Fatores preditivos para evolução grave do paciente com COVID-19 / Predictive factors for severe evolution in patient with COVID-19

Lucas Antônio Garcia de Carvalho, Abner Fernandes da Silva, Anna Luiza Campos de Castro, Bruno Severo de Castro Lippe, Felipe Yoneda Reyes, Gabriel Yoshiaki Hata, Isabella de Moura Magalhães, Marina Mattuella Debenetti, Matheus Lorenzetti Peron, Victório de Moura Magalhães

Abstract


Objetivo: Discutir através de uma revisão da literatura, as principais alterações ao exame físico, exames laboratoriais e de imagem que sugerem uma evolução desfavorável para pacientes acometidos pela COVID-19. Revisão bibliográfica: A avaliação clínica do paciente evidenciou febre, tosse e dispneia como os principais achados nos pacientes acometidos pela COVID-19, sendo a dispneia o único associado à evolução grave. Os exames de imagem estudados na estratificação de risco desses doentes são TC de tórax e Raio-X de tórax, sendo o primeiro relevante quanto ao prognóstico quando há presença de achados que incluem padrão tomográfico em vidro fosco, broncograma aéreo e espessamento de septo interlobular. Quanto aos exames laboratoriais, alterações hematológicas, bioquímicas, marcadores teciduais e de resposta inflamatória sistêmica foram estudadas, com destaque para a diminuição da hemoglobina, a leucocitose neutrofílica, a linfopenia, a plaquetopenia, aumento de ureia e creatinina, o aumento de biomarcadores cardíacos, AST, ALT, BT, bem como a elevação do D-dímero, do PCT, do LDH e citocinas (IL-6 e TNF- α). Conclusão: Foi possível evidenciar a existência de fatores preditivos para evolução grave da COVID-19. Dentre esses, achados ao exame clínico, em exames de imagem e em exames laboratoriais fizerem-se presentes.


Keywords


SARS-CoV-2, COVID-19, fatores de risco, biomarcadores, prognóstico

References


AL-ANI, F.; CHEHADE, S.; LAZO-LANGNER, A. Thrombosis risk associated with COVID-19 infection. A scoping review. Thrombosis Research, v. 192, p. 152–160, 2020.

BAO, C. et al. Coronavirus disease 2019 (COVID-19) CT findings: a systematic review and meta-analysis. Journal of the American College of Radiology, v. 17, n. 6, p. 701, 2020.

CHENG, Z. J; SHAN J. 2019 Novel coronavirus: where we are and what we know. Infection, v. 48, p. 155-163, 2020.

GUPTA, A. et al. Extrapulmonary manifestations of COVID-19. Nature medicine, v. 26, n. 7, p. 1017-1032, 2020.

GUPTA, S. et al. Factors associated with death in critically ill patients with coronavirus disease 2019 in the US. JAMA internal medicine, 2020.

HENRY, B. M. et al. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clinical Chemistry and Laboratory Medicine (CCLM), v. 58, n. 7, p. 1021-1028, 2020.

JAIN, V.; YUAN, J. Predictive symptoms and comorbidities for severe COVID-19 and intensive care unit admission: a systematic review and meta-analysis. International Journal of Public Health, v. 65, n. 5, p. 1, 2020.

LI, X. et al. Risk factors for severity and mortality in adult COVID-19 in patients in Wuhan. Journal of Allergy and Clinical Immunology, v. 146, n. 1, p. 110-118, 2020.

LIPPI, G.; PLEBANI, M. Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): a meta-analysis. Clinica chimica acta; international journal of clinical chemistry, v. 505, p. 190, 2020.

LIPPI, G.; PLEBANI, M.; HENRY, B. M.. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis. Clinica Chimica Acta, v. 506, p. 145–148, 2020.

MAO, R. et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. The lancet Gastroenterology & hepatology, vol. 5, n. 7, p. 667-678, 2020.

PARK, S. E. Epidemiology, virology, and clinical features of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2; Coronavirus Disease-19). Clinical and experimental pediatrics, v. 63, n. 4, p. 119, 2020.

RODRIGUEZ-MORALES, A. J. et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel medicine and infectious disease, v. 34, p. 101623, 2020.

ROTHAN, H. A.; BYRAREDDY, S. N. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. Journal of autoimmunity, v. 109, p. 102433, 2020.

WU, C. et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA internal medicine, v. 180, n. 7, p. 1-11, 2020.

XU, J. et al. Clinical course and predictors of 60-day mortality in 239 critically ill patients with COVID-19: a multicenter retrospective study from Wuhan, China. Critical Care, v. 24, n. 1, p. 1-11, 2020.

YE, Q.; WANG, B.; MAO, J. The pathogenesis and treatment of theCytokine Storm'in COVID-19. Journal of infection, v. 80, n. 6, p. 607-613, 2020.

ZHENG, Z. et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. Journal of Infection, v. 81, n. 2, p. 16–25, 2020.

ZHOU, F. et al. Clinical course and risk factors for mortality of adult in patients with COVID-19 in Wuhan, China: a retrospective cohort study. The lancet, v. 395, n. 10229, p. 1054–1062. 2020.

ZHU, J. et al. CT imaging features of 4121 patients with COVID‐19: A meta‐analysis. Journal of Medical Virology, v. 92, n. 7, p. 891-902, 2020.

ZHU, N. et al. A novel Coronavirus from patients with pneumonia in China, 2019. New England Journal of Medicine, v. 382, n. 8, p. 727-733, 2020.




DOI: https://doi.org/10.34119/bjhrv3n4-342

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