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.

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. Introduction (AKI Covid19 Covid 19 Covid-1 cases ICU Brazil mortality Method criteria 1 26 Results 10 559 55 9 55.9 66.7% 667 66 7 (66.7% 3 RC 1.101 1101 101 95 1026 026 1.02 1.181 1181 181 0.0070, 00070 0.0070 , 0 0070 0.0070) 1.127 1127 127 1022 022 1.243 1243 243 0.0170 00170 0170 3.212 3212 212 1065 065 1.06 9.690 9690 690 0.0380 00380 0380 Twentythree Twenty three 89 8 8.9 deaths 333 33 33.3 RR 5.125 5125 5 125 1598 598 1.59 16.431 16431 16 431 0.0060. 00060 0.0060 . 0060 0.0060) survival days 1.054 1054 054 1014 014 1.01 1.095 1095 095 0.0080 00080 0080 8.953 8953 953 1128 128 1.12 71.048 71048 71 048 Conclusion occurrence Covid1 Covid- 2 55. 66.7 6 (66.7 1.10 110 02 1.0 1.18 118 18 0007 0.007 007 112 12 1.24 124 24 0.017 0017 017 3.21 321 21 106 06 9.69 969 69 0.038 0038 038 8. 33. 5.12 512 159 59 1.5 16.43 1643 43 0006 0.006 006 1.05 105 05 01 1.09 109 09 0.008 0008 008 8.95 895 1.1 71.04 7104 04 66. (66. 11 1. 000 0.00 00 1.2 0.01 001 3.2 32 9.6 96 0.03 003 03 5.1 51 15 16.4 164 4 71.0 710 (66 0.0 9. 5. 16. 71. (6 0. (

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. Introdução LRAna Covid19, Covid19 Covid 19, 19 UTI literatura Brasil hospitalar Método Covid-1 KDIGO 1 2 abril Resultados 10 559 55 9 55,9 66,7% 667 66 7 (66,7% 3 RC 1,101 1101 101 95 1026 026 1,02 1,181 1181 181 0,0070, 00070 0,0070 , 0 0070 0,0070) 1,127 1127 127 1022 022 1,243 1243 243 0,0170 00170 0170 3,212 3212 212 1065 065 1,06 9,690 9690 690 0,0380 00380 0380 faleceram 89 8 8,9 óbitos 333 33 33,3 RR 5,125 5125 5 125 1598 598 1,59 16,431 16431 16 431 0,0060. 00060 0,0060 . 0060 0,0060) sobrevida dias 1,054 1054 054 1014 014 1,01 1,095 1095 095 0,0080 00080 0080 8,953 8953 953 1128 128 1,12 71,048 71048 71 048 Conclusão ocorrência Covid1 Covid- 55, 66,7 6 (66,7 1,10 110 02 1,0 1,18 118 18 0007 0,007 007 112 12 1,24 124 24 0,017 0017 017 3,21 321 21 106 06 9,69 969 69 0,038 0038 038 8, 33, 5,12 512 159 59 1,5 16,43 1643 43 0006 0,006 006 1,05 105 05 01 1,09 109 09 0,008 0008 008 8,95 895 1,1 71,04 7104 04 66, (66, 11 1, 000 0,00 00 1,2 0,01 001 3,2 32 9,6 96 0,03 003 03 5,1 51 15 16,4 164 4 71,0 710 (66 0,0 3, 9, 5, 16, 71, (6 0, (

Resumo Fundamentos A incidência de injúria miocárdica (IM) em pacientes com COVID-19 no Brasil é pouco conhecida e o impacto prognóstico da IM, mal elucidado. Objetivos Descrever a incidência de IM em pacientes com COVID-19 em unidade de terapia intensiva (UTI) e identificar variáveis associadas à sua ocorrência. O objetivo secundário foi avaliar a troponina I ultrassensível (US) como preditor de mortalidade intra-hospitalar. Métodos Estudo observacional, retrospectivo, entre março e abril de 2020, com casos confirmados de COVID-19 internados em UTI. Variáveis numéricas foram comparadas com teste t de Student ou U de Mann-Whitney, sendo o teste X2 empregado para as categóricas. Realizou-se análise multivariada com as variáveis associadas à IM e p<0,2 objetivando determinar preditores de IM. Curva ROC foi empregada para determinar o valor da troponina capaz de predizer maior mortalidade intra-hospitalar. Funções de sobrevida foram estimadas pelo método de Kaplan-Meier a partir do ponto de corte apontado pela curva ROC. Resultados Este estudo avaliou 61 pacientes (63,9% do sexo masculino, média de idade de 66,1±15,5 anos). A IM esteve presente em 36% dos casos. Hipertensão arterial sistêmica (HAS) [RC 1,198; IC95%: 2,246-37,665] e índice de massa corporal (IMC) [RC 1,143; IC95%: 1,013-1,289] foram preditores independentes de risco. Troponina I US >48,3 ng/ml, valor determinado pela curva ROC, prediz maior mortalidade intra-hospitalar [AUC 0,786; p<0,05]. A sobrevida no grupo com troponina I US >48,3 ng/ml foi inferior à do grupo com valores ≤48,3 ng/dl [20,3 x 43,5 dias, respectivamente; p<0,05]. Conclusão Observou-se alta incidência de IM na COVID-19 grave com impacto em maior mortalidade intra-hospitalar. HAS e IMC foram preditores independentes de risco de sua ocorrência. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background The incidence of myocardial injury (MI) in patients with COVID-19 in Brazil and the prognostic impact of MI have not been elucidated. Objectives To describe the incidence of MI in patients with COVID-19 in the intensive care unit (ICU) and to identify variables associated with its occurrence. The secondary objective was to assess high-sensitivity troponin I as a predictor of in-hospital mortality. Methods Retrospective, observational study conducted between March and April 2020 with cases of confirmed COVID-19 admitted to the ICU. Numerical variables were compared by using Student t test or Mann-Whitney U test. The chi-square test was used for categorical variables. Multivariate analysis was performed with variables associated with MI and p<0.2 to determine predictors of MI. The ROC curve was used to determine the troponin value capable of predicting higher in-hospital mortality. Survival functions were estimated by use of the Kaplan-Meier method from the cut-off point indicated in the ROC curve. Results This study assessed 61 patients (63.9% of the male sex, mean age of 66.1±15.5 years). Myocardial injury was present in 36% of the patients. Systemic arterial hypertension (HAS) [OR 1.198; 95%CI: 2.246-37.665] and body mass index (BMI) [OR 1.143; 95%CI: 1.013-1.289] were independent risk predictors. High-sensitivity troponin I >48.3 ng/mL, which was determined in the ROC curve, predicts higher in-hospital mortality [AUC 0.786; p<0.05]. Survival in the group with high-sensitivity troponin I >48.3 ng/mL was lower than that in the group with values ≤48.3 ng/dL [20.3 x 43.5 days, respectively; p<0.05]. Conclusion There was a high incidence of MI in severe COVID-19 with impact on higher in-hospital mortality. The independent risk predictors of MI were SAH and BMI. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)