Authors
Advisor(s)
Abstract(s)
Introdução: Casos de pneumonia organizativa (PO) associados à COVID-19 (doença causada pelo vírus SARS-CoV-2) têm sido descritos na literatura. Como a PO tem uma boa resposta à corticoterapia, alguns autores consideram que esta complicação poderá ser mais frequente do que previamente observado noutras doenças virais, o que poderá explicar os benefícios da corticoterapia na COVID-19.
Objetivos: Estabelecer a incidência de PO na COVID-19, identificar fatores de risco, avaliar o seu impacto no prognóstico e reportar diferentes esquemas terapêuticos.
Métodos: Estudo retrospetivo, referente ao período de março de 2020 a fevereiro de 2021, foi conduzido no serviço de medicina intensiva de um hospital terciário. O diagnóstico de PO foi efetuado com base em achados tomodensitométricos compatíveis.
Resultados: Foram incluídos 377 doentes com COVID-19, 44,3% do quais foram diagnosticados com PO. Não se registaram diferenças significativas nas características dos doentes com e sem PO à admissão. O diagnóstico de PO ocorreu 14 dias (Intervalo Interquartil- IIQ: 7-22) após os sintomas iniciais e 95,25% dos doentes foram tratados com metilprednisolona. Apesar de nos doentes com PO a ventilação mecânica invasiva (VMI) ser mais frequente (66,1% vs. 82,0%, p< 0,01), o tempo desde o início dos sintomas até esta foi maior (9 [IIQ: 6-13] vs. 12 [IIQ: 8-15] dias, p= 0,006). A duração de VMI, frequência de complicações e duração de internamento foram também maiores nos doentes com PO (respetivamente; 11 [IIQ: 5-20] vs. 21 [IIQ: 11-37] dias, p< 0,001; 47,6% vs. 78,44%, p< 0,001 e 9 [IIQ: 4-19] vs. 21 [IIQ: 12-42] dias, p< 0,001), ainda que sem impacto na mortalidade em UCI (31,0 % vs. 28,74%, p=0,642).
Conclusão: Verificamos uma elevada incidência de PO em doentes com COVID-19. Este diagnóstico associou-se a um aumento da duração de internamento, necessidade e duração de VMI, e complicações. Mais estudos são necessários para caracterizar esta complicação.
Background: Organizing pneumonia (OP) has been increasingly reported in Coronavirus Disease 2019 (COVID-19). Since OP usually has a good response to corticosteroids, some hypothesize that secondary OP in COVID-19 could explain the survival benefit with corticosteroids observed in COVID-19. Objectives: To establish the incidence of OP in COVID-19, identify risk factors, assess its impact on prognosis and report different treatment regimens. Methods: A single-center retrospective study was conducted in a tertiary university hospital. Data was collected from patients requiring intensive care unit (ICU) admission between March 2020 and February 2021. OP was defined according to computed tomography findings. Main Results: We included 377 COVID-19 patients and in 44,3% of those (n=167) OP was diagnosed. The diagnosis occurred 14 days (IQR: 7-22) following initial symptoms and 95,25% (n=159) received treatment with methylprednisolone. There were no differences between OP and non-OP patients regarding clinical and demographic characteristics at ICU admission. Although OP patients more frequently underwent invasive mechanical ventilation (IMV) (66,1% vs. 82,0%, p< 0,01) and the time from symptoms until IMV was longer (9 [Interquartile Range - IQR: 6-13] vs. 12 [IQR: 8-15] days, p= 0,006). Remarkably, duration of IMV, ICU complications and length of stay (LOS) were also increased in OP (respectively; 11 [IQR: 5-20] vs. 21 [IQR: 11-37] days, p< 0,001; 47,6% vs. 78,44%, p< 0,001 and 9 [IQR: 4-19] vs. 21 [IQR: 12-42] days, p< 0,001), even though no differences in ICU mortality (31,0 % vs 28,74%, p=0,642) were observed. Conclusions: We recorded a high incidence of OP among severe COVID-19 patients. The diagnosis was associated with a longer ICU LOS, increased need and duration of IMV and a higher rate of ICU complications. Nonetheless, no differences regarding all-cause mortality were observed. Further studies are needed to characterize this condition.
Background: Organizing pneumonia (OP) has been increasingly reported in Coronavirus Disease 2019 (COVID-19). Since OP usually has a good response to corticosteroids, some hypothesize that secondary OP in COVID-19 could explain the survival benefit with corticosteroids observed in COVID-19. Objectives: To establish the incidence of OP in COVID-19, identify risk factors, assess its impact on prognosis and report different treatment regimens. Methods: A single-center retrospective study was conducted in a tertiary university hospital. Data was collected from patients requiring intensive care unit (ICU) admission between March 2020 and February 2021. OP was defined according to computed tomography findings. Main Results: We included 377 COVID-19 patients and in 44,3% of those (n=167) OP was diagnosed. The diagnosis occurred 14 days (IQR: 7-22) following initial symptoms and 95,25% (n=159) received treatment with methylprednisolone. There were no differences between OP and non-OP patients regarding clinical and demographic characteristics at ICU admission. Although OP patients more frequently underwent invasive mechanical ventilation (IMV) (66,1% vs. 82,0%, p< 0,01) and the time from symptoms until IMV was longer (9 [Interquartile Range - IQR: 6-13] vs. 12 [IQR: 8-15] days, p= 0,006). Remarkably, duration of IMV, ICU complications and length of stay (LOS) were also increased in OP (respectively; 11 [IQR: 5-20] vs. 21 [IQR: 11-37] days, p< 0,001; 47,6% vs. 78,44%, p< 0,001 and 9 [IQR: 4-19] vs. 21 [IQR: 12-42] days, p< 0,001), even though no differences in ICU mortality (31,0 % vs 28,74%, p=0,642) were observed. Conclusions: We recorded a high incidence of OP among severe COVID-19 patients. The diagnosis was associated with a longer ICU LOS, increased need and duration of IMV and a higher rate of ICU complications. Nonetheless, no differences regarding all-cause mortality were observed. Further studies are needed to characterize this condition.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Keywords
SARS-CoV-2 COVID-19 Pneumonia organizativa secundária Corticosteróides