Cambios en las características clínicas y desenlaces de pacientes hospitalizados por COVID-19 durante dos años de pandemia: experiencia en un hospital venezolano

María C. Arvelo; María Montes de oca; Laura Sánchez-Traslaviña; Flor H. Pujol; Rossana C. Jaspe; Isabel C. Silva; Irene Stulin; Gabriela Blanco; Jennireth Quevedo; Nathalia Valera; Irene Papa; Santiago Bacci; Fátima de Abreu; Héctor Villaroel; Juan C. Catari; José L. Lopez; Brigitte Moran; Claudio Cárdenas; Saverio Santucci; José L. Viloria; Eleonora García; Jerry Gómez; Antonio Martinelli; Manuel Guzmán

doi:10.17843/rpmesp.2022.393.11195

Autores/as

María C. Arvelo Hospital Centro Médico de Caracas, Caracas, Venezuela; Universidad Central de Venezuela (UCV), Facultad de Medicina, Caracas, Venezuela https://orcid.org/0000-0002-6412-0357
María Montes de oca Hospital Centro Médico de Caracas, Caracas, Venezuela; Universidad Central de Venezuela (UCV), Facultad de Medicina, Caracas, Venezuela https://orcid.org/0000-0002-5274-7574
Laura Sánchez-Traslaviña Hospital Centro Médico de Caracas, Caracas, Venezuela https://orcid.org/0000-0003-1975-6257
Flor H. Pujol Laboratorio de Virología Molecular, Centro de Microbiología y Biología Celular (CMBC), Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas, Venezuela https://orcid.org/0000-0001-6086-6883
Rossana C. Jaspe Laboratorio de Virología Molecular, Centro de Microbiología y Biología Celular (CMBC), Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas, Venezuela https://orcid.org/0000-0002-4816-1378
Isabel C. Silva Hospital Centro Médico de Caracas, Caracas, Venezuela https://orcid.org/0000-0001-8963-8980
Irene Stulin Hospital Centro Médico de Caracas, Caracas, Venezuela https://orcid.org/0000-0002-3408-8552
Gabriela Blanco Hospital Centro Médico de Caracas, Caracas, Venezuela https://orcid.org/0000-0003-4110-4482
Jennireth Quevedo Hospital Centro Médico de Caracas, Caracas, Venezuela https://orcid.org/0000-0003-0467-2181
Nathalia Valera Hospital Centro Médico de Caracas, Caracas, Venezuela https://orcid.org/0000-0003-0242-2824
Irene Papa Hospital Centro Médico de Caracas, Caracas, Venezuela https://orcid.org/0000-0001-9981-9638
Santiago Bacci Hospital Centro Médico de Caracas, Caracas, Venezuela https://orcid.org/0000-0003-1733-6793
Fátima de Abreu Hospital Centro Médico de Caracas, Caracas, Venezuela https://orcid.org/0000-0002-5780-4064
Héctor Villaroel Hospital Centro Médico de Caracas, Caracas, Venezuela https://orcid.org/0000-0002-0183-0167
Juan C. Catari Hospital Centro Médico de Caracas, Caracas, Venezuela https://orcid.org/0000-0002-9224-244X
José L. Lopez Hospital Centro Médico de Caracas, Caracas, Venezuela https://orcid.org/0000-0002-6860-9002
Brigitte Moran Hospital Centro Médico de Caracas, Caracas, Venezuela https://orcid.org/0000-0002-0402-4419
Claudio Cárdenas Hospital Centro Médico de Caracas, Caracas, Venezuela https://orcid.org/0000-0003-1008-0369
Saverio Santucci Hospital Centro Médico de Caracas, Caracas, Venezuela https://orcid.org/0000-0001-9397-2455
José L. Viloria Hospital Centro Médico de Caracas, Caracas, Venezuela https://orcid.org/0000-0001-5654-3010
Eleonora García Hospital Centro Médico de Caracas, Caracas, Venezuela https://orcid.org/0000-0003-1239-6965
Jerry Gómez Hospital Centro Médico de Caracas, Caracas, Venezuela https://orcid.org/0000-0002-0958-9777
Antonio Martinelli Hospital Centro Médico de Caracas, Caracas, Venezuela https://orcid.org/0000-0002-8841-7577
Manuel Guzmán Hospital Centro Médico de Caracas, Caracas, Venezuela https://orcid.org/0000-0003-1965-1826

