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1. Characteristics and outcomes of patients with COVID-19 admitted to the ICU in a university hospital in São Paulo, Brazil - study protocol

Author

Juliana C. Ferreira, Yeh-Li Ho, Bruno A.M.P. Besen, Luiz M.S. Malbuisson, Leandro U. Taniguchi, Pedro V. Mendes, Eduardo L.V. Costa, Marcelo Park, Renato Daltro-Oliveira, Roberta M.L. Roepke, João M. Silva Jr, Maria José C. Carmona, Carlos Roberto Ribeiro Carvalho, Adriana Hirota, Alberto Kendy Kanasiro, Alessandra Crescenzi, Amanda Coelho Fernandes, Anna Miethke-Morais, Arthur Petrillo Bellintani, Artur Ribeiro Canasiro, Bárbara Vieira Carneiro, Beatriz Keiko Zanbon, Bernardo Pinheiro De Senna Nogueira Batista, Bianca Ruiz Nicolao, Bruno Adler Maccagnan Pinheiro Besen, Bruno Biselli, Bruno Rocha De Macedo, Caio Machado Gomes De Toledo, Carlos Eduardo Pompilio, Carlos Roberto Ribeiro De Carvalho, Caroline Gomes Mol, Cassio Stipanich, Caue Gasparotto Bueno, Cibele Garzillo, Clarice Tanaka, Daniel Neves Forte, Daniel Joelsons, Daniele Robira, Eduardo Leite Vieira Costa, Elson Mendes Da Silva Júnior, Fabiane Aliotti Regalio, Gabriela Cardoso Segura, Gustavo Brasil Marcelino, Giulia Sefrin Louro, Isabela Argollo Ferreira, Jeison de Oliveira Gois, Joao Manoel Da Silva Junior, Jose Otto Reusing Junior, Julia Fray Ribeiro, Juliana Carvalho Ferreira, Karine Vusberg Galleti, Katia Regina Silva, Larissa Padrao Isensee, Larissa dos Santos Oliveira, Leandro Utino Taniguchi, Leila Suemi Letaif, Lígia Trombetta Lima, Lucas Yongsoo Park, Lucas Chaves Netto, Luciana Cassimiro Nobrega, Luciana Haddad, Ludhmila Hajjar, Luiz Marcelo Malbouisson, Manuela Cristina Adsuara Pandolfi, Maria José Carvalho Carmona, Maria Castilho Prandini H De Andrade, Mariana Moreira Santos, Matheus Pereira Bateloche, Mayra Akimi Suiama, Mayron Faria de Oliveira, Mayson Laercio Sousa, Michelle Louvaes, Natassja Huemer, Pedro Mendes, Paulo Ricardo Gessolo Lins, Pedro Gaspar Dos Santos, Pedro Ferreira Paiva Moreira, Renata Mello Guazzelli, Renato Batista Dos Reis, Renato Daltro De Oliveira, Roberta Muriel Longo Roepke, Rodolpho Augusto De Moura Pedro, Rodrigo Kondo, Samia Zahi Rached, Sergio Roberto Silveira Da Fonseca, Thais Sousa Borges, Thalissa Ferreira, Vilson Cobello Junior, Vivian Vieira Tenório Sales, and Willaby Serafim Cassa Ferreira

Subjects
Ventilation, Artificial, Severe Acute Respiratory Syndrome, Intensive Care Units, SARS Virus, COVID-19, Medicine (General), R5-920
Abstract

