Factores relacionados al óbito por COVID-19 en mujeres embarazadas hospitalizadas en Unidad de Cuidado Intensivo

Ribeiro, Milena Ricioli; Silva, Marcela de Andrade Pereira; Prates, Leticia Furlan de Lima; Oliveira, Rosana Rosseto de; Carvalho, Maria Dalva de Barros; Pelloso, Sandra Marisa

Milena Ricioli Ribeiro

conception or design of the study/research

analysis and/or interpretation of data

Universidade Estadual de Maringá. Maringá, Paraná, Brazil

https://orcid.org/0009-0004-1778-6377

Marcela de Andrade Pereira Silva Corresponding author Marcela de Andrade Pereira Silva, E-mail: enf.marceladeandrade@gmail.com

conception or design of the study/research

analysis and/or interpretation of data

Centro Universitário Ingá. Maringá, Paraná, Brazil

https://orcid.org/0000-0002-2091-5975

Leticia Furlan de Lima Prates

final review with critical

intellectual participation in the manuscript

Universidade Estadual de Maringá. Maringá, Paraná, Brazil

https://orcid.org/0000-0003-1376-4619

Rosana Rosseto de Oliveira

analysis and/or interpretation of data

Centro Universitário Ingá. Maringá, Paraná, Brazil

https://orcid.org/0000-0003-3373-1654

Maria Dalva de Barros Carvalho

final review with critical

intellectual participation in the manuscript

Universidade Estadual de Maringá. Maringá, Paraná, Brazil

https://orcid.org/0000-0002-1377-3331

Sandra Marisa Pelloso

final review with critical

intellectual participation in the manuscript

Universidade Estadual de Maringá. Maringá, Paraná, Brazil

https://orcid.org/0000-0001-8455-6839

Corresponding author
Marcela de Andrade Pereira Silva, E-mail: enf.marceladeandrade@gmail.com

EDITOR IN CHIEF

Antonio José de Almeida Filho

ASSOCIATE EDITOR

Marcia Cubas

Variables	n (%)	Desfecho		Crude OR	95% CI	p
Variables	n (%)	Death	Discharge	Crude OR	95% CI	p
Age
< 20 years	170 (4.8)	22 (12.9)	148 (87.1)	0.54	0.34-0.85	0.008
20-34 years	2,209 (62.3)	478 (21.6)	1,731 (78.4)	-
> 34 years	1,168 (32.9)	311 (26.6)	857 (73.4)	1.31	1.11-1.55	0.001
Race/Color¹ 1 n = 3.057; 2 n = 3.115; 3 n = 3.448; 4 n = 1.561; OR - Odds Ratio; CI - Confidence interval.
White	1,445 (47.3)	298 (20.6)	1,147 (79.4)	-
Non-white	1,612 (57.7)	435 (27.0)	1,177(73.0)	1.42	1.20-1.68	< 0.001
Region of residence
South	582 (16.4)	134 (23.0)	448 (77.0)	-
Southeast	1,669 (47.1)	335 (20.1)	1,334 (79.9)	0.84	0.67-1.05	0.131
Center-West	440 (12.4)	102 (23.2)	338 (76.8)	1.01	0.75-1.35	0.953
North	269 (7.6)	92 (34.2)	177 (65.8)	1.74	1.26-2.39	0.001
Northeast	587 (16.5)	148 (25.2)	439 (74.8)	1.13	1.26-2.39	0.382
Residence zone²2 World Health Organization (WHO). Global Health Observatory Data Repository. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV) [Internet]. 2020 [cited 2022 Jun 1]. Available from: https://www.who.int/news/item/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov) https://www.who.int/news/item/30-01-2020...
Urban	2,917 (93.6)	671 (23.0)	2,246 (77.0)	-
Rural ou peri-urban	198 (6.4)	57 (28.8)	141 (71.2)	1.35	0.98-1.86	0.064
Gestacional Trimester³3 World Health Organization (WHO). Global Health Observatory Data Repository. WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020 [Internet]. 2020 [cited 2022 Jul 15]. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 https://www.who.int/director-general/spe...
1st trimester	257 (7.5)	65 (25.3)	192 (74.7)	-
2nd trimester	1154 (33.5)	262 (22.7)	892 (77.3)	0.87	0.63-1.19	0.374
3rd trimester	2,037 (59.0)	451 (22.1)	1,586 (77.9)	0.84	0.62-1.13	0.255
Received the COVID-19 vaccine⁴4 World Health Organization (WHO). Histórico da pandemia de COVID-19 [Internet]. Geneva: WHO; 2023 [cited 2022 Jul 15]. Available from: https://www.paho.org/pt/covid19/historico-da-pandemia-covid-19 https://www.paho.org/pt/covid19/historic...
Yes	318 (20.4)	36 (11.3)	282 (88.7)	-
No	1,243 (79.6)	360 (29.0)	883 (71.0)	3.19	2.21-4.61	< 0.001

