Reporte de 4 casos COVID-19 hospitalizados en unidad de cuidados intensivos en una institución hospitalaria en Barranquilla, Colombia

Palabras clave: Palabras clave: Coronavirus, COVID-19, Sars-CoV-2, injuria renal aguda, falla multisistémica, cloroquina, azitromicina, UCI.

Resumen

Objetivo: Presentar una serie de casos de COVID-19 con requerimiento de ingreso a Unidad de Cuidados Intensivos.

Métodos: La información fue tomada de las historias clínicas, y su evaluación y diagnóstico fue realizado mediante estudios paraclínicos en sangre, orina, PCR e imágenes diagnósticas en 4 pacientes con diferentes comorbilidades y nexo epidemiológico presente para desarrollo de la enfermedad. El caso 1 desarrolló falla orgánica múltiple, incluyendo injuria renal aguda con una estancia en UCI de 4 dias antes de su fallecimiento, mientras los casos 2, 3 y 4 tuvieron una evolución favorable y fueron dados de alta de UCI. Los cuatro casos fueron manejados con cloroquina 300 mg via oral cada 12 horas y azitromicina 1 gr via oral cada 24 horas durante 5 dias sin complicaciones ni toxicidad asociada.

Conclusiones:  Se requieren estudios multicéntricos rápidos que orienten científicamente hacia un mejor abordaje diagnóstico y manejo, en el contexto de una enfermedad con un comportamiento clínico-epidemiologico que debe estudiarse en profundidad y que probablemente cobrará muchas vidas, ademas, debido a la ausencia de pruebas diagnósticas rápidas, la utilización de una clasificación basada en la severidad de lesiones radiológicas llamada CO-RADS (Covid-19 Imaging Reporting and Data System), podría ser de gran importancia para instalar de manera temprana los tratamientos farmacológicos disponibles y la asistencia respiratoria mecánica precoz.

