Importância prognóstica da disfunção gastrintestinal em pacientes graves com COVID-19

Abstract

Objective: To analyze in-hospital and 1-year morbidity and mortality associated with acute gastrointestinal dysfunction (GID) in critically ill patients with COVID-1, using a prespecified scoring system. Methods: Between March and July 2020, hospitalized patients with COVID-19 from a single institution were retrospectively analyzed by medical chart review. Only those who remained in the intensive care unit for more than 24 hours were included. GID was assessed according to a predefined 5-grade progressive gastrointestinal injury scoring system, ranging from 0 (no risk) to IV (life-threatening dysfunction), considering the first 7 days of hospitalization. Laboratory data, comorbidities, the need for mechanical ventilation, the duration of intensive care unit stay, and subsequent in-hospital and 1-year mortality rates were also recorded.Results: Among 230 patients who were screened, 215 were included in the analysis. The median age was 68 years (54 – 82), and 57.7% were male. The total gastrointestinal dysfunction scores were 0 (79.1%), I (15.3%), II (4.7%), III (0.9%), and IV (0%). Any manifestation of gastrointestinal dysfunction was present in 20.9% of all patients and was associated with longer lengths of stay (20 days [11 – 33] versus 7 days [4 – 16]; p < 0.001] and higher C-reactive protein levels on admission (12.8mg/mL [6.4 - 18.4] versus 5.7mg/mL [3.2 – 13.4]; p < 0.001). The gastrointestinal dysfunction score was significantly associated with mortality (OR 2.8; 95%CI 1.7 - 4.8; p < 0.001) and the need for mechanical ventilation (OR 2.8; 95%CI 1.7 - 4.6; p < 0.001). Both in-hospital and 1-year death rates progressively increased as gastrointestinal dysfunction scores increased. Conclusion: In the current series of intensive care unit patients with COVID-19, gastrointestinal dysfunction severity, as defined by a prespecified scoring system, was predictive of adverse in-hospital and 1-year outcomes.