Ângulo de fase e desfechos clínicos de pacientes hospitalizados com covid-19: um estudo observacional transversal
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2024-02-05
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Universidade Estadual Paulista (Unesp)
Resumo
A COVID-19 é uma doença respiratória com grandes processos pró-inflamatórios, podendo levar a complicações como desconforto respiratório agudo, sepse, falência de órgãos e óbito. Além dos fatores de risco para gravidade e mortalidade na doença como a idade avançada, sexo masculino, obesidade e comorbidades, a análise do Ângulo de Fase (AngF) pode ser utilizada para avaliar a integridade celular e o estado dos processos inflamatórios. Dessa forma, o AngF representa um potencial preditor de complicações e risco de morte, além de desfechos clínicos ruins, como tempo de internação (Ti). Visto que os indivíduos com COVID-19 desenvolvem uma resposta inflamatória importante, o AngF pode estar comprometido. Dessa forma, analisar e entender a relação entre o AngF e os desfechos clínicos como saída hospitalar (alta ou óbito) e Ti, sobretudo em indivíduos hospitalizados, pode gerar informações que auxiliem em estratégias de monitoramento apropriado e de tratamento para a doença. Hipotetiza-se que quanto menor o AngF, maior é a prevalência de mortes e maior é o Ti de pacientes hospitalizados com COVID-19. O objetivo primário do presente estudo foi descrever, correlacionar e associar os valores de AngF aos desfechos clínicos como saída hospitalar e Ti de indivíduos hospitalizados com COVID-19. O objetivo secundário foi comparar os valores de AngF e desfechos clínicos entre indivíduos hospitalizados devido ao diagnóstico de COVID-19 (Grupo 1 – G1) e indivíduos hospitalizados por outros motivos e que adquiriram COVID-19 durante a hospitalização (Grupo 2 – G2). Foram incluídos indivíduos hospitalizados com COVID-19 com idade igual ou superior a 18 anos. A avaliação foi realizada em até 24 horas após a admissão hospitalar no G1, ou em até 24 horas após resultado positivo para COVID-19 no G2. A análise do AngF foi realizada por meio da bioimpedância elétrica (BIA). Os desfechos clínicos de saída hospitalar e Ti foram coletados através de acompanhamento via prontuário médico até o término da hospitalização. A normalidade dos dados foi verificada por meio do teste de Shapiro-Wilk. Os dados foram expressos como frequência absoluta e relativa, média ± desvio padrão ou mediana [intervalo interquartílico 25-75%], de acordo com a distribuição dos dados. A análise intergrupos foi realizada por meio do teste t de Student quando dados paramétricos ou o teste de Mann–Whitney quando dados não-paramétricos. Para análise de comparação de variáveis categóricas foi utilizado teste qui-quadrado. Para o estudo da correlação foi utilizada a correlação de Pearson para variáveis paramétricas e o coeficiente de Spearman para variáveis não-paramétricas. Para todas as análises estatísticas foi aceita significância de p<0,05. Quarenta indivíduos com COVID-19 foram incluídos nas análises, (65±18 anos, 22 mulheres, 18 homens). Não houve associações estatisticamente significantes nas variáveis de AngF e desfechos clínicos. Foi observada diferença estatística entre G1 e G2 nas variáveis de Ti (p=0,001) e Ti prolongada (maior que 15 dias) (p=0,033). Conclui-se que não houve associação entre AngF e desfechos clínicos em indivíduos hospitalizados com COVID-19. Indivíduos que adquiriram COVID-19 durante a internação permaneceram maior tempo hospitalizados que aqueles hospitalizados devido ao diagnóstico de COVID-19.
