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CARACTERÍSTICAS CLÍNICAS E LABORATORIAIS DA COVID-19: UMA
ANÁLISE NA INTERNAÇÃO HOSPITALAR
CLINICAL AND LABORATORY
CHARACTERISTICS FOR COVID-19: ANALYSIS OF HOSPITAL INTERNMENT
Letícia Silveira Goulart[1]
* Kassila Conceição Ferreira Santos[2]
* Débora Aparecida da Silva Santos[3]
* Magda de Mattos[4]
<=
/p>
ABSTRACT
Background: The COVID-19 pandemic has been a very serious issue in public health,
with high morbidity and mortality rates. The disease has a wide spectrum of=
clinical
symptoms with laboratory alterations. Objectives: Toanalyze the clinical a=
nd
laboratory characteristics of patients with COVID-19 in hospitalization. Methodology: Patients diagnosed w=
ith
COVID-19 and admitted in a Health Care Unit and in a specialized Municipal
Hospital were included. Data were retrieved from the patients´ electronic
charts and descriptive statistics were employed. Results: 205 patients were included. The most frequent clinical
symptoms comprised dyspnoea (48.29%), coughs (30.73%) and myalgia
(24.39%).Systemic arterial hypert=
ension
was the dominant co-morbidity (73.47%). Most patients also had lymphopenia
(73.12%), rise in reactive protein C (97.53%), increase in lactic dehydroge=
nase
(94.52%) and decrease in pO2 (69.00%). Conclusion:
Data retrieved determined the clinical and laboratory profile of patien=
ts
with COVID-19 at hospitalization. Results may contribute towards a better
analysis of the disease´s pathogeny.
Keywords: COVID-19, <=
/span>signs and symptoms,
laboratory test, biomarkers.
RESUMO
Objetivo:
Analisar as características clínicas e laboratoriais de pacientes com COVID=
-19
na internação hospitalar.Métodos:=
Foram
incluídos no estudo pacientes com diagnóstico de COVID-19 internados em uma=
Unidade de Pronto Atendimento e em um Hospital
Municipalde referê=
ncia
para a doença. Os dados foram coletados dos prontuários eletrônicos =
dos
pacientes. Aplicou-se a estatística descritiva. Resultados:Foram incluídos 205 pacientes. Os sinais e sintomas clínicos m=
ais
frequentes foram dispneia (48,29%), tosse (30,73%) e mialgia (24,39%). A
hipertensão arterial sistêmica foi a comorbidade predominante (73,47%). A
maioria dos pacientes apresentou linfopenia (73,12%), elevação na proteína C
reativa (97,53%), aumento de desidrogenase láctica (94,52%) e redução na pO2
(69,00%). Conclusões:Os dados
gerados possibilitaram determinar o perfil clínico e laboratorial de pacien=
tes
com COVID-19 na internação hospitalar. Esses resultados podem contribuir pa=
ra
uma melhor compreensão da patogenia da doença.
Palavras-chave:COVID-19; Si=
nais e
Sintomas; Testes Laboratoriais; Biomarcadores
INTRODUCTION
In
the end of 2019 in Wuhan c=
ity,
Hubei province, China, a new species
of Coronavirus was identified after an outbreak of pneumonia unknownetiology, later t=
he etiologicagent was named Severe Acute Respiratory SyndromeCoronavirus (SARS -CoV-2)1. =
In February 2020, the severe acute<=
/span> respiratory syndrome that was sp=
readingaround the world was named=
by the World Health Organization as Coronavíurs
Disease 2019 (COVID-19) and on March 11 of the same year, the disease was characteri=
zed
as a pandemic2.
It
is estimated that most ind=
ividuals
with COVID-19 are asymptomatic or have only mildsymptoms, including =
fever, fatigue, cough, and myalgia. There may be anosmia, ageusia, nausea, headache, vomiting, abdom=
inal
pain, diarrhea, odynophagi=
a
and rhinorrhea. The severe cases may
include dyspnea, cyanosis<=
/span>, tachypnea, hypotension, <=
span
class=3DSpellE>decompensation of underlying
diseases, lymphopenia and =
require
hospital internment3,4,5. The most common c=
omplications
are Severe Acute Respiratory Syndrome, acutecardiacinjury and second=
ary
infection6.