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Referencias

Bibliografía
1. World Health Organization. Director-General’s remarks at the media briefing on 2019-nCoV on 11 February 2020. https://www.who.int/dg/speeches/detail/who-director-general-s-remarks-at-the-media-briefing-on-2019-ncov-on-11-february-2020. 2020.
2. Zaki AM, Van Boheemen S, Bestebroer TM, Osterhaus ADME, Fouchier RAM. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med. 2012;367(19):1814–20.
3. Wilde AH de, Snijder EJ, Kikkert M, Van MJ. Host Factors in Coronavirus Replication. Curr Top Microbiol Immunol [Internet]. 2017;37:35. Available from: http://books.google.com/books?id=_DDwCqx6wpcC&printsec=frontcover&dq=unwritten+rules+of+phd+research&hl=&cd=1&source=gbs_api%255Cnpapers2://publication/uuid/48967E01-55F9-4397-B941-310D9C5405FA%255Cnhttp://medcontent.metapress.com/index/A65RM03P4874243N.pdf%255
4. Müller MA, Corman VM, Jores J, Meyer B, Younan M, Liljander A, et al. Mers coronavirus neutralizing antibodies in camels, eastern Africa, 1983–1997. Emerg Infect Dis. 2014;20(12):2093–5.
5. Organización Mundial de la Salud. Nuevo coronavirus - China. 2020.
6. Vardavas CI, Nikitara K. COVID-19 and smoking: A systematic review of the evidence. Tob Induc Dis. 2020;18(March):20.
7. Han R, Huang L, Jiang H, Dong J, Peng H, Zhang D. Early Clinical and CT Manifestations of Coronavirus Disease 2019 (COVID-19) Pneumonia. Am J Roentgenol. 2020;(1):1–6.
8. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA - J Am Med Assoc. 2020;323(11):1061–9.
9. Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. Jama [Internet]. 2020;1–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32250385
10. Grasselli G, Pesenti A, Cecconi M. Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy. JAMA - J Am Med Assoc. 2020;
11. Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases from the Chinese Center for Disease Control and Prevention. JAMA - J Am Med Assoc. 2020;2019:3–6.
12. Onder G, Rezza G, Brusaferro S. Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. Jama [Internet]. 2020;2019:2019–20. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32203977
13. Salud instituto nacional de. Coronavirus (COVID - 2019) en Colombia. 2020.
14. Smithuis F, Smithuis R. 32 cases of suspected COVID-19 Imaging findings and follow up. Radiology Assistant. 2020. p. https://radiologyassistant.nl/chest/covid-19-ct-fi.
15. World Health Organization (WHO). Coronavirus disease 2019 (COVID-19) Situation Report – 82. 2020.
16. Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, et al. Covid-19 in Critically Ill Patients in the Seattle Region — Case Series. N Engl J Med. 2020 Mar;NEJMoa2004500.
17. Liu Y, Yan L-M, Wan L, Xiang T-X, Le A, Liu J-M, et al. Viral dynamics in mild and severe cases of COVID-19. Lancet Infect Dis [Internet]. 2020;2019(20):2019–20. Available from: https://doi.org/10.1016/S1473-3099(20)30232-2
18. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet [Internet]. 2020;395(10229):1054–62. Available from: http://dx.doi.org/10.1016/S0140-6736(20)30566-3
19. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia. N Engl J Med. 2020;1199–207.
20. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506.
21. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet [Internet]. 2020;395(10229):1054–62. Available from: http://dx.doi.org/10.1016/S0140-6736(20)30566-3
22. Murthy S, Gomersall CD, Fowler RA. Care for Critically Ill Patients with COVID-19. JAMA - J Am Med Assoc. 2020;1–2.
23. Wang T, Du Z, Zhu F, Cao Z, An Y, Gao Y, et al. Comorbidities and multi-organ injuries in the treatment of COVID-19. Lancet [Internet]. 2020;395(10228):e52. Available from: http://dx.doi.org/10.1016/S0140-6736(20)30558-4
24. Panitchote A, Mehkri O, Hasting A, Hanane T, Demirjian S, Torbic H, et al. Factors associated with acute kidney injury in acute respiratory distress syndrome. Ann Intensive Care [Internet]. 2019;9(1). Available from: https://doi.org/10.1186/s13613-019-0552-5
25. Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020 Mar;(March).
26. Volunteers A-2019-nCoV, Li Z, Wu M, Guo J, Yao J, Liao X, et al. Caution on Kidney Dysfunctions of 2019-nCoV Patients. medRxiv. 2020;2020.02.08.20021212.
27. Bai HX, Hsieh B, Xiong Z, Halsey K, Choi JW, Tran TML, et al. Performance of radiologists in differentiating COVID-19 from viral pneumonia on chest CT. Radiology. 2020;200823.
28. Simpson S, Kay FU, Abbara S, Bhalla S, Chung JH, Chung M, et al. Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. Radiol Cardiothorac Imaging. 2020;2(2):e200152.
29. Colson P, Rolain J-M, Lagier J-C, Brouqui P, Raoult D. Chloroquine and hydroxychloroquine as available weapons to fight COVID-19. Int J Antimicrob Agents [Internet]. 2020;105932. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32145363
30. Yao X, Ye F, Zhang M, Cui C, Huang B, Niu P, et al. In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Main point : Hydroxychloroquine was found to be more potent than chloroquine at inhibiting SARS-CoV-2 in vit. Clin Infect Dis. 2020;2:1–25.
31. Gautret P, Lagier J-C, Parola P, Hoang VT, Meddeb L, Mailhe M, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents [Internet]. 2020;105949. Available from: https://doi.org/10.1016/j.ijantimicag.2020.105949
32. Chan JFW, Yanfeng Yao A, Yeung M-L, Deng W, Bao L, Lilong, et al. Treatment with lopinavir/ritonavir or interferon-β1b improves outcome of MERS-CoV infection in a non-human primate model of common marmoset. J Infect Dis. 2020;212(12).
Publicado
2020-04-13
Cómo citar
1.
Iglesias Pertuz S, Aroca-Martinez G, Velez Verbel M de los A, Cadena Osorio A, Cadena-Bonfanti A, Correa-Monterrosa M, Lemus Castro J, Brochado L, Armesto W, Camargo Vasquez T, Martínez Bula E, Turizo Turizo E, Avendaño Echavez LG, Hernández-Agudelo S, Peña Vargas W, Riascos W, Palmera J, Sierra A, Varón Suárez F, Gómez Giraldo L, González-Torres H, Navarro Quiroz E, Vásquez Obeso E, Ángel Depine S, Ospino Herrera D. Reporte de 4 casos COVID-19 hospitalizados en unidad de cuidados intensivos en una institución hospitalaria en Barranquilla, Colombia. Rev. Colomb. Nefrol. [Internet]. 13 de abril de 2020 [citado 4 de junio de 2020];7(Supl 2). Disponible en: https://revistanefrologia.org/index.php/rcn/article/view/420
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Artículo de investigación original