DOI:

https://doi.org/10.17843/rpmesp.2022.393.11195

Palabras clave:

COVID-19, SARS-CoV-2, Infección por SARS-CoV-2, Unidad de Cuidados Intensivos, Mortalidad Intrahospitalaria

Resumen

Objetivos. Determinar los cambios en las características clínicas y desenlaces intrahospitalarios de los pacientes hospitalizados por COVID-19 en un hospital privado de Caracas durante dos años de pandemia. Materiales y métodos. Estudio retrospectivo, observacional, de pacientes hospitalizados por COVID-19. Se investigó la correspondencia entre las olas de ingresos hospitalarios con las variantes circulantes del SARS-CoV-2 en la población general del Distrito Capital y estado Miranda. Resultados. Se incluyeron 1025 pacientes (569 hombres y 456 mujeres), con edad promedio de 62,9 DE: 16,2 años. Cuatro olas de ingresos hospitalarios fueron identificadas: primera (marzo-noviembre 2020) 150/1025 (14,6%) casos; segunda (diciembre-2020 a mayo-2021) 415/1025 (40,5%) casos; tercera (junio-diciembre 2021) 344/1025 (33,6%) casos; cuarta (enero-febrero 2022) 116/1025 (11,3%) casos. La edad promedio fue mayor en la cuarta ola (primera 64,0±15,7, segunda 61,4±15,8, tercera 62,1±16,5, y cuarta ola 68,5±16,4), mientras que la proporción de pacientes masculinos (primera 66,7%, segunda 58,8%, tercera 50,3%, y cuarta 44,8%), los pacientes con enfermedad grave-crítica (primera 65,3%, segunda 57%, tercera 51,7% y cuarta 44,8%), la estadía intrahospitalaria (primera 9,1±6,0, segunda 9,0±7,3, tercera 8,8±7,7, y cuarta 6,9±5,0 días), los ingresos a la UCI (primera 23,3%, segunda 15,7%, tercera 14,0%, y cuarta 11,2%; p=0,027) y la mortalidad (primera 21.8%, segunda 10,7%, tercera 9,1%, y cuarta 7,1%; p<0,001) disminuyeron progresivamente con el tiempo. Conclusiones. Los resultados muestran menor frecuencia de casos severos y mejoría de los desenlaces intrahospitalarios en dos años de pandemia. Es probable que los cambios en las variantes circulantes, las mejoras del manejo de la enfermedad y la vacunación hayan influido sobre estos resultados.

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Referencias

Universidad Central de Venezuela. Centro de Estudios del Desarrollo (CENDES) [Internet]. 2022. Disponible en: http://www.ucv.ve/cendes.

World Health Organization. COVID-19: variants. Tracking SARSCoV-2 variants. [Internet]. 2022 [citado el 2 de marzo del 2022] Disponible en: https://www.who.int/activities/tracking-SARS-CoV-2-variants.

Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ, et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet. 2020;395(10242):1973-1987. doi: 10.1016/S0140-6736(20)31142-9.

Rader B, White LF, Burns MR, Chen J, Brilliant J, Cohen J, et al. Mask-wearing and control of SARS-CoV-2 transmission in the USA: a cross-sectional study. Lancet Digit Health. 2021;3(3):e148-e157. doi: 10.1016/S2589-7500(20)30293-4.

Andrejko KL, Pry JM, Myers JF, Fukui N, DeGuzman JL, Openshaw J, et al. Effectiveness of Face Mask or Respirator Use in Indoor Public Settings for Prevention of SARS-CoV-2 Infection - California, February-December 2021. MMWR Morb Mortal Wkly Rep. 2022;71(6):212-216. doi: 10.15585/mmwr.mm7106e1.

Haas EJ, Angulo FJ, McLaughlin JM, Anis E, Singer SR, Khan F, et al. Impact and effectiveness of mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID-19 cases, hospitalisations, and deaths following a nationwide vaccination campaign in Israel: an observational study using national surveillance data. Lancet. 2021;397(10287):1819-1829. doi: 10.1016/S0140-6736(21)00947-8.

Tenforde MW, Self WH, Adams K, Gaglani M, Ginde AA, McNeal T, et al. Association Between mRNA Vaccination and COVID-19 Hospitalization and Disease Severity. JAMA. 2021;326(20):2043-2054. doi: 10.1001/jama.2021.19499.

