Sinais e sintomas da COVID-19: relação com gravidade e evolução da doença

Abstract

To analyze the signs and symptoms of Coronavirus Disease-2019 (COVID-19) and their relationship with the severity and progression of the disease. Methods: A retrospective cohort study was conducted using data from the Influenza Epidemiological Surveillance Information System (SIVEP Gripe), including hospitalized patients in 2020 and 2021 due to Severe Acute Respiratory Syndrome (SARS) caused by COVID-19. The outcomes studied were disease progression (recovery or death) and disease severity (need for Intensive Care Unit – ICU admission; use of ventilatory support – invasive and non-invasive; and length of hospital stay – total and in ICU). In addition to the frequencies of epidemiological variables and signs and symptoms (independent), the incidence of outcomes was assessed with a 95% confidence interval (CI95) and their distribution according to the independent variables (chi-square test; 5% type I error). Results: The sample consisted of 5,265 patients, predominantly male (58.2%) and white (94.3%). The mean age was 56.8 years (SD ± 17.3), with 20.6% of patients aged between 50 and 59 years. Approximately 75% had other comorbidities, and most presented five or more signs/symptoms (54.3%), the most frequent being oxygen saturation below 95% (SpO2<95%), dyspnea, and respiratory distress. The incidence of outcomes was 57.6% (56.2-59.0) for hospital stay longer than 7 days, 32.3% (31.0-33.6) for ICU admission, 38.8% (36.0-41.7) for ICU stay longer than 12 days, 25.0% (23.7-26.3) for invasive ventilatory support use, and 27.2% (25.9-28.5) for death. The presence of dyspnea was related to all outcomes (p<0.001, p<0.001, p=0.009, p=0.002, and p<0.001, respectively). Longer hospital stays (p<0.001) and ICU admission (p<0.001) were significantly more observed in patients with five or more signs/symptoms. The use of invasive ventilatory support was also observed in patients with SpO2<95% (p=0.030), while longer ICU stays were more common in patients with respiratory distress (p=0.045). Furthermore, for longer hospital stays, ICU admission, and mortality, both clinical characteristics were significantly noted (p<0.001 for all outcomes). Conclusion: The combination of signs/symptoms, including saturation below 95%, dyspnea, and respiratory discomfort stands out as an indicator of severe outcomes of COVID-19.