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      Resultados y características clínicas de personas con obesidad y covid-19: revisión integrativa Translated title: Outcomes and clinical characteristics of people with obesity and covid-19: integrative review Translated title: Desfechos e características clinicas de pessoas com obesidade e covid-19: revisão integrativa

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          Abstract

          RESUMEN: Objetivo Identificar los resultados y las características clínicas de las personas con obesidad y covid-19 en la literatura científica nacional e internacional. Método Revisión Integrativa, en la que tuvo como objetivo dar respuesta a la pregunta orientadora: “¿Cuáles son las características clínicas que presentan las personas con obesidad con diagnóstico confirmado de COVID-19, y su impacto en la salud?” indexados en la base de datos Medical Literature and Retrivial System on Line, y Virtual Health Library en noviembre de 2020. Resultados De los 13 artículos analizados en su totalidad, todos fueron publicados en revistas internacionales, en el año 2020, en relación a los resultados clínicos, se evidenció una alta tasa de mortalidad en pacientes ingresados con covid-19 que presentaban obesidad en comparación con aquellos sin obesidad, estancia hospitalaria más prolongada, necesidad de oxigenoterapia, aumento de la gravedad de la enfermedad Covid-19, factor de riesgo para las tasas de morbilidad en personas más jóvenes, pudiendo predisponer al riesgo de enfermedades más graves e influir en la progresión y pronóstico de la enfermedad . En cuanto a las características clínicas, mostraron que la ferritina tendía a permanecer más alta en el grupo de personas obesas, siendo más propensas a tener fiebre, tos y dificultad para respirar. Conclusión La obesidad en personas con covid-19 potencia características clínicas como tos, fatiga, fiebre y cansancio. Además, los resultados clínicos incluyen el riesgo potencial de complicaciones, altas tasas de mortalidad, mayor propensión a intubar, mayor tiempo de terapia de oxígeno. Por tanto, los equipos sanitarios deberían prestar más atención a estos pacientes.

          Translated abstract

          ABSTRACT: Objective To identify people's outcomes and clinical characteristics of those with obesity and covid-19 in the national and international scientific literature. Method Integrative Review, in which it aimed to answer the guiding question: What are the clinical characteristics presented by people with obesity with a confirmed diagnosis of COVID-19, and its impact on health?" indexed in the database Medical LiteratureandRetrivial System on Line, and Virtual Health Library in November 2020. Results Out of the 13 articles analyzed in total, all were published in international journals; in the year 2020, concerning clinical outcomes, a high mortality rate was evidenced in patients admitted with covid-19 who had obesity in comparison with those without obesity, more extended hospital stay, need for oxygen therapy, increased severity of Covid-19 disease, a risk factor for morbidity rates in younger people, being able to predispose to risk of more severe conditions and influence the progression and prognosis of the disease. Regarding the clinical characteristics, they showed that ferritin tended to remain higher in the group of obese people, being more likely to have fever, cough, and shortness of breath. Conclusion Obesity in people with covid-19 potentiates clinical characteristics such as cough, fatigue, fever, and tiredness. Clinical outcomes include the potential risk of complications, high mortality rates, greater propensity to be intubated, longer oxygen therapy time. Thus, more attention should be paid to these patients by the health teams.

          Translated abstract

          RESUMO: Objetivo: Identificar os desfechos e características clínicas de pessoas com obesidade e covid-19 na literatura científica nacional e internacional. Método Revisão Integrativa, na qual visou responder à questão norteadora: “Quais as características clínicas apresentadas por pessoas com obesidade com diagnóstico confirmado de COVID-19, e sua repercussão para a saúde?” indexadas na base de dados Medical Literature and Retrivial System on Line e Biblioteca Virtual de Saúde no mês de novembro de 2020. Resultados Dos 13 artigos analisados na íntegra, todos foram publicados em periódicos internacionais, no ano de 2020, em relação aos desfechos clínicos evidenciou-se alta taxa de mortalidade nos pacientes admitidos com covid-19 que tinham obesidade em comparação com aqueles sem obesidade, maior tempo de permanência hospitalar, necessidade de oxigenoterapia, aumento da gravidade da doença do Covid-19, fator de risco para as taxas de morbidade em pessoas mais jovens, podendo predispor a risco de doenças mais graves e influenciar na progressão e o prognóstico da doença. A respeito das características clínicas, demostraram que a ferritina tendeu a permanecer mais elevada no grupo de pessoas obesas, sendo mais propensos a apresentar febre, tosse e falta de ar. Conclusão A obesidade em pessoas com covid-19 potencializa as características clinicas como tosse, fadiga, febre e cansaço. Ademais, tem como desfechos clínicos o potencial risco de complicações, altas taxas de mortalidade, maior propensão a serem intubados, maior tempo de oxigenoterapia. Assim, mais atenção deve ser dispensada a esses pacientes por parte das equipes de saúde.