Comorbidities	n (%)	Outcome		Crude OR	95% CI	p
Comorbidities	n (%)	Death	Discharge	Crude OR	95% CI	p
Chronic cardiovascular disease
Yes	419 (11.8)	127 (30.3)	292 (69.7)	1.55	1.24-1.95	< 0.001
No	3.128 (88.2)	684 (21.9)	2.444 (78.1)	-
Chronic hematological disease
Yes	17 (0.5)	6 (35.3)	11 (64.7)	1.85	0.68-5.01	0.228
No	3.530 (99.5)	805 (22.8)	2.725 (77.2)	-
Chronic liver disease
Yes	10 (0.3)	4 (40.0)	6 (60.0)	2.25	0.64-8.01	0.209
No	3,537 (99.7)	807 (22.8)	2,730 (77.2)	-
Asthma and/or pneumopathy
Yes	183 (5.1)	47 (25.7)	136 (74.3)	1.18	0.84-1.65	0.352
No	3,364 (94.9)	764 (22.7)	2,600 (77.3)	-
Diabetes mellitus
Yes	363 (10.2)	110 (30.3)	253 (69.7)	1.54	1.21-1.96	< 0.001
No	3,184 (89.8)	701 (22.0)	2,483 (78.0)	-
Chronic neurological disease
Yes	30 (0.8)	8 (26.7)	22 (73.3)	1.23	0.54-2.77	0.619
No	3,517 (99.2)	803 (22.8)	2,714 (77.2)	-
Immunodeficiency
Yes	36 (1.0)	14 (38.9)	22 (61.1)	2.17	1.10-4.25	0.025
No	3,511 (99.0)	797 (22.7)	2,714 (77.3)	-
Chronic kidney disease
Yes	30 (0.8)	7 (23.3)	23 (76.7)	1.02	0.44-2.40	0.951
No	3,517 (99.2)	804 (22.9)	2,713 (77.1)	-
Obesity
Yes	409 (11.5)	141 (34.5)	268 (65.5)	1.94	1.55-2.42	< 0.001
No	3,138 (88.5)	670 (21.4)	2,468 (78.6)	-

