Critically ill COVID-19 patients in northeast Brazil: mortality predictors during the first and second waves including SAPS 3

Lázaro, Ana Paula Pires; Albuquerque, Polianna Lemos Moura Moreira; Meneses, Gdayllon Cavalcante; Zaranza, Marza de Sousa; Batista, Ana; Aragão, Natália Linhares Ponte; Aragão, Nilcyeli Linhares; Leitão, Alessandra Marjorye Maia; Carvalho, Marcelo Costa Freire de; Cavalcante, Maria Isabel de Alencar; Mota, Fábio Augusto Xerez; Daher, Elizabeth De Francesco; Martins, Alice Maria Costa; Silva, Geraldo Bezerra da

doi:10.1093/trstmh/trac046

Cited by 8 publications

(6 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…that patients with low predicted risk of death in reality have higher risk of dying than expected and vice versa in patients with high predicted risk of death. In contrast to a single-center study from Brazil, the present study found SAPS3 to have similar prognostic performance across waves of COVD-19 [ 25 ]. Despite different viral strains, different patient case mixes, pressure on ICU resources and evolving practice of care, SAPS3 performed equally well across the waves of COVID-19.…”

Section: Discussioncontrasting

confidence: 99%

Prior physical illness predicts death better than acute physiological derangement on intensive care unit admission in COVID-19: A Swedish registry study

Stattin,

Hultström,

Frithiof

et al. 2023

PLoS ONE

View full text Add to dashboard Cite

COVID-19 is associated with prolonged intensive care unit (ICU) stay and considerable mortality. The onset of persistent critical illness, defined as when prior illness predicts death better than acute physiological derangement, has not been studied in COVID-19. This national cohort study based on the Swedish Intensive Care Registry (SIR) included all patients admitted to a Swedish ICU due to COVID-19 from 6 March 2020 to 9 November 2021. Simplified Acute Physiology Score-3 (SAPS3) Box 1 was used as a measure of prior illness and Box 3 as a measure of acute derangement to evaluate the onset and importance of persistent critical illness in COVID-19. To compare predictive capacity, the area under receiver operating characteristic (AUC) of SAPS3 and its constituent Box 1 and 3 was calculated for 30-day mortality. In 7 969 patients, of which 1 878 (23.6%) died within 30 days of ICU admission, the complete SAPS3 score had acceptable discrimination: AUC 0.75 (95% CI 0.74 to 0.76) but showed under prediction in low-risk patients and over prediction in high-risk patients. SAPS3 Box 1 showed markedly better discrimination than Box 3 (AUC 0.74 vs 0.65, P<0,0001). Using custom logistic models, the difference in predictive performance of prior and acute illness was validated, AUC 0.76 vs AUC 0.69, p<0.0001. Prior physical illness predicts death in COVID-19 better than acute physiological derangement during ICU stay, and the whole SAPS3 score is not significantly better than just prior illness. The results suggests that COVID-19 may exhibit similarities to persistent critical illness immediately from ICU admission, potentially because of long median ICU length-of-stay. Alternatively, the variables in the acute physiological derangement model may not adequately capture the severity of illness in COVID-19.

show abstract

Section: Discussioncontrasting

confidence: 99%

Prior physical illness predicts death better than acute physiological derangement on intensive care unit admission in COVID-19: A Swedish registry study

Stattin,

Hultström,

Frithiof

et al. 2023

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…Patients in the second wave were less likely to need vasopressors and RRT during their ICU stay than patients in the first wave, as noted in other studies [39,40,48]. These results support the finding that better clinical outcomes in the second wave could be associated with younger age and less severe disease at ICU admission.…”

Section: Plos Onesupporting

confidence: 87%

Temporal trends of severity and outcomes of critically ill patients with COVID-19 after the emergence of variants of concern: A comparison of two waves