OBJECTIVES: We designed a cohort study to describe characteristics and outcomes of patients with coronavirus disease (COVID-19) admitted to the intensive care unit (ICU) in the largest public hospital in Sao Paulo, Brazil, as Latin America becomes the epicenter of the pandemic. METHODS: This is the protocol for a study being conducted at an academic hospital in Brazil with 300 adult ICU beds dedicated to COVID-19 patients. We will include adult patients admitted to the ICU with suspected or confirmed COVID-19 during the study period. The main outcome is ICU survival at 28 days. Data will be collected prospectively and retrospectively by trained investigators from the hospital’s electronic medical records, using an electronic data capture tool. We will collect data on demographics, comorbidities, severity of disease, and laboratorial test results at admission. Information on the need for advanced life support and ventilator parameters will be collected during ICU stay. Patients will be followed up for 28 days in the ICU and 60 days in the hospital. We will plot Kaplan-Meier curves to estimate ICU and hospital survival and perform survival analysis using the Cox proportional hazards model to identify the main risk factors for mortality. ClinicalTrials.gov: NCT04378582. RESULTS: We expect to include a large sample of patients with COVID-19 admitted to the ICU and to be able to provide data on admission characteristics, use of advanced life support, ICU survival at 28 days, and hospital survival at 60 days. CONCLUSIONS: This study will provide epidemiological data about critically ill patients with COVID-19 in Brazil, which could inform health policy and resource allocation in low- and middle-income countries.

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2. Community-acquired pneumonia severity assessment tools in patients hospitalized with COVID-19: a validation and clinical applicability study

Author

Hassam Rahhal, Maria Lorraine Silva de Rosa, Manuela Cristina Adsuara Pandolfi, Yago Henrique Padovan Chio, Cauê Gasparatto Bueno, Andrea Palomeque, Rodrigo Cezar Miléo, Erika Thiemy Brito Miyaguchi, Danilo Dias de Francesco, Julio Cesar Leite Fortes, Marcelo Petrof Sanches, Thiago Areas Lisboa Netto, Clara Carvalho de Alves Pereira, Diego Juniti Takamune, Matheus Finardi Lima de Faria, Patricia Albuquerque de Moura, Sabrina Ribeiro, Beatriz Larios Fantinatti, Otavio T. Ranzani, Rodolfo Affonso Xavier, Fernando Valente, Diogo Visconti Guidotte, Nilo Arthur Bezerra Martins, Giovanna Babikian Costa, Eduardo Padrão, Gabriel Martinez, Nuria Albacar, Antoni Torres, Heraldo Possolo de Souza, Daniel Rodrigues Ribeiro, Lucas Oliveira Marino, Gabriel de Paula Maroni Escudeiro, Rafael Faria Pisciolaro, Debora Lopes Emerenciano, Rafael Berenguer Luna, Emily Cristine Oliveira Silva, Isabela Harumi Omori, Catia Cilloniz, Edwin Albert D'Souza, Rodrigo Werner Toccoli, Everton Luis Santos Moreira, Yasmine Souza Filippo Fernandes, Carine Faria, Laura de Góes Campos, Eduardo Mariani Pires de Campos, Bruna Tolentino Caldeira, Rodrigo de Souza Abreu, João Pedro Afonso Nascimento, Lucas Gonçalves Dias Barreto, Julio Flávio Meirelles Marchini, Vitor Macedo Brito Medeiros, Felippe Lazar Neto, Ligia Trombetta Lima, Geovane Wiebelling da Silva, Luiza Boscolo, Tales Cabral Monsalvarga, Andrew Araujo Tavares, Pedro Antonio Araújo Simões, Mauricio Ursoline do Nascimento, Luz Marina Gomez Gomez, Júlio César Garcia de Alencar, Rodrigo Antonio Brandão Neto, Mariana Mendes Gonçalves Cimatti De Calasans, Ester Minã Gomes da Silva, Renata Kan Nishiaka, Fernanda Máximo Fonseca e Silva, Alicia Dudy Müller Veiga, Gustavo Biz Martins, Felipe Liger Moreira, Gabriel Travessini, Maria Clara Saad Menezes, João Martelleto Baptista, Alexandre Lemos Bortolotto, Marcelo de Oliveira Silva, Felipe Mouzo Bortoleto, Henrique Tibucheski dos Santos, Ademar Lima Simões, Arthur Petrillo Bellintani, Carlos Eduardo Umehara Juck, Stefany Franhan Barbosa de Souza, and Bianca Ruiz Nicolao