Clinical and Respiratory Symptoms	n (%)	Outcome		Crude OR (95% CI)	p
Clinical and Respiratory Symptoms	n (%)	Death	Discharge	Crude OR (95% CI)	p
Fever¹ 1 n = 3.035; 2 n = 3.207; 3 n = 2.554; 4 n = 3.242; 5 n = 2.937; 6 n = 3.052; 7 n = 2.512; 8 n = 2.505; 9 n = 2.182; 10 n = 2.306; 11 n = 2.282; 12 n = 2.241; 13 n = 2.687; OR - Odds Ratio; CI - Confidence interval.
Yes	2,095 (69.0)	517 (24.7)	1,578 (75.3)	1.25 (1.04;1.51)	0.018
No	940 (31.0)	195 (20.7)	745 (19.3)	-
Cough²2 World Health Organization (WHO). Global Health Observatory Data Repository. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV) [Internet]. 2020 [cited 2022 Jun 1]. Available from: https://www.who.int/news/item/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov) https://www.who.int/news/item/30-01-2020...
Yes	2,674 (83.4)	611 (22.8)	2,063 (77.2)	0.82 (0.67;1.02)	0.073
No	533 (16.6)	141 (26.5)	392 (73.5)	-
Sore throat³3 World Health Organization (WHO). Global Health Observatory Data Repository. WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020 [Internet]. 2020 [cited 2022 Jul 15]. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 https://www.who.int/director-general/spe...
Yes	655 (25.0)	152 (23.2)	503 (76.8)	0.96 (0.78;1.19)	0.736
No	1,899 (75.0)	453 (23.9)	1.446 (76.1)	-
Dyspnea⁴4 World Health Organization (WHO). Histórico da pandemia de COVID-19 [Internet]. Geneva: WHO; 2023 [cited 2022 Jul 15]. Available from: https://www.paho.org/pt/covid19/historico-da-pandemia-covid-19 https://www.paho.org/pt/covid19/historic...
Yes	2,740 (84.5)	678 (24.7)	2,062 (75.3)	1.76 (1.36;2.27)	< 0.001
No	502 (15.5)	79 (15.7)	423 (84.3)	-
Respiratory Discomfort⁵5 Elmore R, Schmidt L, Lam J, Howard BE, Tandon A, Norman C, et al. Risk and protective factors in the COVID-19 Pandemic: a rapid evidence map. Front Public Health. 2020;8:582205. https://doi.org/10.3389/fpubh.2020.582205 https://doi.org/10.3389/fpubh.2020.58220...
Yes	2,103 (71.6)	544 (25.9)	1,559 (74.1)	1.37 (1.13;1.67)	0.001
No	834 (28.4)	169 (20.3)	665 (79.7)	-
O₂ saturation < 95%⁶6 Villar J, Ariff S, Gunier RB, Thiruvengadam R, Rauch S, Kholin A, et al. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 Infection: the INTERCOVID Multinational Cohort Study. JAMA Pediatr. 2021;175(8):817-26. https://doi.org/10.1001/jamapediatrics.2021.1050 https://doi.org/10.1001/jamapediatrics.2...
Yes	2,192 (71.8)	586 (26.7)	1,606 (73.3)	1.88 (1.53;2.30)	< 0.001
No	860 (28.2)	140 (16.3)	720 (83.7)	-
Diarrhea⁷7 Orellana J, Jacques N, Leventhal DGP, Marrero L, Morón-Duarte LS. Excess maternal mortality in Brazil: regional inequalities and trajectories during the COVID-19 epidemic. Plos One. 2022;17(10):e0275333. https://doi.org/10.1371/journal.pone.0275333 https://doi.org/10.1371/journal.pone.027...
Yes	321 (12.7)	77 (24.0)	244 (76.0)	1.01 (0.77;1.33)	0.949
No	2,191 (87.3)	522 (23.8)	1,669 (76.2)	-
Vomiting⁸
Yes	325 (12.9)	61 (18.8)	264 (81.2)	0.73 (0.55;0.99)	0.040
No	2,180 (87.1)	522 (23.9)	1,658 (76.1)	-
Abdominal Pain⁹9 Ministério da Saúde (BR). Resolução no 510, de 7 de abril de 2016. Dispões sobre normas aplicáveis a pesquisas em Ciências Humanas e Sociais [Internet]. Brasília; 2016 [cited 2021 Dec 15]. Available from: https://conselho.saude.gov.br/resolucoes/2016/Reso510.pdf https://conselho.saude.gov.br/resolucoes...
Yes	215 (9.8)	52 (24.2)	163 (75.8)	1.01 (0.73;1.41)	0.941
No	1,966 (90.2)	471 (24.0)	1,495 (76.0)	-
Fatigue¹⁰10 Nakamura PM, Amorim RMM, Pacagnella RC, Takemoto LSM, Penso CCF, Rezende FJ, et al. Covid-19 and Maternal Death in Brazil: an invisible tragedy. Rev Bras Ginecol Obstet. 2020;42(08):445-7. https://doi.org/10.1055/s-0040-1715138 https://doi.org/10.1055/s-0040-1715138...
Yes	907 (39.3)	218 (24.0)	689 (76.0)	1.05 (0.86;1.27)	0.657
No	1,399 (60.7)	325 (23.2)	1,074 (76.8)	-
Loss of smell¹¹
Yes	490 (21.5)	88 (18.0)	402 (82.0)	0.68 (0.53;0.88)	0.004
No	1,792 (78.5)	434 (24.2)	1,358 (75.8)	-
Loss of taste¹²12 Brendolin M, Fuller T, Wakimoto M, Rangel L, Rodrigues GM, Rohloff RD, et al. Severe maternal morbidity and mortality during the COVID-19 pandemic: a cohort study in Rio de Janeiro. IJID Regions. 2023;(6):1-6. https://doi.org/10.1016/j.ijregi.2022.11.004 https://doi.org/10.1016/j.ijregi.2022.11...
Yes	394 (17.6)	70 (17.8)	324 (82.2)	0.66 (0.50;0.87)	0.003
No	1,847 (82.4)	456 (24.7)	1,391 (75.3)	-
Others¹³13 Jain V, Yuan J. Predictive symptoms and comorbidities for severe COVID-19 and intensive care unit admission: a systematic review and meta-analysis. Int J Public Health. 2020;65(5):533-546. https://doi.org/10.1007/s00038-020-01390-7 https://doi.org/10.1007/s00038-020-01390...
Yes	1,423 (52.9)	311 (21.9)	1,112 (78.1)	0.83 (0.70;0.99)	0.049
No	1,264 (47.1)	317 (25.1)	947 (74.9)

