Palabras clave
infección COVID-19
unidad de cuidados intensivos
Cómo citar
Resumen
Contexto: la infección por COVID-19 se ha asociado a un incremento significativo de complicaciones renales, especialmente en pacientes críticos. La injuria renal aguda (IRA) en este grupo constituye un marcador de compromiso clínico y se relaciona con alta mortalidad en unidades de cuidados intensivos (UCI).
Objetivo: determinar las características clínicas, de laboratorio y los factores asociados a la mortalidad en pacientes con infección COVID-19 e injuria renal aguda (IRA) hospitalizados en la Unidad de Cuidados Intensivos (UCI) del Hospital Nacional Arzobispo Loayza.
Metodología: estudio de cohorte retrospectivo, con muestreo por conveniencia durante el periodo de abril 2020 a marzo 2021, a través de la revisión de datos de historias clínicas. Los criterios de inclusión fueron: pacientes mayores de 18 años, con diagnóstico de infección por COVID-19, que ingresaron a la UCI con función renal normal y desarrollaron IRA durante su estancia en la UCI. Los criterios de exclusión fueron: pacientes que desarrollaron IRA antes de su ingreso a la UCI y pacientes con enfermedad renal crónica, con y sin diálisis.
Resultados: se evaluaron 177 historias clínicas que cumplían con los criterios de inclusión y exclusión. La edad promedio fue de 57,2 ± 13,2 años, 145 (81,4?%) participantes fueron de sexo masculino, las comorbilidades fueron: 112 pacientes con obesidad (63,3?%), 55 con hipertensión arterial (31,1?%) y 30 con diabetes mellitus (16,9?%). La causa de la IRA más frecuente fue hipoperfusión en el 93,0?% de los participantes y 83 sujetos (46,8?%) recibieron soporte dialítico en la modalidad de hemodiálisis intermitente. La mortalidad hospitalaria fue del 85,3?% (151 casos), donde el grupo más afectado fue el de IRA estadio 3: 109 casos (72,2?%). Los mayores niveles de ferritina (OR?=?4,42 (IC 95?% 4,31-18,44), p <0,001) y score APACHE II (OR?=?2,41 (IC 95?% 1,18-4,93), p <0,016), así como la disminución del nivel PaO2/FiO2 (OR?=?0,85 (IC 95?% 0,52-0,92), p <0,042) se relacionaron con la mortalidad, ajustados por edad, sexo y comorbilidades.
Conclusiones: la IRA en pacientes en la UCI con infección por COVID-19 tiene una mortalidad elevada y los factores relacionados fueron el incremento en el puntaje APACHE y del nivel de ferritina, así como la disminución del nivel de PaO2/FiO2.
Citas
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