TBI had a lower mean age (45.3 ± 19.1 versus 57.1 ± 24.1 years, p < 0.001), higher median APACHE II (19 versus 15, p < 0.001) and SOFA (6 versus 3, p < 0.001) scores, lower median Glasgow Coma Scale (GCS) score (10 versus 15, p < 0.001), higher median length of stay (7 days versus 4 days, p < 0.001) and higher mortality (27.6% versus 13.3%, p < 0.001). In the multivariate analysis, the predictors of mortality were older age (OR: 1.008 [1.002-1.015], p = 0.016), higher APACHE II score (OR: 1.180 [1.155-1.204], p < 0.001), lower GCS score for the first 24 h (OR: 0.730 [0.700-0.760], p < 0.001), greater number of brain injuries and presence of associated chest trauma (OR: 1.727 [1.192-2.501], p < 0.001). CONCLUSION Patients admitted to the ICU for TBI were younger and had worse prognostic scores, longer hospital stays and higher mortality than those admitted to the ICU for other traumas. The independent predictors of mortality were older age, high APACHE II score, low GCS score, number of brain injuries and association with chest trauma.
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Affiliation(s)
- Álvaro Réa-Neto
- Center for Studies and Research in Intensive Care Medicine (CEPETI), Monte Castelo Street, 366, Curitiba, Paraná, 82530-200, Brazil. .,Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, General Carneiro Street, 181, Curitiba, Paraná, 80060-900, Brazil.
| | | | - Gabriela Hassler
- Federal University of Paraná, General Carneiro Street, 181, Curitiba, Paraná, 80060-900, Brazil
| | - Valkiria Backes Dos Santos
- Center for Studies and Research in Intensive Care Medicine (CEPETI), Monte Castelo Street, 366, Curitiba, Paraná, 82530-200, Brazil
| | - Rafaella Stradiotto Bernardelli
- Center for Studies and Research in Intensive Care Medicine (CEPETI), Monte Castelo Street, 366, Curitiba, Paraná, 82530-200, Brazil.,School of Medicine and Life Sciences, Pontifical Catholic University of Paraná, Imaculada Conceição Street, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Amanda Christina Kozesinski-Nakatani
- Center for Studies and Research in Intensive Care Medicine (CEPETI), Monte Castelo Street, 366, Curitiba, Paraná, 82530-200, Brazil.,Hospital Santa Casa de Curitiba., Praça Rui Barbosa, 694, Curitiba, Paraná, 80010-030, Brazil
| | - Marcelo José Martins-Junior
- Center for Studies and Research in Intensive Care Medicine (CEPETI), Monte Castelo Street, 366, Curitiba, Paraná, 82530-200, Brazil
| | - Fernanda Baeumle Reese
- Center for Studies and Research in Intensive Care Medicine (CEPETI), Monte Castelo Street, 366, Curitiba, Paraná, 82530-200, Brazil.,Complexo Hospitalar do Trabalhador (CHT), República Argentina Street, 4406, Curitiba, Paraná, 81050-000, Brazil
| | - Mariana Bruinje Cosentino
- Center for Studies and Research in Intensive Care Medicine (CEPETI), Monte Castelo Street, 366, Curitiba, Paraná, 82530-200, Brazil.,Complexo Hospitalar do Trabalhador (CHT), República Argentina Street, 4406, Curitiba, Paraná, 81050-000, Brazil
| | - Mirella Cristine Oliveira
- Center for Studies and Research in Intensive Care Medicine (CEPETI), Monte Castelo Street, 366, Curitiba, Paraná, 82530-200, Brazil.,Complexo Hospitalar do Trabalhador (CHT), República Argentina Street, 4406, Curitiba, Paraná, 81050-000, Brazil
| | - Hélio Afonso Ghizoni Teive
- Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, General Carneiro Street, 181, Curitiba, Paraná, 80060-900, Brazil
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