Subjects
Male, 0301 basic medicine, Pneumonia severity index, coronavirus, Psychological intervention, severity, Validation Studies as Topic, Severity of Illness Index, law.invention, 0302 clinical medicine, Community-acquired pneumonia, Risk Factors, law, Hospital Mortality, 030212 general & internal medicine, validation, Aged, 80 and over, Mortality rate, General Medicine, Middle Aged, Prognosis, Intensive care unit, Community-Acquired Infections, Hospitalization, Intensive Care Units, Infectious Diseases, Area Under Curve, Original Article, Female, Brazil, Adult, Microbiology (medical), medicine.medical_specialty, 030106 microbiology, Risk Assessment, 03 medical and health sciences, Internal medicine, Prohibitins, medicine, pneumonia, Humans, Aged, Retrospective Studies, Receiver operating characteristic, business.industry, COVID-19, Retrospective cohort study, prediction, medicine.disease, mortality, Pneumonia, Spain, business
Abstract

Objective To externally validate community-acquired pneumonia (CAP) tools on patients hospitalized with coronavirus disease 2019 (COVID-19) pneumonia from two distinct countries, and compare their performance with recently developed COVID-19 mortality risk stratification tools. Methods We evaluated 11 risk stratification scores in a binational retrospective cohort of patients hospitalized with COVID-19 pneumonia in Sao Paulo and Barcelona: Pneumonia Severity Index (PSI), CURB, CURB-65, qSOFA, Infectious Disease Society of America and American Thoracic Society Minor Criteria, REA-ICU, SCAP, SMART-COP, CALL, COVID GRAM and 4C. The primary and secondary outcomes were 30-day in-hospital mortality and 7-day intensive care unit (ICU) admission, respectively. We compared their predictive performance using the area under the receiver operating characteristics curve (AUC), sensitivity, specificity, likelihood ratios, calibration plots and decision curve analysis. Results Of 1363 patients, the mean (SD) age was 61 (16) years. The 30-day in-hospital mortality rate was 24.6% (228/925) in Sao Paulo and 21.0% (92/438) in Barcelona. For in-hospital mortality, we found higher AUCs for PSI (0.79, 95% CI 0.77–0.82), 4C (0.78, 95% CI 0.75–0.81), COVID GRAM (0.77, 95% CI 0.75–0.80) and CURB-65 (0.74, 95% CI 0.72–0.77). Results were similar for both countries. For the 1%–20% threshold range in decision curve analysis, PSI would avoid a higher number of unnecessary interventions, followed by the 4C score. All scores had poor performance (AUC Conclusions Recent clinical COVID-19 assessment scores had comparable performance to standard pneumonia prognostic tools. Because it is expected that new scores outperform older ones during development, external validation studies are needed before recommending their use.

Published
2021
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3. Characteristics and outcomes of patients with COVID-19 admitted to the ICU in a university hospital in São Paulo, Brazil - study protocol