Accorsi EK, Britton A, Fleming-Dutra KE, Smith ZR, Shang N, Derado G, et al. Association Between 3 Doses of mRNA COVID-19 Vaccine and Symptomatic Infection Caused by the SARS-CoV-2 Omicron and Delta Variants. JAMA. 2022;327(7):639-651. doi: 10.1001/jama.2022.0470.

Iftimie S, López-Azcona AF, Vallverdú I, Hernández-Flix S, de Febrer G, Parra S, et al. First and second waves of coronavirus disease-19: A comparative study in hospitalized patients in Reus, Spain. PLoS One. 2021;16(3):e0248029. doi: 10.1371/journal.pone.0248029.

Roth GA, Emmons-Bell S, Alger HM, Bradley SM, Das SR, de Lemos JA, et al. Trends in Patient Characteristics and COVID-19 In-Hospital Mortality in the United States During the COVID-19 Pandemic. JAMA Netw Open. 2021;4(5):e218828. doi: 10.1001/jamanetworkopen.2021.8828.

Budweiser S, Baş Ş, Jörres RA, Engelhardt S, Thilo C, Delius SV, et al. Comparison of the First and Second Waves of Hospitalized Patients With SARS-CoV-2. Dtsch Arztebl Int. 2021;118(18):326-27. doi: 10.3238/arztebl.m2021.0215.

Xu H, Garcia-Ptacek S, Annetorp M, Cederholm T, Engel G, Engström M, et al. Decreased Mortality Over Time During the First Wave in Patients With COVID-19 in Geriatric Care: Data From the Stockholm GeroCovid Study. J Am Med Dir Assoc. 2021;22(8):1565-1573.e4. doi: 10.1016/j.jamda.2021.06.005.

Aznar-Gimeno R, Paño-Pardo JR, Esteban LM, Labata-Lezaun G, Esquillor-Rodrigo MJ, Lanas A, et al. Changes in severity, mortality, and virus genome among a Spanish cohort of patients hospitalized with SARSCoV-2. Sci Rep. 2021;11(1):18844. doi: 10.1038/s41598-021-98308-x.

Zuil M, Benítez ID, Cabo-Gambín R, Manzano Senra C, Moncusí-Moix A, Gort-Paniello C, et al. Clinical management and outcome differences between first and second waves among COVID-19 hospitalized patients: A regional prospective observational cohort. PLoS One. 2021;16(10):e0258918. doi: 10.1371/journal.pone.0258918.

Carbonell R, Urgelés S, Rodríguez A, Bodí M, Martín-Loeches I, Solé-Violán J, et al. Mortality comparison between the first and second/third waves among 3,795 critical COVID-19 patients with pneumonia admitted to the ICU: A multicentre retrospective cohort study. Lancet Reg Health Eur. 2021;11:100243. doi: 10.1016/j.lanepe.2021.100243.

Oda Y, Shimada M, Shiraishi S, Kurai O. Treatment and outcome of COVID-19 patients in a specialized hospital during the third wave: advance of age and increased mortality compared with the first/second waves. JA Clin Rep. 2021;7(1):85. doi: 10.1186/s40981-021-00489-x.

Meschiari M, Cozzi-Lepri A, Tonelli R, Bacca E, Menozzi M, Franceschini E, et al. First and second waves among hospitalised patients with COVID-19 with severe pneumonia: a comparison of 28-day mortality over the 1-year pandemic in a tertiary university hospital in Italy. BMJ Open. 2022;12(1):e054069. doi: 10.1136/bmjopen-2021-054069.

Zeiser FA, Donida B, da Costa CA, Ramos GO, Scherer JN, Barcellos NT, et al. First and second COVID-19 waves in Brazil: A cross-sectional study of patients’ characteristics related to hospitalization and in-hospital mortality. Lancet Reg Health Am. 2022;6:100107. doi: 10.1016/j.lana.2021.100107.

Moreno-Torres V, Muñoz-Serrano A, Calderón-Parra J, Mills-Sánchez P, Pintos-Pascual I, Rodríguez-Olleros C, et al. Mortality by COVID-19 Before Vaccination - One Year Experience of Hospitalized Patients in Madrid. Int J Infect Dis. 2022;116:339-43. doi: 10.1016/j.ijid.2022.01.043.

Norma COVENIN 2339:87. Clínicas, policlinicas, institutos u hospitales privados. Clasificación [Internet]. 2019/06. Disponible en: https://pandectasdigital.blogspot.com/2019/06/norma-covenin-233987-clinicas.html.

