SUMMARY OBJECTIVE: This study aims to analyze the risk factors for in-hospital mortality in a cohort of patients admitted to a newly adapted intensive care unit in a public hospital in Rio de Janeiro. METHODS: This was an observational, retrospective, and descriptive study. Data were obtained from electronic medical records. Coronavirus disease 2019 (COVID-19) was diagnosed by detecting viral ribonucleic acid using reverse transcription polymerase chain reaction. Factors associated with the risk/protection from death were determined using the odds ratio and adjusted odds ratio. RESULTS: Fifty-one patients were admitted to the hospital. The median age of the patients was 63 years, 60% were male patients, and 54% were white patients. Sixty-seven percent of the patients were diagnosed with COVID-19. Sepsis at admission increased the chance of in-hospital death by 21 times (adjusted odds ratio=21.06 [0.79–555.2]; p=0.06). The strongest risk factor for death was the development of septic shock during hospitalization (adjusted odds ratio=98.56 [2.75–352.5]; p=0.01), and one in four patients had multidrug-resistant bacteria. Mechanical ventilation, vasopressors, neuromuscular blockers, and sedatives were also the risk factors for in-hospital mortality. The in-hospital mortality rate was 41%, and the mortality rate of patients on mechanical ventilation was 60%. The diagnosis of COVID-19 was not statistically related to the adverse outcomes. CONCLUSIONS: In this cohort, the strongest risk factor for in-hospital death was the development of nosocomial septic shock. Healthcare-associated infections have a significant impact on mortality rates. Therefore, to have a better outcome, it is important to consider not only the availability of beds but also the way healthcare is delivered.

Resumo: O objetivo deste estudo foi investigar a associação entre experiências adversas na infância (ACEs) e uso de álcool, fumo e drogas ilícitas em adolescentes de uma coorte brasileira. A ocorrência de cinco ACEs, o uso de álcool e fumo e a experimentação de drogas ilícitas foram investigados na Coorte de Nascimentos de 1993 de Pelotas, aos 15 anos (n = 4.230). Um escore de ACEs foi criado e sua associação com o uso de substâncias foi avaliada. Cerca de 25% dos adolescentes consumiram álcool, 6% fumaram e 2,1% relataram ter usado drogas pelo menos uma vez na vida. Os ACEs estiveram associados com o uso de álcool, fumo e drogas ilícitas. Uma relação dose-resposta entre o número de ACEs e o consumo de substâncias foi evidenciada, especialmente para drogas ilícitas. A ocorrência de ACEs esteve positivamente associada com o uso de álcool, tabaco e drogas ilícitas em adolescentes, e o risco pode diferir conforme o sexo. Esses resultados salientam que as estratégias para a prevenção do uso de substâncias devem conter intervenções para adolescentes, bem como no ambiente familiar.

Abstract: The objective of this study was to investigate the association between adverse childhood experiences (ACEs) and the use of alcohol, tobacco and illicit drugs among adolescents from a Brazilian cohort. The occurrence of five ACEs, the use of alcohol and tobacco and trying illicit drugs were investigated in the 1993 Pelotas birth cohort at the age of 15 (n = 4,230). A score was created for the ACEs and their association with the use of substances was evaluated. Around 25% of adolescents consumed alcohol, 6% smoked and 2.1% reported having used drugs at least once in their lives. The ACEs were associated with the use of alcohol, tobacco and illicit drugs. A dose-response relation between the number of ACEs and the substance use was found, particularly with regard to illicit drugs. The occurrence of ACEs was positively associated with the use of alcohol, tobacco and illicit drugs among adolescents and the risk may be different for men and women. These results point to the fact that strategies for preventing the use of substances should include interventions both among adolescents and within the family environment.