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          Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study

          Abstract Objective To describe outcomes of people admitted to hospital with coronavirus disease 2019 (covid-19) in the United States, and the clinical and laboratory characteristics associated with severity of illness. Design Prospective cohort study. Setting Single academic medical center in New York City and Long Island. Participants 5279 patients with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection between 1 March 2020 and 8 April 2020. The final date of follow up was 5 May 2020. Main outcome measures Outcomes were admission to hospital, critical illness (intensive care, mechanical ventilation, discharge to hospice care, or death), and discharge to hospice care or death. Predictors included patient characteristics, medical history, vital signs, and laboratory results. Multivariable logistic regression was conducted to identify risk factors for adverse outcomes, and competing risk survival analysis for mortality. Results Of 11 544 people tested for SARS-Cov-2, 5566 (48.2%) were positive. After exclusions, 5279 were included. 2741 of these 5279 (51.9%) were admitted to hospital, of whom 1904 (69.5%) were discharged alive without hospice care and 665 (24.3%) were discharged to hospice care or died. Of 647 (23.6%) patients requiring mechanical ventilation, 391 (60.4%) died and 170 (26.2%) were extubated or discharged. The strongest risk for hospital admission was associated with age, with an odds ratio of >2 for all age groups older than 44 years and 37.9 (95% confidence interval 26.1 to 56.0) for ages 75 years and older. Other risks were heart failure (4.4, 2.6 to 8.0), male sex (2.8, 2.4 to 3.2), chronic kidney disease (2.6, 1.9 to 3.6), and any increase in body mass index (BMI) (eg, for BMI >40: 2.5, 1.8 to 3.4). The strongest risks for critical illness besides age were associated with heart failure (1.9, 1.4 to 2.5), BMI >40 (1.5, 1.0 to 2.2), and male sex (1.5, 1.3 to 1.8). Admission oxygen saturation of 1 (4.8, 2.1 to 10.9), C reactive protein level >200 (5.1, 2.8 to 9.2), and D-dimer level >2500 (3.9, 2.6 to 6.0) were, however, more strongly associated with critical illness than age or comorbidities. Risk of critical illness decreased significantly over the study period. Similar associations were found for mortality alone. Conclusions Age and comorbidities were found to be strong predictors of hospital admission and to a lesser extent of critical illness and mortality in people with covid-19; however, impairment of oxygen on admission and markers of inflammation were most strongly associated with critical illness and mortality. Outcomes seem to be improving over time, potentially suggesting improvements in care.
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            Complex Immune Dysregulation in COVID-19 Patients with Severe Respiratory Failure

            Summary Proper management of COVID-19 mandates better understanding of disease pathogenesis. The sudden clinical deterioration 7–8 days after initial symptom onset suggests that severe respiratory failure (SRF) in COVID-19 is driven by a unique pattern of immune dysfunction. We studied immune responses of 54 COVID-19 patients, 28 of whom had SRF. All patients with SRF displayed either macrophage activation syndrome (MAS) or very low human leukocyte antigen D related (HLA-DR) expression accompanied by profound depletion of CD4 lymphocytes, CD19 lymphocytes, and natural killer (NK) cells. Tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) production by circulating monocytes was sustained, a pattern distinct from bacterial sepsis or influenza. SARS-CoV-2 patient plasma inhibited HLA-DR expression, and this was partially restored by the IL-6 blocker Tocilizumab; off-label Tocilizumab treatment of patients was accompanied by increase in circulating lymphocytes. Thus, the unique pattern of immune dysregulation in severe COVID-19 is characterized by IL-6-mediated low HLA-DR expression and lymphopenia, associated with sustained cytokine production and hyper-inflammation.
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              Cytokine release syndrome in severe COVID-19

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                Author and article information

                Journal
                eg
                Enfermería Global
                Enferm. glob.
                Universidad de Murcia (Murcia, Murcia, Spain )
                1695-6141
                2021
                : 20
                : 63
                : 544-580
                Affiliations
                [3] Picos PI orgnameUniversidad Federal de Piauí orgdiv1Grupo de Investigación en Salud Colectiva - UFPI/CNPq Brasil
                [4] Picos PI orgnameUniversidad Federal de Piauí orgdiv1Departamento de Enfermería Brasil
                [1] Picos PI orgnameUniversidad Federal de Piauí orgdiv1Grupo de Investigación en Salud Colectiva - UFPI/CNPq Brasil franciscojoaodecarvalhoneto@ 123456gmail.com
                [2] Picos PI orgnameUniversidad Federal de Piauí orgdiv1Grupo de Investigación en Salud Colectiva - UFPI/CNPq Brasil
                Article
                S1695-61412021000300017 S1695-6141(21)02006300017
                10.6018/eglobal.461101
                9e7d2216-09c9-4b14-a4e9-738323b329f6

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

                History
                : 09 April 2021
                : 25 December 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 21, Pages: 37
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                SciELO Spain

                Categories
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                Obesidad,Características clínicas,Covid-19,Obesidade,clinical features,Obesity

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