Author

Juliana C. Ferreira, Yeh-Li Ho, Bruno A.M.P. Besen, Luiz M.S. Malbuisson, Leandro U. Taniguchi, Pedro V. Mendes, Eduardo L.V. Costa, Marcelo Park, Renato Daltro-Oliveira, Roberta M.L. Roepke, João M. Silva, Maria José C. Carmona, Carlos Roberto Ribeiro Carvalho, Adriana Hirota, Alberto Kendy Kanasiro, Alessandra Crescenzi, Amanda Coelho Fernandes, Anna Miethke-Morais, Arthur Petrillo Bellintani, Artur Ribeiro Canasiro, Bárbara Vieira Carneiro, Beatriz Keiko Zanbon, Bernardo Pinheiro De Senna Nogueira Batista, Bianca Ruiz Nicolao, Bruno Adler Maccagnan Pinheiro Besen, Bruno Biselli, Bruno Rocha De Macedo, Caio Machado Gomes De Toledo, Carlos Eduardo Pompilio, Carlos Roberto Ribeiro De Carvalho, Caroline Gomes Mol, Cassio Stipanich, Caue Gasparotto Bueno, Cibele Garzillo, Clarice Tanaka, Daniel Neves Forte, Daniel Joelsons, Daniele Robira, Eduardo Leite Vieira Costa, Elson Mendes Da Silva, Fabiane Aliotti Regalio, Gabriela Cardoso Segura, Gustavo Brasil Marcelino, Giulia Sefrin Louro, Isabela Argollo Ferreira, Jeison de Oliveira Gois, Joao Manoel Da Silva, Jose Otto Reusing, Julia Fray Ribeiro, Juliana Carvalho Ferreira, Karine Vusberg Galleti, Katia Regina Silva, Larissa Padrao Isensee, Larissa dos Santos Oliveira, Leandro Utino Taniguchi, Leila Suemi Letaif, Lígia Trombetta Lima, Lucas Yongsoo Park, Lucas Chaves, Luciana Cassimiro Nobrega, Luciana Haddad, Ludhmila Hajjar, Luiz Marcelo Malbouisson, Manuela Cristina Adsuara Pandolfi, Maria José Carvalho Carmona, Maria Castilho Prandini H De Andrade, Mariana Moreira Santos, Matheus Pereira Bateloche, Mayra Akimi Suiama, Mayron Faria de Oliveira, Mayson Laercio Sousa, Michelle Louvaes, Natassja Huemer, Pedro Mendes, Paulo Ricardo Gessolo Lins, Pedro Gaspar Dos Santos, Pedro Ferreira Paiva Moreira, Renata Mello Guazzelli, Renato Batista Dos Reis, Renato Daltro De Oliveira, Roberta Muriel Longo Roepke, Rodolpho Augusto De Moura Pedro, Rodrigo Kondo, Samia Zahi Rached, Sergio Roberto Silveira Da Fonseca, Thais Sousa Borges, Thalissa Ferreira, Vilson Cobello, Vivian Vieira Tenório Sales, and Willaby Serafim Cassa Ferreira

Subjects
Research design, medicine.medical_specialty, Medicine (General), Pneumonia, Viral, 030204 cardiovascular system & hematology, Severe Acute Respiratory Syndrome, law.invention, Cohort Studies, Hospitals, University, 03 medical and health sciences, Betacoronavirus, 0302 clinical medicine, R5-920, law, Epidemiology, medicine, Humans, 030212 general & internal medicine, Hospital Mortality, Pandemics, Proportional hazards model, business.industry, SARS-CoV-2, Medical record, COVID-19, General Medicine, SARS Virus, Intensive care unit, Ventilation, Advanced life support, Observational Studies as Topic, Intensive Care Units, Research Design, Public hospital, Emergency medicine, Artificial, Original Article, business, Coronavirus Infections, Brazil, Cohort study
Abstract

OBJECTIVES: We designed a cohort study to describe characteristics and outcomes of patients with coronavirus disease (COVID-19) admitted to the intensive care unit (ICU) in the largest public hospital in Sao Paulo, Brazil, as Latin America becomes the epicenter of the pandemic. METHODS: This is the protocol for a study being conducted at an academic hospital in Brazil with 300 adult ICU beds dedicated to COVID-19 patients. We will include adult patients admitted to the ICU with suspected or confirmed COVID-19 during the study period. The main outcome is ICU survival at 28 days. Data will be collected prospectively and retrospectively by trained investigators from the hospital’s electronic medical records, using an electronic data capture tool. We will collect data on demographics, comorbidities, severity of disease, and laboratorial test results at admission. Information on the need for advanced life support and ventilator parameters will be collected during ICU stay. Patients will be followed up for 28 days in the ICU and 60 days in the hospital. We will plot Kaplan-Meier curves to estimate ICU and hospital survival and perform survival analysis using the Cox proportional hazards model to identify the main risk factors for mortality. ClinicalTrials.gov: NCT04378582. RESULTS: We expect to include a large sample of patients with COVID-19 admitted to the ICU and to be able to provide data on admission characteristics, use of advanced life support, ICU survival at 28 days, and hospital survival at 60 days. CONCLUSIONS: This study will provide epidemiological data about critically ill patients with COVID-19 in Brazil, which could inform health policy and resource allocation in low- and middle-income countries.

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