Resumen: El objetivo fue investigar la asociación entre experiencias adversas en la infancia (ACEs) y consumo de alcohol, tabaco y drogas ilícitas en adolescentes de una cohorte brasileña. La ocurrencia de cinco ACEs, el consumo de alcohol y tabaco y el primer consumo de drogas ilícitas se investigaron en la Cohorte de Nacimientos de 1993 de Pelotas, a los 15 años (n = 4.230). Se creó un marcador de ACEs y se evaluó su asociación con el uso de estas sustancias. Cerca de un 25% de los adolescentes consumieron alcohol, un 6% fumaron y un 2,1% informaron haber consumido drogas por lo menos una vez en la vida. Los ACEs estuvieron asociados con el consumo de alcohol, tabaco y drogas ilícitas. Se evidenció una relación dosis-respuesta entre el número de ACEs y el consumo de sustancias, especialmente, en el caso de drogas ilícitas. La ocurrencia de ACEs estuvo positivamente asociada con el uso de alcohol, tabaco y drogas ilícitas en adolescentes y el riesgo puede diferir según sexo. Esos resultados resaltan que las estrategias para la prevención del consumo de estas sustancias deben contar con intervenciones para adolescentes, así como en su ambiente familiar.

Resumo: O objetivo deste estudo foi investigar a associação entre experiências adversas na infância (ACEs) e uso de álcool, fumo e drogas ilícitas em adolescentes de uma coorte brasileira. A ocorrência de cinco ACEs, o uso de álcool e fumo e a experimentação de drogas ilícitas foram investigados na Coorte de Nascimentos de 1993 de Pelotas, aos 15 anos (n = 4.230). Um escore de ACEs foi criado e sua associação com o uso de substâncias foi avaliada. Cerca de 25% dos adolescentes consumiram álcool, 6% fumaram e 2,1% relataram ter usado drogas pelo menos uma vez na vida. Os ACEs estiveram associados com o uso de álcool, fumo e drogas ilícitas. Uma relação dose-resposta entre o número de ACEs e o consumo de substâncias foi evidenciada, especialmente para drogas ilícitas. A ocorrência de ACEs esteve positivamente associada com o uso de álcool, tabaco e drogas ilícitas em adolescentes, e o risco pode diferir conforme o sexo. Esses resultados salientam que as estratégias para a prevenção do uso de substâncias devem conter intervenções para adolescentes, bem como no ambiente familiar.

Abstract: The objective of this study was to investigate the association between adverse childhood experiences (ACEs) and the use of alcohol, tobacco and illicit drugs among adolescents from a Brazilian cohort. The occurrence of five ACEs, the use of alcohol and tobacco and trying illicit drugs were investigated in the 1993 Pelotas birth cohort at the age of 15 (n = 4,230). A score was created for the ACEs and their association with the use of substances was evaluated. Around 25% of adolescents consumed alcohol, 6% smoked and 2.1% reported having used drugs at least once in their lives. The ACEs were associated with the use of alcohol, tobacco and illicit drugs. A dose-response relation between the number of ACEs and the substance use was found, particularly with regard to illicit drugs. The occurrence of ACEs was positively associated with the use of alcohol, tobacco and illicit drugs among adolescents and the risk may be different for men and women. These results point to the fact that strategies for preventing the use of substances should include interventions both among adolescents and within the family environment.

Resumen: El objetivo fue investigar la asociación entre experiencias adversas en la infancia (ACEs) y consumo de alcohol, tabaco y drogas ilícitas en adolescentes de una cohorte brasileña. La ocurrencia de cinco ACEs, el consumo de alcohol y tabaco y el primer consumo de drogas ilícitas se investigaron en la Cohorte de Nacimientos de 1993 de Pelotas, a los 15 años (n = 4.230). Se creó un marcador de ACEs y se evaluó su asociación con el uso de estas sustancias. Cerca de un 25% de los adolescentes consumieron alcohol, un 6% fumaron y un 2,1% informaron haber consumido drogas por lo menos una vez en la vida. Los ACEs estuvieron asociados con el consumo de alcohol, tabaco y drogas ilícitas. Se evidenció una relación dosis-respuesta entre el número de ACEs y el consumo de sustancias, especialmente, en el caso de drogas ilícitas. La ocurrencia de ACEs estuvo positivamente asociada con el uso de alcohol, tabaco y drogas ilícitas en adolescentes y el riesgo puede diferir según sexo. Esos resultados resaltan que las estrategias para la prevención del consumo de estas sustancias deben contar con intervenciones para adolescentes, así como en su ambiente familiar.