RESUMO
OBJECTIVES: This study aimed to compare the characteristics of fully and partially vaccinated or unvaccinated coronavirus disease 2019 (COVID-19) patients who were hospitalised in a population of 220,000 habitants. METHODS: Retrospective, observational, and population studies were conducted on patients who were hospitalised due to COVID-19 from March to October 2021. We assessed the impact of vaccination and other risk factors through Cox multivariate analysis. RESULTS: A total of 500 patients were hospitalised, among whom 77 (15.4%) were fully vaccinated, 86 (17.2%) were partially vaccinated, and 337 (67.4%) were unvaccinated. Fully vaccinated (FV) patients were older and had a higher Charlson index than those of partially vaccinated and unvaccinated patients (NFV). Bilateral pneumonia was more frequent among NFV (259/376 (68.9%)) than among FV patients (32/75 (42.7%)). The former had more intensive care unit admissions (63/423) than the latter (4/77); OR: 2.80; CI (1.07-9.47). Increasing age HZ: 1.1 (1.06-1.14)) and haematological disease at admission HZ: 2.99 (1.26-7.11)) were independent risk factors for higher mortality during the first 30 days of hospitalisation. The probability of an earlier discharge in the subgroup of 440 patients who did not die during the first 30 days of hospitalisation was related to age (older to younger: HZ: 0.98 (0.97-0.99)) and vaccination status. CONCLUSIONS: Among the patients hospitalised because of COVID-19, complete vaccination was associated with less severe forms of COVID-19, with an earlier discharge date. Age and haematological disease were related to a higher mortality rate during the first 30 days of hospitalisation.
Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , SARS-CoV-2 , Estudos Retrospectivos , Hospitalização , Unidades de Terapia Intensiva , VacinaçãoRESUMO
La incidencia de neumomediastino en los pacientes hospitalizados con diagnóstico de neumonía por coronavirus 2 delsíndrome respiratorio agudo grave (SARS-CoV-2) no es para nada desdeñable, muy superior en comparación con la pobla-ción general. La fisiopatología del neumomediastino en la neumonía por SARS-CoV-2 viene explicada por el aumento delgradiente de presión alveolo-intersticio (accesos de tos seca, trabajo respiratorio, barotrauma por soporte ventilatorio) sobreunos pulmones especialmente «frágiles» debido al daño alveolo-intersticial difuso de origen infeccioso-inflamatorio, todo locual aumenta significativamente el riesgo de rotura de la pared alveolar. Cuanta mayor gravedad revista la neumonía porSARS-CoV-2, más probable será la aparición de neumomediastino. El desarrollo de neumomediastino en pacientes conneumonía por SARS-CoV-2 se asocia a unas frecuencias mayores de exitus letalis, ingreso en unidad de cuidados intensi-vos (UCI) y traqueostomía y a unos tiempos mayores de estancia hospitalaria y en UCI. En la mayoría de los casos, elneumomediastino producido en el seno de la neumonía por SARS-CoV-2 es un proceso benigno y autolimitado que seresuelve con tratamiento conservador.(AU)
The incidence of pneumomediastinum in hospitalised patients diagnosed with SARS-CoV-2 pneumonia is by no means ne-gligible, much higher compared to the general population. The pathophysiology of pneumomediastinum in severe acute res-piratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is explained by the increase in alveolar-interstitial pressure gradient(dry coughing spells, respiratory work, barotrauma from ventilatory support) in the context of particularly fragile lungs due todiffuse alveolar-interstitial damage from infectious-inflammatory origin, all of which significantly increases the risk of alveolarwall rupture. The more severe the SARS-CoV-2 pneumonia, the more likely it is that pneumomediastinum will occur. The deve-lopment of pneumomediastinum in patients with SARS-CoV-2 pneumonia is associated with higher frequencies of death,intensive care unit (ICU) admission and tracheostomy and longer hospital and ICU lengths of stay. In most cases, pneumo-mediastinum in SARS-CoV-2 pneumonia is a benign and self-limiting process that resolves with conservative treatment.(AU)
