RESUMO
BACKGROUND: One of the main challenges of the COVID-19 pandemic is to make sense of available, but often heterogeneous and noisy data. This contribution presents a data-driven methodology that allows exploring the hospitalization dynamics of COVID-19, exemplified with a study of 17 autonomous regions in Spain from summer 2020 to summer 2021. METHODS: We use data on new daily cases and hospitalizations reported by the Spanish Ministry of Health to implement a Bayesian inference method that allows making short-term predictions of bed occupancy of COVID-19 patients in each of the autonomous regions of the country. RESULTS: We show how to use the temporal series for the number of daily admissions and discharges from hospital to reproduce the hospitalization dynamics of COVID-19 patients. For the case-study of the region of Aragon, we estimate that the probability of being admitted to hospital care upon infection is 0.090 [0.086-0.094], (95% C.I.), with the distribution governing hospital admission yielding a median interval of 3.5 days and an IQR of 7 days. Likewise, the distribution on the length of stay produces estimates of 12 days for the median and 10 days for the IQR. A comparison between model parameters for the regions analyzed allows to detect differences and changes in policies of the health authorities. CONCLUSIONS: We observe important regional differences, signaling that to properly compare very different populations, it is paramount to acknowledge all the diversity in terms of culture, socio-economic status, and resource availability. To better understand the impact of this pandemic, much more data, disaggregated and properly annotated, should be made available.
Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , SARS-CoV-2 , Espanha/epidemiologia , Pandemias , Teorema de Bayes , HospitalizaçãoRESUMO
Anemia is common in critically ill patients; almost 95% of patients admitted to intensive care units (ICUs) have hemoglobin levels below normal. Several causes may explain this phenomenon as well as the tendency to transfuse patients without adequate cause: due to a lack of adherence to protocols, lack of supervision, incomplete transfusion request forms, or a lack of knowledge about the indications, risks, and costs of transfusions. Daily sampling to monitor the coagulation parameters and the acid-base balance can aggravate anemia as the main iatrogenic factor in its production. We studied the association and importance of iatrogenic blood loss and other factors in the incidence of anemia in ICUs. We performed a prospective, observational, multicenter study in five Spanish hospitals. A total of 142 patients with a median age of 58 years (IQI: 48-69), 71.83% male and 28.17% female, were admitted to ICUs without a diagnosis of iatrogenic anemia. During their ICU stay, anemia appeared in 66.90% of the sample, 95 patients, (95% CI: 58.51-74.56%). Risk factors associated with the occurrence of iatrogenic anemia were arterial catheter insertion (72.63% vs. 46.81%, p-value = 0.003), venous catheter insertion (87.37% vs. 72.34%, p-value = 0.023), drainages (33.68% vs. 12. 77%, p-value = 0.038), and ICU stay, where the longer the stay, the higher the rate of iatrogenic anemia (p-value < 0.001). We concluded that there was a statistical significance in the production of iatrogenic anemia due to the daily sampling for laboratory monitoring and critical procedures in intensive care units. The implementation of patient blood management programs could address these issues.
RESUMO
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