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. 2022 May;118(5):927-934.
doi: 10.36660/abc.20210349.

Impact of High Cardiovascular Risk on Hospital Mortality in Intensive Care Patients Hospitalized for COVID-19

[Article in English, Portuguese]
Bruno Ferraz de Oliveira Gomes  1   2 , João Luiz Fernandes Petriz  1 , Iliana Regina Ribeiro Menezes  1 , Anny de Sousa Azevedo  1 , Thiago Moreira Bastos da Silva  2 , Valdilene Lima Silva  1 , Leticia de Sousa Peres  1 , David Fernandes Pedro Pereira  1 , Giovanni Possamai Dutra  1   3 , Suzanna Andressa Morais de Paula  1 , Bárbara Ferreira da Silva Mendes  1 , Plinio Resende do Carmo Junior  1   2 , Basilio de Bragança Pereira  2 , Gláucia Maria Moraes de Oliveira  2
Affiliations

Impact of High Cardiovascular Risk on Hospital Mortality in Intensive Care Patients Hospitalized for COVID-19

[Article in English, Portuguese]
Bruno Ferraz de Oliveira Gomes et al. Arq Bras Cardiol. 2022 May.

Abstract
in English, Portuguese

Background: Some studies have shown a higher prevalence of deaths in patients with cardiovascular risk factors (CRF) during hospitalization for COVID-19.

Objectives: To assess the impact of high cardiovascular risk in patients hospitalized in intensive care for COVID-19.

Methods: Retrospective study with patients admitted to an intensive care unit, with a diagnosis of COVID-19 confirmed by RT-PCR, and with at least one troponin measurement during hospitalization. The criteria for defining high cardiovascular risk (HCR) patients were: history of established cardiovascular disease (myocardial infarction, stroke, or peripheral arterial disease), diabetes, chronic kidney disease with clearance < 60ml/min, or presence of 3 CRFs (hypertension, smoking, dyslipidemia, or age > 65 years). The primary outcome of this study is all-cause in-hospital mortality. P<0.05 was considered significant.

Results: This study included 236 patients, mean age = 61.14±16.2 years, with 63.1% men, 55.5% hypertensive, and 33.1% diabetic; 47.4% of the patients also presented HCR. A significant increase in mortality was observed as the number of risk factors increased (0 FRC: 5.9%; 1 FRC: 17.5%; 2 FRC: 32.2% and ≥3 FRC: 41.2%; p=0.001). In the logistic regression adjusted for severity (SAPS3 score), the HCR and myocardial injury group had a higher occurrence of in-hospital mortality (OR 40.38; 95% CI 11.78-138.39). Patients without HCR but with myocardial injury also exhibited a significant association with the primary outcome (OR 16.7; 95% CI 4.45-62.74).

Conclusion: In patients hospitalized in intensive care for COVID-19, HCR impacts in-hospital mortality only in patients with myocardial injury.

Fundamento: Alguns estudos demonstraram uma maior prevalência de óbitos em portadores de fatores de risco cardiovascular (FRC) durante internação por COVID-19.

Objetivos: Avaliar o impacto do alto risco cardiovascular em pacientes internados em terapia intensiva por COVID-19.

Métodos: Estudo retrospectivo com pacientes admitidos em terapia intensiva, com diagnóstico confirmado de COVID-19 por RT-PCR e com pelo menos uma dosagem de troponina durante a internação. Os critérios para definição de paciente de alto risco cardiovascular (ARC) foram: histórico de doença cardiovascular estabelecida (infarto, AVC ou doença arterial periférica), diabetes, doença renal crônica com clearance < 60ml/min ou presença de 3 FRC (hipertensão, tabagismo, dislipidemia ou idade > 65 anos). O desfecho primário deste estudo é mortalidade hospitalar por todas as causas. P<0,05 foi considerado significativo.

Resultados: Foram incluídos 236 pacientes, média de idade= 61,14±16,2 anos, com 63,1% homens, 55,5% hipertensos e 33,1% diabéticos. Um total de 47,4% dos pacientes apresentavam ARC. Observou-se um aumento significativo da mortalidade conforme aumento do número de fatores de risco (0 FRC: 5,9%; 1 FRC: 17,5%; 2 FRC: 32,2% e ≥3 FRC: 41,2%; p=0,001). Na regressão logística ajustada para gravidade (escore SAPS3), o grupo de alto risco cardiovascular e troponina elevada apresentou maior ocorrência de mortalidade hospitalar (OR 40,38; IC95% 11,78-138,39). Pacientes sem alto risco cardiovascular, mas com troponina elevada, também exibiram associação significativa com o desfecho primário (OR 16,7; IC95% 4,45-62,74).

Conclusão: Em pacientes internados em terapia intensiva por COVID-19, a presença de alto risco cardiovascular afeta a mortalidade hospitalar somente em pacientes que apresentaram elevação de troponina.

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Conflict of interest statement

Potencial conflito de interesse

Não há conflito com o presente artigo

Figures

Figura 1
Figura 1. – Fluxo de inclusão de pacientes no estudo.
Figura 2
Figura 2. – Evolução do desfecho primário e secundário conforme o número de fatores de risco, realizada pelo teste qui-quadrado.
Figura 3
Figura 3. – Ocorrência do desfecho primário nos subgrupos determinados conforme risco cardiovascular e elevação de troponina. Comparação entre grupos realizada com o teste de qui-quadrado. ARC: alto risco cardiovascular.
Figura 4
Figura 4. – Árvore de Classificação para o desfecho primário.
Figure 1
Figure 1. – Flow chart of inclusion of patients in the study.
Figure 2
Figure 2. – Evolution of the primary and secondary outcome according to the number of risk factors, performed using the chi-square test.
Figure 3
Figure 3. – Occurrence of the primary outcome in the subgroups determined according to cardiovascular risk and troponin elevation. Comparison between groups performed with the chi-square test. HRC: high cardiovascular risk.
Figure 4
Figure 4. – Classification tree for the primary outcome.
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