The
similarity of the symptoms=
COVID-19 with those other pathologies associate=
d with
the upper and lower=
respiratorytractmakes the initial disease=
difficultdiagnosis. Howe=
ver,
laboratory tests, carried out in the initial ph=
ase of
the disease, such as Reverse Transcriptionfollowed by Polymerase ChairReaction (RT-PCR) w=
hich enables the identification of
SARS-CoV-2 RNA and tests that detect viral antigens in the secretion=
nasal
are important to guide clinical management=
7.
Different
clinical and laboratory characteristics are observed
among patients affected by COVID-19. However, dynamic<=
/span>
monitoring laboratory tests can
be significant to predict the prognosis of pati=
ents, especiallybecause the di=
sease is
associated with a severe inflammatory process w=
ith organ dysfunction8. C=
onsiderable
laboratory parameters for =
monitoring
the progression of COVID-19 include lacticdehydrogenase, prolactin, C-reactive pro=
tein,
and pro-inflammatory cytokines, as well as biomarkerssuch as lymphocytes, neut=
rophils,
clottingfactors, D=
-dimer,
and oximetry9,10
Therefore,
knowing the changes in laboratory tests and the=
signs and symptoms presen=
ted by
patients affected with COVID-19 during hospitalization=
can be a useful too=
l to understand the evolution of the disease, and proposeadequate care str=
ategies
and conducts. these
patients.
OBJECTIVES
The
aim was to analyze =
the
clinical and laboratory characteristics of patients with COVID-19 during
hospital internment.
MATERIAL
AND METHOD
It
is an observational and retrospective study, with patients diagnosed
with COVID-19, admitted to an Emergency Care Un=
it
(UPA) and to a Municipal Hospital of reference =
for
care to COVID-19 in the municipality of Rondonó=
polis,
MT, in the period between January to April 2021.
Subjects
with laboratory confirmation for the disease by
RT-PCR or by rapidantigen=
testing from nasopharyngeal swab
samples during the study period were included in the study. Patients whose data in the medical records were incomplete
and excluded.
Clinical
data and results of laboratory tests presented =
by
patients at the time of admission to health institutions were collected. Information was obtained from the patient'selectronic medical record<=
/span>
and transcribedinto a structuredform for data =
collection.
The
analyzedvariables =
were classifiedintoblocks:
a)
sociodemographic (age and =
gender)
b)
clinical (co-morbidities, duration, COVID) symptoms;
Data
were tabulatedusing the
Microsoft Excel 2013 program and analyzedusing the JASP program.
Descriptive statistics were performed.
Continuous variables were =
expressed
as mean with standard devi=
ation,
median, minimum and=
maximum values. Categorical variables were expressed =
as absolute and relativefrequency.
RESULTS
A
total of 205 patients were included in the present
study, 111 (54.15%) male, mean age 57.13 years
(Standard deviation: 17.41, Minimum=3D13
and Maximum=3D94). The most frequent clinical <=
span
class=3DSpellE>signs and symptoms in the=
studiedpopulation were <=
span
class=3DSpellE>dyspnea (48.29%), cough (30.73%), myalgia (24.39%), a=
nd fever (20.00%). The average
period of onset of signs
and symptomsbefore
hospital admission was 8.3 days.
The
prevalence of comorbiditie=
s
in patients hospitalized for COVID-19 was 47.80=
%. The
most frequent comorbidities were systemic
arterial hypertension (73.47%), diabetes mellit=
us
(31.63%), and obesity (13.26%). Table
1 describes the sociodemog=
raphic
and clinical characteristics of the studiedpopulation.
Table 1 -Sociodemographic and clinical characteristics of individuals with COVID-19. Rondonópolis, MT, 2021.
