Desfechos clínicos em pacientes com doenças cardiovasculares preexistentes e COVID-19: uma revisão sistemática e meta-análise
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Data
2023-04-03
Autores
Favoretto, Carolina
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Universidade Estadual Paulista (Unesp)
Resumo
O vírus da Sars-Cov-2 (Severe Acute Respiratory Syndrome Coronavirus) responsável pela doença intitulada coronavirus disease (COVID-19) vem se disseminando mundialmente de maneira extremamente alta, sendo declarada uma pandemia pela OMS em março de 2020. Apesar de altamente contagioso, as taxas de letalidade são relativamente baixas na população geral, com a maioria dos infectados assintomáticos ou apresentando sintomas respiratórios de leve a moderados. No entanto, tem-se observado um risco maior de gravidade em pacientes com doenças crônicas preexistentes, incluindo as doenças cardiovasculares. Os objetivos do estudo são: analisar as evidências científicas disponíveis na literatura sobre os pacientes adultos com COVID-19 com doenças cardiovasculares preexistentes e verificar nos pacientes adultos com COVID-19 o efeito da doença DCV nos desfechos mortalidade, alterações de biomarcadores cardiovasculares, eventos tromboembólicos e lesão renal. Trata-se de uma revisão sistemática e meta-análise de ensaios clínicos randomizados ou observacionais obtidos por meio das bases de dados Medline via PubMed, Embase, Latin America and Caribbean Health Sciences Literature (LILACS), Scientific Library on Line (SciELO), e Registro Central Cochrane de Ensaios Controlados (CENTRAL). para avaliar quais características clínicas dos pacientes infectados com COVID-19 e com doenças cardiovasculares preexistentes. O protocolo foi registrado na PROSPERO (Registro Internacional de Revisão Sistemática) código CRD42020185329. Os desfechos primários avaliados foram: sinais e sintomas coronarianos agudos, alterações de biomarcadores cardiovasculares, arritmia cardíaca, miocardite, choque cardiogênico, eventos tromboembólicos; eventos secundários que também foram avaliados: eventos vasculares periféricos, lesão renal, choque séptico, mortalidade cardiovascular, tempo de permanência na unidade de terapia intensiva e duração da internação. Em conclusão, esta revisão sistemática e meta-análise indica que a presença de DCV prévia em indivíduos com COVID-19 estão associadas ao risco maior de desenvolver alteração de biomarcadores (Troponina), lesão renal aguda e principalmente mortalidade. Descritores: Infecções por Coronavírus; Complicações; Doenças Cardiovasculares
The Sars-Cov-2 virus (Severe Acute Respiratory Syndrome Coronavirus) responsible for the disease called coronavirus disease (COVID-19) has been spreading worldwide at an extremely high rate, being declared a pandemic by the WHO in March 2020. Despite being highly contagious, lethality rates are relatively low in the general population, with the majority of those infected asymptomatic or presenting mild to moderate respiratory symptoms, however, a greater risk of severity has been observed in patients with preexisting diseases, including the diseases cardiovascular. As cardiovascular diseases are the leading cause of death in the world, according to the WHO, and also with the increasing number of new publications and data regarding COVID-19 and cardiovascular diseases emerging all the time, it was perceived the need to evaluate the evolution and clinical outcomes of these patients. The objective was to analyze the evidence available in the (inter)national literature on the clinical characteristics of adult patients with COVID-19 and pre-existing cardiovascular disease. A systematic review and meta-analysis of randomized or observational clinical trials obtained from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to present), EMBASE (1980 to present), LILACS (1982 to present), Scopus (international database produced by Elsevier) and Web of Science to assess the clinical characteristics of patients infected with COVID-19 with preexisting cardiovascular diseases and their outcomes, the protocol was registered in PROSPERO (International Systematic Review Registry) code CRD42020185329. The primary outcomes assessed were acute coronary signs and symptoms, changes in cardiovascular biomarkers, cardiac arrhythmia, myocarditis, cardiogenic shock, thromboembolic events; secondary events that were also evaluated: peripheral vascular events, kidney injury, septic shock, cardiovascular mortality, length of stay in the intensive care unit (ICU) and length of stay. It was possible to characterize the population infected by COVID-19 with previous cardiovascular diseases and find a significant relationship or absence of this between severity and clinical outcomes in populations, verifying that the association of these two diseases generates an additional risk factor for worse evolution of COVID-19. Keywords: Coronavirus Infections; Complications; Cardiovascular diseases.
The Sars-Cov-2 virus (Severe Acute Respiratory Syndrome Coronavirus) responsible for the disease called coronavirus disease (COVID-19) has been spreading worldwide at an extremely high rate, being declared a pandemic by the WHO in March 2020. Despite being highly contagious, lethality rates are relatively low in the general population, with the majority of those infected asymptomatic or presenting mild to moderate respiratory symptoms, however, a greater risk of severity has been observed in patients with preexisting diseases, including the diseases cardiovascular. As cardiovascular diseases are the leading cause of death in the world, according to the WHO, and also with the increasing number of new publications and data regarding COVID-19 and cardiovascular diseases emerging all the time, it was perceived the need to evaluate the evolution and clinical outcomes of these patients. The objective was to analyze the evidence available in the (inter)national literature on the clinical characteristics of adult patients with COVID-19 and pre-existing cardiovascular disease. A systematic review and meta-analysis of randomized or observational clinical trials obtained from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to present), EMBASE (1980 to present), LILACS (1982 to present), Scopus (international database produced by Elsevier) and Web of Science to assess the clinical characteristics of patients infected with COVID-19 with preexisting cardiovascular diseases and their outcomes, the protocol was registered in PROSPERO (International Systematic Review Registry) code CRD42020185329. The primary outcomes assessed were acute coronary signs and symptoms, changes in cardiovascular biomarkers, cardiac arrhythmia, myocarditis, cardiogenic shock, thromboembolic events; secondary events that were also evaluated: peripheral vascular events, kidney injury, septic shock, cardiovascular mortality, length of stay in the intensive care unit (ICU) and length of stay. It was possible to characterize the population infected by COVID-19 with previous cardiovascular diseases and find a significant relationship or absence of this between severity and clinical outcomes in populations, verifying that the association of these two diseases generates an additional risk factor for worse evolution of COVID-19. Keywords: Coronavirus Infections; Complications; Cardiovascular diseases.
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Infecções por coronavírus, Complicações, Doenças cardiovasculares, COVID-19 (Doença)