International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) [Internet]. 2022. Disponible en: https://isaric.tghn.org/.

World Health Organization. Clinical management of COVID-19 (Interim Guidance) World Health Organization. [Internet]. 2020 [citado el 27 de mayo del 2020].; Disponible en: https://apps.who.int/iris/handle/10665/332196.

National Institutes of Health. COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines [Internet]. 2022 [citado el 01 de junio del 2022]. Disponible en: https://www.covid19treatmentguidelines.nih.gov/.

Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008;246(3):697-722. doi: 10.1148/radiol.2462070712.

Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time Course of Lung Changes at Chest CT during Recovery from Coronavirus Disease 2019 (COVID-19). Radiology. 2020;295(3):715-21. doi: 10.1148/radiol.2020200370.

Montes de Oca M, García E, Sánchez-Traslaviña L, Gutiérrez-Correia F, Stulin I, Blanco G, et al. Características tomográficas de las lesiones pulmonares en pacientes hospitalizados con COVID-19 y su valor pronóstico. Invest Clin. 2021;62(4):357-70. doi: 10.22209/IC.v62n4a06.

Loureiro CL, Jaspe RC, D Angelo P, Zambrano JL, Rodriguez L, Alarcon V, et al. SARS-CoV-2 genetic diversity in Venezuela: Predominance of D614G variants and analysis of one outbreak. PLoS One. 2021;16(2):e0247196. doi: 10.1371/journal.pone.0247196.

Jaspe RC, Loureiro CL, Sulbaran Y, Moros ZC, D’Angelo P, Rodríguez L, et al. Introduction and rapid dissemination of SARS-CoV-2 Gamma Variant of Concern in Venezuela. Infect Genet Evol. 2021;96:105147. doi: 10.1016/j.meegid. 2021.105147.

Jaspe RC, Zambrano JL, Hidalgo M, Sulbarán Y, Loureiro CL, Moros ZC, et al. Detection of the Omicron variant of SARS- CoV-2 by restriction analysis targeting the mutations K417N and N440K of the spike protein. Invest Clin. 2022;63(1):92-9. doi: 10.54817/IC.v63n1a08.

Jaspe RC, Loureiro CL, Sulbaran Y, Moros ZC, D’Angelo P, Hidalgo M, et al. Description of a One-Year Succession of Variants of Interest and Concern of SARS-CoV-2 in Venezuela. Viruses. 2022;14(7):1378. doi.org/10.3390/v14071378.

Meo SA, Meo AS, Al-Jassir FF, Klonoff DC. Omicron SARS-CoV-2 new variant: global prevalence and biological and clinical characteristics. Eur Rev Med Pharmacol Sci. 2021;25(24):8012-18. doi: 10.26355/eurrev_202112_27652.

Luliano AD, Brunkard JM, Boehmer TK, Peterson E, Adjei S, Binder AM, et al. Trends in Disease Severity and Health Care Utilization During the Early Omicron Variant Period Compared with Previous SARS-CoV-2 High Transmission Periods - United States, December 2020-January 2022. MMWR Morb Mortal Wkly Rep. 2022;71(4):146-52. doi: 10.15585/mmwr.mm7104e4.

Abdullah F, Myers J, Basu D, Tintinger G, Ueckermann V, Mathebula M, et al. Decreased severity of disease during the first global omicron variant covid-19 outbreak in a large hospital in tshwane, south africa. Int J Infect Dis. 2022;116:38-42. doi: 10.1016/j.ijid.2021.12.357.

Modes ME, Directo MP, Melgar M, Johnson LR, Yang H, Chaudhary P, et al. Clinical Characteristics and Outcomes Among Adults Hospitalized with Laboratory-Confirmed SARS-CoV-2 Infection During Periods of B.1.617.2 (Delta) and B.1.1.529 (Omicron) Variant Predominance - One Hospital, California, July 15-September 23, 2021, and December 21, 2021-January 27, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(6):217-23. doi: 10.15585/mmwr.mm7106e2.

Wang L, Berger NA, Kaelber DC, Davis PB, Volkow ND, Xu R. COVID infection rates, clinical outcomes, and racial/ethnic and gender disparities before and after Omicron emerged in the US. medRxiv. 2022;2022.02.21.22271300. doi: 10.1101/2022.02.21.22271300.