Variable
N (%)
Gênero
Female
94
(45.85)
Male
111
(54.15)
Age years)
Median (Min - Ma=
x)
57
(13 - 94)
13
to 39
29
(14.14)
40
to 59
91
(44.39)
60
or more
85
(41.46)
Comorbidities
Yes
98
(47.81)
Not
107
(52.19)
Systemic arterial =
hypertension
72
(73.47)
Diabetes
mellitus
31
(31.63)
Obesity
13
(13.26)
Heart
disease
7
(7.14)
Cancer
3
(3.06)
Alzheimer's
1
(1.02)
Leprosy
1
(1.02)
Epilepsy
1
(1.02)
Leprosy
1
(1.02)
Psychiatricdisorder
1
(1.02)
Duration of symptoms=
beforeadmission in days
=
;
Average
8.3
up to 7
86
(42.00)
8
to 14
108
(53.00)
15
or more
11
(5.36)
Clinical signs and <=
span
class=3DSpellE>symptoms on admission
Dyspnea
99
(48.29)
Cough
63
(30.73)
Myalgia
50
(24.39)
Fever
41
(20)
Asthenia
5
(17.07)
Headache
23
(11.21)
Anosmia
17 (8.29)
Ageusia
13
(6.34)
Nausea and puke
17
(8.29)
Source: The authors=
The
analysis of hematological data revealed
that most cases had values within the normal ra=
nge
for the count of total leu=
kocytes
(68.29 %), monocytes (88.44%), erythrocytes
(81.00%), and platelets (88.67 %), as well as for the values of hemato=
crit
(80.00%) and hemoglobin (84.39%). Lymphopenia
was observed in most patients (73.13%), with a =
median of 496.00 cells pe=
r mm3 (Table 2).
Table 2 -Hematologicalindividuals=
parameters with COVID-19. Rondonópolis, MT, 2021.
Variable
N (%)
Leukocytecount (4000 - 11000 /mm³)
Median per mm3
7.520
Normal
120 (68.29)
High
52 (25.36)
Reduced
13 (6.34)
<=
span
style=3D'font-size:12.0pt;font-family:"Times New Roman",serif'>Lymphocyte=
count (1000 - 4.950 /mm³)
Median per mm3
496.00
Normal
54 (27.00)
High
0 (0.00)
Reduced
147 (73.13)
<=
span
style=3D'font-size:12.0pt;font-family:"Times New Roman",serif'>Monocytecount (80 - 1100 /mm³)
Median per mm3
377.00
Normal
176 (88.44)
High
17 (8.54)
Reduced
6 (3.01)
Red cell count
(400 - 540 million/mm³)=
Median per mm3
4.60
Normal
166 (81.00)
High
1 (0.48)
Reduced
38 (18.53)
<=
span
style=3D'font-size:12.0pt;font-family:"Times New Roman",serif'>Hematocrit=
(37-45%)<=
o:p>
Median
40.60
Normal
164 (80.00)
High
2 (0.97)
Reduced
39 (19.02)
<=
span
style=3D'font-size:12.0pt;font-family:"Times New Roman",serif'>Hemoglobin=
Dosage (11.7 - 16.0 g/dL)
Median g/dL=
13.40
Normal
173 (84.39)
High
1 (0.48)
Reduced
31 (15.12)
<=
span
style=3D'font-size:12.0pt;font-family:"Times New Roman",serif'>Plateletcount (150000 to 450000 /mm³)=
Median per mm3
235.967
Normal
180 (88.67)
High
2 (0.98)
Reduced
21 (10.34)
Source:
The authors
The
patients studied presented increased levels of =
PCR
(97.53%) and lacticdehydr=
ogenase
(94.52%) on admission, as =
well
as a reduction in pO2 (69.00%). Sodium,
potassium, bicarbonate, pH
and pCO2 values were normal for most cases (Table
3).
The patients studied presented increased levels of PCR (97.53%) an=
d lacticdehydrogenase (94.=
52%) on admission, as well as a <=
span
class=3DSpellE>reduction in pO2 (69.00%). Sodiu=
m,
potassium, bicarbonate, pH,
and pCO2 were values normal for most cases
Table 3 -Biochemicalparameters of=
individuals with COVID-19. Rondonópolis, MT, 2021.
Variável
N
(%)
<=
span
style=3D'font-size:12.0pt;font-family:"Times New Roman",serif'>C-Reactive=
Protein (=
Lessthan 6 mg/L)<=
/o:p>
Median in mg/L
102.90
Normal
5 (2.46)
High
198 (97.53)
Reduced
0 (0.00)
<=
span
style=3D'font-size:12.0pt;font-family:"Times New Roman",serif'>Sodium (136 to 1=
45
mmol/L)
Median in mmol/L=
137.00
Normal
179 (91.00)
High
4 ( 2.03)
Reduced
14 (7.10)
<=
span
style=3D'font-size:12.0pt;font-family:"Times New Roman",serif'>Potassium<=
/span> (3.6 to 5=
.5
mmol/L)
Median in mmol/L=
4.30
Normal
176 (90.25)
High
7 ( 3.59)
Reduced
12 (6.15)
<=
span
style=3D'font-size:12.0pt;font-family:"Times New Roman",serif'>Lacticdehydrogenase (135 to 225 U/L)
Median in U/L
409.00
Normal
4 ( 5.479)
High
67 ( 94.52)
Reduced
0 (0.00)
pCO2 (35 to 45 mmHg)
Median in mmHg
35.70
Normal
91 (52.29)
High
16 (9.19)
Reduced
67 (35.50)
=
pO2 (83 to=
108
mmHg)
Median in mmHg
65.15
Normal
39 (22.41)
High
15 (8.62)
Reduced
120 (69.00)
<=
span
style=3D'font-size:12.0pt;font-family:"Times New Roman",serif'>Bicarbonat=
e (21 - 28 =
Mol/L)
Median in Mol/L<=
o:p>
23.05
Normal
121 (69.54)
High
8 (4.59)
Reduced
45 (26.00)
pH (7.32 to 7.43)<=
/span>
Median
7.42
Normal
137 (79.65)
High
23 (13.37)
Reduced
12 (7.00)
Source:
the authors
DISCUSSION
Patients
with COVID-19 included in this research had a <=
span
class=3DSpellE>mean age of 57.13 years, with a =
predominance
of males (54.15%). The analysis of the demographic
patients diagnosed profile with COVID-19 in a p=
ublic reference hospital in the city of
Fortaleza, Ceará, Brazil, revealed that most pa=
tients
were male, aged between 36 and 60 years11<=
/sup>.
A retrospective study in 1335 patients hospitalized
for COVID-19 in London, England indicated the <=
span
class=3DSpellE>mean age was 70 years and 56% were men12. A
survey conducted in Scotland found that the mean age of patients hospitalize=
d
for COVID-19 was 76 years and 52.70% were male13.
A
study that determinedfact=
ors
associated with risk or protection for COVID-19=
in southern Brazil showed th=
at the prevalence of hospitalization for
COVID-19 is lower for fema=
les.
The authorssuggest=
that biologicaldifferences be=
tween men and women shouldreflectdistinctimmune responses, impacting the
course of the disease14.Individual geneticsusceptibility an=
d environmentalinfluences =
on virus
infection should also be c=
onsidered,
which canresult in=
different clinical phenotypes
between populations and countries15<=
o:p>
According
to the Ministry of Health, fever,
cough, dyspnea, myalgia and fatigue are considered the most common signs=
and symptoms in COVID-1916. In the populationstudied, there=
was a predominance of dyspnea, =
cough,
and fever. Liu et al., des=
cribed
that fever, cough, and fatigue were the most prevalentsymptoms in cas=
es of hospitalization for COVID-19. In the study by Teich et al., the most common clinical manifestations=
in
patients hospitalized for COVID-19 were headache, cough, and nasal congestion4. Variations
in clinical manifestations are due, among other proper=
ties,
to differences in age, mor=
bidity,
social and cultural conditions, and health care=
. Identifying the main clin=
ical
characteristics of patients infected with SARS-=
CoV-2 maycontribute to the man=
agement
of the disease18
The
most frequent comorbidities were systemic
arterial hypertension and diabetes mellitus, corroboratingprevious st=
udies4,12,13.
The presence of comorbidit=
ies
is associated with the development of severe CO=
VID-19
and a higher risk of death9,14,19.
SARS-CoV-2 infection is triggered when the S pr=
otein
of the virus binds to the angiotensin-2 convertingenzyme (ACE2),=
resulting in an accumulation of angiotensin 2 and a reduction of angiotensin 1-7.
The
role of angiotensin 2 in COVID-19 hypertensive
patients seems to be crucial because
it promotes vasoconstriction, sodiumretention, oxidative
stress, inflammation and f=
ibrosis,
compromising the arterial pressure regulation20.
ACE2 expression is increased in patients with t=
ype 2
diabetes mellitus. Thisup=
regulation
is associated with chronicinflammation,
activation of endothelial<=
/span> cells and insulinresistance which aggravates the inflammatory
response and leads to alveolar-capillarybarrierdysfunction. COVI=
D-19 is
a systemic infection with a significant impact =
on the
hematopoietic system and h=
emostasis.
Among
the hematologicalalterati=
ons,
lymphopeniacan be =
considered an important
laboratory finding, with r=
elevance
for the prognosis of the disease. Most (73%) of the patients analyzed had lymphopenia,=
as described in previous stu=
dies4,23,24,25.
Individuals with severe or critical
COVID-19 have a lowerlymp=
hocytecount compared to patients with non-severe dise=
ase9,21.
The
case-control study by Pan et al. identified tha=
t lymphopenia was an independent
factor associated with mortality in individuals=
with
severe COVID-19. The reduction in lymphocytecountmayresult from viral binding=
to cells with subsequentlysis, exudation of circulatinglymphocytes <=
span
class=3DSpellE>intolungtissues
and atrophy of lymphoid organs, which impairs cel=
l renewal.
The
analysis of laboratory tests revealed an increa=
se in PCR
levels in 97.04% of cases. Among the markers re=
lated
to the response to the acute-phase inflammatory=
reaction, PCR is the most sensit=
ive,
but with low specificity.
The protein activates the =
complement
system through the classicalpathway,
initiatesopsonization,
promotes chemotaxis and, f=
inally,
stimulates the processes of phagocytosis
and lysis of antigens26. A frequency of 88% of Iranian patients admitted
to a referral hospital for COVID-19 had elevated PCR levels25. A study conducted in a hospital in São Paulo – SP, observed that 93% of patients ho=
spitalized
for COVID-19 had increased PCR. In patients with COVID-19 admitted
to a hospital in Wuhan, China, increased PCR levels were associated with greater disease severity, the hi=
ghestmean values were observed<=
/span>
in the progression phase of the infection.=
Another
laboratory alterationobse=
rved
was the reduction in pO2 levels, thisfinding was also described=
in other studies8,23. A multicentercohort study including hospitals in Europe
and the United States found that, among other <=
span
class=3DSpellE>factors, a reduction in O=
2 saturation levels ≤ 93% was associated with higher mortality from COVID-1927. The main
clinical manifestation presented by the studied patients was dyspnea,
which can be explained by
the frequent observation of a reduction
in pO2. Monitoringhypoxem=
ia
in these patients is essen=
tial
for decision-making, both for treatmentguidance and for evaluating the
prognosis of the infection23.
Another
laboratory alterationobse=
rved
was the reduction in pO2 levels, thisfinding was also described=
in other studies8,23.A multicentercohort study including hospitals in Europe and the United States
found that, among other factors, a reduction in O2 saturation levels
≤ 93% was associated with higher mortalit=
y from
COVID-1927.The main
clinical manifestation presented by the studied patients was dyspnea,
which can be explained by
the frequent observation of a reduction
in pO2. Monitoringhypoxem=
ia
in these patients is essen=
tial
for decision-making, guiding treatment and evaluating both the prognosis of the infection28=
.
The
present study has s=
ome limitations, such as incompleteinformation in=
some
medical records, especiallylacticdehydrogenase data, which were not available for most patients. it is worth highlighting that limitation is
frequent in retrospective studies that use medical records. Future studies
including other laboratory tests should be carr=
ied
out in order to contribute=
to a betterunderstanding<=
/span>
of COVID-19.
CONCLUSIONS
The
data presented allowedus<=
/span>
to define the clinical and laboratory profile of patients hospitalized
for COVID-19 in the southernregion
of Mato Grosso. The most frequent clinical manifestati=
on
was dyspnea and systemic
arterial hypertension was the most prevalentcomorbidity. Lymphopenia, elevated PCR=
, lacticdehydrogenase and =
reduced
pO2 were the laboratory alterationsobserved. These results <=
span
class=3DSpellE>maycontribute to a betterunderstanding of t=
he epidemiology of COVID-19.
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o:p>
9.
Gao Y, Ding M, Dong=
X, et
al. Risk factors for severe and criticallyill COVID-19 patients: A review. Allergy,
2021; 76: 428–455.
C=
OVID-19
and Hospital Palliative Care - A service evaluation ex=
ploring
the symptoms and outcomes of 186 patients and t=
he impact
of the pandemic on specialist Hospital Palliati=
ve
Care. Palliat. Med. 2020; 34 (9): 1256–62.
GZ. Alterações laboratoriai=
s em
pacientes com COVID-19. Res. Soc. Develop. 2020=
; 9 (12):
e30191211115.