ABSTRACT Some studies have shown that secondary infections during the COVID-19 pandemic may have contributed to the high mortality. Our objective was to identify the frequency, types and etiology of bacterial infections in patients with COVID-19 admitted to an intensive care unit (ICU) and to evaluate the results of ICU stay, duration of mechanical ventilation (MV) and in-hospital mortality. It was a single-center study with a retrospective cohort of patients admitted consecutively to the ICU for more than 48 h between March and May 2020. Comparisons of groups with and without ICU- acquired infection were performed. A total of 191 patients with laboratory-confirmed COVID-19 were included and 57 patients had 97 secondary infectious events. The most frequent agents were Acinetobacter baumannii (28.9%), Pseudomonas aeruginosa (22.7%) and Klebsiella pneumoniae (14.4%); multi-drug resistance was present in 96% of A. baumannii and in 57% of K. pneumoniae. The most prevalent infection was ventilator-associated pneumonia in 57.9% of patients with bacterial infections, or 17.3% of all COVID-19 patients admitted to the ICU, followed by tracheobronchitis (26.3%). Patients with secondary infections had a longer ICU stay (40.0 vs. 17 days; p < 0.001), as well as a longer duration of MV (24.0 vs 9.0 days; p= 0.003). There were 68 (35.6%) deaths overall, of which 27 (39.7%) patients had bacterial infections. Among the 123 survivors, 30 (24.4%) had a secondary infections (OR 2.041; 95% CI 1.080 - 3.859). A high incidence of secondary infections, mainly caused by gram-negative bacteria has been observed. Secondary infections were associated with longer ICU stay, MV use and higher mortality.

Resumo Introdução: A lesão renal aguda (LRA)na Covid-19, apesar de relevante na prática clínica em UTI, dispõe de poucos dados na literatura, sobretudo no Brasil. Objetivo foi identificar a incidência de LRA, fatores preditores e impacto na mortalidade hospitalar. Método: Coorte retrospectiva de pacientes com Covid-19 internados em UTI. LRA foi definida segundo critérios de KDIGO. Dados coletados de registros de prontuários eletrônicos entre 17 de março e 26 de abril. Resultados: Dos 102 pacientes, 55,9% evoluíram com LRA e a maioria (66,7%) foi classificada como estágio 3. Regressão logística multivariada mostrou idade (RC 1,101; IC 95% 1,026 - 1,181; p = 0,0070), taxa de filtração glomerular estimada - TFGe (RC 1,127; IC 95% 1,022 - 1,243; p = 0,0170) e hipertensão (RC 3,212; IC 95% 1,065 - 9,690; p = 0,0380) como preditores independentes de LRA. Vinte e três pacientes faleceram. No grupo sem lesão renal ocorreu 8,9% de óbitos, enquanto que no grupo com LRA 33,3% dos pacientes morreram (RR 5,125; IC 95% 1,598 - 16,431; p = 0,0060). A média de sobrevida, em dias, foi maior no grupo sem LRA. Análise multivariada de Cox mostrou idade (RR 1,054; IC 95% 1,014 - 1,095; p = 0,0080) e síndrome do desconforto respiratório agudo grave (RR 8,953; IC 95% 1,128 - 71,048; p = 0,0380) como preditores de mortalidade hospitalar. Conclusão: Encontramos alta incidência de LRA; e como fatores preditores para sua ocorrência: idade, TFGe e hipertensão. A LRA estava associada a maior mortalidade hospitalar.

Abstract Introduction: There is little data in the literature on acute kidney injury (AKI) in Covid-19 cases, although relevant in clinical practice in the ICU, especially in Brazil. Our goal was to identify the incidence of AKI, predictive factors and impact on hospital mortality. Method: Retrospective cohort of patients with Covid-19 admitted to the ICU. AKI was defined according to KDIGO criteria. Data was collected from electronic medical records between March 17 and April 26. Results: Of the 102 patients, 55.9% progressed with AKI, and the majority (66.7%) was classified as stage 3. Multivariate logistic regression showed age (RC 1.101; 95% CI 1.026 - 1.181; p = 0.0070), estimated glomerular filtration rate - eGFR (RC 1.127; 95% CI 1.022 - 1.243; p = 0.0170) and hypertension (RC 3.212; 95% CI 1.065 - 9.690; p = 0.0380) as independent predictors of AKI. Twenty-three patients died. In the group without kidney injury, there were 8.9% deaths, while in the group with AKI, 33.3% of patients died (RR 5.125; 95% CI 1.598 - 16.431; p = 0.0060). The average survival, in days, was higher in the group without AKI. Cox multivariate analysis showed age (RR 1.054; 95% CI 1.014 - 1.095; p = 0.0080) and severe acute respiratory distress syndrome (RR 8.953; 95% CI 1.128 - 71.048; p = 0.0380) as predictors of hospital mortality. Conclusion: We found a high incidence of AKI; and as predictive factors for its occurrence: age, eGFR and hypertension. AKI was associated with higher hospital mortality.

Introdução: A idade avançada é factor de risco para má percepção de sintomas, gravidade e mortalidade devido à asma. Entretanto, na literatura, existem poucos trabalhos onde a relação entre sintomas respiratórios e função pulmonar é analisada especificamente nos idosos asmáticos. Objectivos: Avaliar o percentual de dissociação entre a classificação clínica e a funcional da asma no idoso, bem como caracterizar os subgrupos de doentes com maior risco de dissociação clinicofuncional. Material e métodos: Foi realizado um estudo de corte transversal, em que foram avaliados 41 doentes idosos (60 anos ou mais) com diagnóstico de asma. Foram recolhidos dados como idade, sexo, nível de escolaridade, tabagismo, tempo desde o diagnóstico da doença e peso, e realizadas a classificação clínica, a medida do pico de fluxo expiratório e a espirometria. Resultados: Dos 41 doentes estudados, 33 eram mulheres, com média de idade de 68,2 anos. Houve correlação positiva do volume expiratório forçado no primeiro segundo (VEF1) com os demais parâmetros funcionais, assim como correlação negativa do VEF1 com o tempo desde o diagnóstico da doença. A taxa do grupo com dissociação clinicofuncional foi de 73,2%, sendo que o sexo feminino e os doentes com baixa escolaridade apresentaram, respectivamente, risco 8,6 e 9,3 vezes maior. Conclusão: A alta taxa de dissociação clinicofuncional no idoso com asma mostra a obrigatoriedade da realização de medidas funcionais para a classificação da sua gravidade.

Introduction: Advanced age is a risk factor for a blunted perception of the symptoms, severity and mortality of asthma. There are only a few studies in the literature on the relationship between respiratory symptoms and pulmonary function in elderly asthmatics. Aims: To evaluate the divergence between clinical and functional classification of asthma in the elderly and to characterise subgroups of patients at greater risk of clinico-functional divergence. Material and methods: A cross-sectional study evaluating 41 elderly asthmatics (60 years old or over; 33 female; mean age 68.2 years old). Data on age, gender, educational level, smoking, time since diagnosis of the disease and weight were obtained. Clinical classification, peak expiratory flow measurement and spirometry were performed. Results: We found that forced expiratory volume in one second (FEV1) correlated positively with the other functional parameters, and FEV1 correlated negatively with time since diagnosis of the disease. The percentage of clinico-functional divergence was 73.2%. Female patients and those with lower levels of schooling had an 8.6 and 9.3 risk of clinico-functional divergence respectively. Conclusion: The great clinico-functional divergence in elderly asthmatics shows the need to esta blish functional measurements as markers of asthma severity.