COVID-19 is a respiratory disease with large pro-inflammatory processes, which can lead to complications such as acute respiratory distress, sepsis, organ failure and death. In addition to risk factors for disease severity and mortality such as advanced age, male gender, obesity and comorbidities, the Phase Angle (AngF) analysis can be used to assess cell integrity and the state of inflammatory processes. Thus, AngF represents a potential predictor of complications and risk of death, as well as poor clinical outcomes, such as length of hospitalization (Ti). Since individuals with COVID-19 develop an important inflammatory response, AngF may be compromised. Thus, analyzing and understanding the relationship between AngF and clinical outcomes such as hospital exit (discharge or death) and Ti, especially in hospitalized individuals, can generate information that helps in appropriate monitoring and treatment strategies for the disease. It is hypothesized that the lower the AngF, the higher the prevalence of deaths and the higher the Ti of hospitalized patients with COVID-19. The primary objective of this study was to describe, correlate and associate the values of AngF to clinical outcomes such as hospital exit and Ti of hospitalized individuals with COVID-19. The secondary objective was to compare the AngF values and clinical outcomes between hospitalized individuals due to the diagnosis of COVID-19 (Group 1 - G1) and individuals hospitalized for other reasons and who acquired COVID-19 during hospitalization (Group 2 - G2). Individuals hospitalized with COVID-19 aged 18 years or older were included. The evaluation was performed within 24 hours after hospital admission to G1, or within 24 hours after positive result for COVID-19 in G2. The analysis of AngF was performed by means of electrical impedance (BIA). The clinical outcomes of hospital exit and Ti were collected through follow-up via medical record until the end of hospitalization. The normality of the data was verified by the Shapiro-Wilk test. Data were expressed as absolute and relative frequency, mean standard deviation or median [interquartile range 25-75%], according to data distribution. The intergroup analysis was performed using the Student’s t-test when parametric data or the Mann-Whitney test when non-parametric data. Chi-square test was used to compare categorical variables. For the correlation study, Pearson correlation for parametric variables and Spearman’s coefficient for non-parametric variables were used. Significance of p<0.05 was accepted for all statistical analysis. Forty individuals with COVID-19 were included in the analysis (65±18 years, 22 women, 18 men). There were no statistically significance associations in the variables of AngF and clinical outcomes. A statistical difference was observed between G1 and G2 in the variables of Ti (p=0.001) and prolonged Ti (greater than 15 days) (p=0.033). We conclude that there was no association between AngF and clinical outcomes in hospitalized individuals with COVID-19. Individuals who acquired COVID-19 during hospitalization remained longer hospitalized than those hospitalized due to the diagnosis of COVID-19.
COVID-19 is a respiratory disease with large pro-inflammatory processes, which can lead to complications such as acute respiratory distress, sepsis, organ failure and death. In addition to risk factors for disease severity and mortality such as advanced age, male gender, obesity and comorbidities, the Phase Angle (AngF) analysis can be used to assess cell integrity and the state of inflammatory processes. Thus, AngF represents a potential predictor of complications and risk of death, as well as poor clinical outcomes, such as length of hospitalization (Ti). Since individuals with COVID-19 develop an important inflammatory response, AngF may be compromised. Thus, analyzing and understanding the relationship between AngF and clinical outcomes such as hospital exit (discharge or death) and Ti, especially in hospitalized individuals, can generate information that helps in appropriate monitoring and treatment strategies for the disease. It is hypothesized that the lower the AngF, the higher the prevalence of deaths and the higher the Ti of hospitalized patients with COVID-19. The primary objective of this study was to describe, correlate and associate the values of AngF to clinical outcomes such as hospital exit and Ti of hospitalized individuals with COVID-19. The secondary objective was to compare the AngF values and clinical outcomes between hospitalized individuals due to the diagnosis of COVID-19 (Group 1 - G1) and individuals hospitalized for other reasons and who acquired COVID-19 during hospitalization (Group 2 - G2). Individuals hospitalized with COVID-19 aged 18 years or older were included. The evaluation was performed within 24 hours after hospital admission to G1, or within 24 hours after positive result for COVID-19 in G2. The analysis of AngF was performed by means of electrical impedance (BIA). The clinical outcomes of hospital exit and Ti were collected through follow-up via medical record until the end of hospitalization. The normality of the data was verified by the Shapiro-Wilk test. Data were expressed as absolute and relative frequency, mean standard deviation or median [interquartile range 25-75%], according to data distribution. The intergroup analysis was performed using the Student’s t-test when parametric data or the Mann-Whitney test when non-parametric data. Chi-square test was used to compare categorical variables. For the correlation study, Pearson correlation for parametric variables and Spearman’s coefficient for non-parametric variables were used. Significance of p<0.05 was accepted for all statistical analysis. Forty individuals with COVID-19 were included in the analysis (65±18 years, 22 women, 18 men). There were no statistically significance associations in the variables of AngF and clinical outcomes. A statistical difference was observed between G1 and G2 in the variables of Ti (p=0.001) and prolonged Ti (greater than 15 days) (p=0.033). We conclude that there was no association between AngF and clinical outcomes in hospitalized individuals with COVID-19. Individuals who acquired COVID-19 during hospitalization remained longer hospitalized than those hospitalized due to the diagnosis of COVID-19.
Descrição
Palavras-chave
COVID-19, Composição corporal, Impedância, Hospitalização, Sobrevivência, Body composition, Impedance, Hospitalization, Survival
Como citar
SUZUKI, Natalia Narumi Voltareli. Ângulo de fase e desfechos clínicos de pacientes hospitalizados com covid-19: um estudo observacional transversal. Orientador: Ercy Mara Cipulo Ramos. 2024. 22 f. Trabalho de Conclusão (Residência em Fisioterapia) - Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, 2024.