Freitas,

Costa,

Zimmermann

et al. 2024

PLoS ONE

View full text Add to dashboard Cite

Background The emergence of SARS-CoV-2 variants led to subsequent waves of COVID-19 worldwide. In many countries, the second wave of COVID-19 was marked by record deaths, raising the concern that variants associated with that wave might be more deadly. Our aim was to compare outcomes of critically-ill patients of the first two waves of COVID-19. Methods This retrospective cohort included critically-ill patients admitted between March-June 2020 and April-July 2021 in the largest academic hospital in Brazil, which has free-access universal health care system. We compared admission characteristics and hospital outcomes. The main outcome was 60‐day survival and we built multivariable Cox model based on a conceptual causal diagram in the format of directed acyclic graph (DAG). Results We included 1583 patients (1315 in the first and 268 in the second wave). Patients in the second wave were younger, had lower severity scores, used prone and non-invasive ventilatory support more often, and fewer patients required mechanical ventilation (70% vs 80%, p<0.001), vasopressors (60 vs 74%, p<0.001), and dialysis (22% vs 37%, p<0.001). Survival was higher in the second wave (HR 0.61, 95%CI 0.50–0.76). In the multivariable model, admission during the second wave, adjusted for age, SAPS3 and vaccination, was not associated with survival (aHR 0.85, 95%CI 0.65–1.12). Conclusions In this cohort study, patients with COVID-19 admitted to the ICU in the second wave were younger and had better prognostic scores. Adjusted survival was similar in the two waves, contrasting with record number of hospitalizations, daily deaths and health system collapse seen across the country in the second wave. Our findings suggest that the combination of the burden of severe cases and factors such as resource allocation and health disparities may have had an impact in the excess mortality found in many countries in the second wave.

show abstract

“…Some studies support the association between dialysis and elevated mortality [17, 18]. In addition, the correlation between elevated SAPS 3 and pulmonary and renal dysfunction in predicting mortality has been reported [19].…”

Section: Discussionmentioning

confidence: 95%

Endothelial Biomarkers in Critically Ill COVID-19 Patients: Potential Predictors of the Need for Dialysis

Zaranza,

Meneses,

Oriá

et al. 2023

Kidney Blood Press Res

View full text Add to dashboard Cite

Introduction: To evaluate the function of vascular biomarkers to predict need for hemodialysis in critically-ill patients with COVID-19. Methods: This is a prospective study with 58 critically-ill patients due to COVID-19 infection. Laboratory tests in general and vascular biomarkers, such as VCAM-1, Syndecan-1, Angiopoietin-1 and Angiopoeitin-2 were quantified on intensive care unit (ICU) admission. Results: There was a 40% death rate. VCAM and Ang-2/Ang-1 ratio on ICU admission were associated with need for hemodialysis. Vascular biomarkers (VCAM-1, Syndecan-1, angiopoetin-2/ anogiopoetin-1 ratio) were predictors of death and their cut-off values were useful to stratify patients with a worse prognosis. In the multivariate cox regression analysis with adjusted models, VCAM-1 [O.R. 1.13 (C.I. 95%: 1.01 - 1.27); p= 0.034] and Ang-2/Ang-1 ratio [O.R. 4.87 (C.I.95%: 1.732 - 13.719); p= 0.003] were associated with need for dialysis. Conclusion: Vascular biomarkers, mostly VCAM-1 and Ang-2/Ang-1 ratio, showed better efficiency to predict need for hemodialysis in critically-ill COVID-19 patients.

show abstract

Critically ill COVID-19 patients in northeast Brazil: mortality predictors during the first and second waves including SAPS 3

Cited by 8 publications

References 27 publications

Prior physical illness predicts death better than acute physiological derangement on intensive care unit admission in COVID-19: A Swedish registry study

Prior physical illness predicts death better than acute physiological derangement on intensive care unit admission in COVID-19: A Swedish registry study

Temporal trends of severity and outcomes of critically ill patients with COVID-19 after the emergence of variants of concern: A comparison of two waves

Endothelial Biomarkers in Critically Ill COVID-19 Patients: Potential Predictors of the Need for Dialysis

Contact Info

Product

Resources

About