¹
n = 3.035; ²2 World Health Organization (WHO). Global Health Observatory Data Repository. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV) [Internet]. 2020 [cited 2022 Jun 1]. Available from: https://www.who.int/news/item/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)
https://www.who.int/news/item/30-01-2020... n = 3.207; ³3 World Health Organization (WHO). Global Health Observatory Data Repository. WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020 [Internet]. 2020 [cited 2022 Jul 15]. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020
https://www.who.int/director-general/spe... n = 2.554; ⁴4 World Health Organization (WHO). Histórico da pandemia de COVID-19 [Internet]. Geneva: WHO; 2023 [cited 2022 Jul 15]. Available from: https://www.paho.org/pt/covid19/historico-da-pandemia-covid-19
https://www.paho.org/pt/covid19/historic... n = 3.242; ⁵5 Elmore R, Schmidt L, Lam J, Howard BE, Tandon A, Norman C, et al. Risk and protective factors in the COVID-19 Pandemic: a rapid evidence map. Front Public Health. 2020;8:582205. https://doi.org/10.3389/fpubh.2020.582205
https://doi.org/10.3389/fpubh.2020.58220... n = 2.937; ⁶6 Villar J, Ariff S, Gunier RB, Thiruvengadam R, Rauch S, Kholin A, et al. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 Infection: the INTERCOVID Multinational Cohort Study. JAMA Pediatr. 2021;175(8):817-26. https://doi.org/10.1001/jamapediatrics.2021.1050
https://doi.org/10.1001/jamapediatrics.2... n = 3.052; ⁷7 Orellana J, Jacques N, Leventhal DGP, Marrero L, Morón-Duarte LS. Excess maternal mortality in Brazil: regional inequalities and trajectories during the COVID-19 epidemic. Plos One. 2022;17(10):e0275333. https://doi.org/10.1371/journal.pone.0275333
https://doi.org/10.1371/journal.pone.027... n = 2.512; ⁸8 Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ. 2020;370:m3320. https://doi.org/10.1136/bmj.m3320
https://doi.org/10.1136/bmj.m3320... n = 2.505; ⁹9 Ministério da Saúde (BR). Resolução no 510, de 7 de abril de 2016. Dispões sobre normas aplicáveis a pesquisas em Ciências Humanas e Sociais [Internet]. Brasília; 2016 [cited 2021 Dec 15]. Available from: https://conselho.saude.gov.br/resolucoes/2016/Reso510.pdf
https://conselho.saude.gov.br/resolucoes... n = 2.182; ¹⁰10 Nakamura PM, Amorim RMM, Pacagnella RC, Takemoto LSM, Penso CCF, Rezende FJ, et al. Covid-19 and Maternal Death in Brazil: an invisible tragedy. Rev Bras Ginecol Obstet. 2020;42(08):445-7. https://doi.org/10.1055/s-0040-1715138
https://doi.org/10.1055/s-0040-1715138... n = 2.306; ¹¹11 Paganoti CF, Costa RA, Papageorghiou AT, Costa FS, Quintana SM, Godoi LG, et al. COVID-19 Vaccines Confer Protection in Hospitalized Pregnant and Postpartum Women with Severe COVID-19: a retrospective cohort study. Vaccines. 2022;10(5):794. https://doi.org/10.3390/vaccines10050749
https://doi.org/10.3390/vaccines10050749... n = 2.282; ¹²12 Brendolin M, Fuller T, Wakimoto M, Rangel L, Rodrigues GM, Rohloff RD, et al. Severe maternal morbidity and mortality during the COVID-19 pandemic: a cohort study in Rio de Janeiro. IJID Regions. 2023;(6):1-6. https://doi.org/10.1016/j.ijregi.2022.11.004
https://doi.org/10.1016/j.ijregi.2022.11... n = 2.241; ¹³13 Jain V, Yuan J. Predictive symptoms and comorbidities for severe COVID-19 and intensive care unit admission: a systematic review and meta-analysis. Int J Public Health. 2020;65(5):533-546. https://doi.org/10.1007/s00038-020-01390-7
https://doi.org/10.1007/s00038-020-01390... n = 2.687; OR - Odds Ratio; CI - Confidence interval.

Variables	Adjusted OR (95% CI)	p
No COVID-19 vaccination	2.72 (1.83;4.04)	< 0.001
Dyspnea	1.73 (1.17;2.56)	0.006
Obesity	1.51 (1.05;2.17)	0.024
Chronic cardiovascular disease	1.65 (1.14;2.38)	0.007
Non-white	1.29 (1.00;1.66)	0.047

[1] Corresponding author
Marcela de Andrade Pereira Silva, E-mail: enf.marceladeandrade@gmail.com

Brasil

Brasil

Factores relacionados al óbito por COVID-19 en mujeres embarazadas hospitalizadas en Unidad de Cuidado Intensivo

RESUMEN

Objetivos:

Métodos:

Resultados:

Conclusiones: