Marcadores de gravidade na covid-19: associação entre hiperlactatemia e desfechos clínicos na srag

Abstract

Acute Severe Respiratory Syndrome (SARS) is a potentially serious respiratory disease capable of causing acute lung injury. Among the infectious agents involved are viruses (Influenza types A and B, Respiratory Syncytial Virus, SARS-CoV-2), bacteria, and fungi. With the Covid-19 pandemic, there was an exponential increase in the number of SARS cases, as well as in the admission rates to intensive care units. Studies show the relationship between elevated lactate levels and unfavorable outcomes in heterogeneous patients in the intensive care environment; however, analyzes on lactate measurement in patients with Covid-19 induced SARS are scarce. Therefore, the main objective of this work is to evaluate the impact of hyperlactatemia on the unfavorable clinical outcomes of patients with Severe Acute Respiratory Syndrome in the context of Covid-19 in intensive care units in Sergipe. The study is a retrospective cohort, carried out in ICUs of five hospitals in the state of Sergipe (public and private). Patients of both sexes aged eighteen years or over, with a minimum length of stay of 24 hours and who had a positive RT-PCR for Covid-19, were included. The data were obtained by reading the medical records of patients admitted from April 2020 to January 2022, completing a standardized collection instrument. There was data tabulation in an electronic spreadsheet and analysis using Jamovi 2.3.28 Software, using appropriate statistical tests. As a result, a significant association was observed between the admission lactate level and the increase in the chances of death (OR 1.804; p-value 0.028). By comparing the groups, it was possible to verify that patients with hyperlactatemia were more likely to die (RR 1.58) and presented a higher risk of developing cardiac complications (RR 1.79; p-value 0.016). The outcomes “acute kidney injury” and “need for dialysis” were not relevant when associated with lactate levels. On the other hand, the mean and median days of hospital and ICU stay were notably lower in patients with high lactate (mean 20.7 and 11.8 versus 29.9 and 26.9 - median 9.5 and 9 versus 15 and 11), as well as its survival time (p-value 0.009 and 0.002), indicating a higher risk of death in this population. Analyzing lactate clearance in 24 hours, the number of deaths exceeded the number of survivors for clearance < 30% (76.92%). In general, this study demonstrated that hyperlactatemia is associated with worse clinical outcomes in patients with Covid-19 and SARS, which reinforces its relevance as an essential marker in intensive care units.