Main Article Content

Abstract


RÉSUMÉ
Objectif. Décrire les aspects épidémiologiques et déterminer les facteurs de mauvais pronostic des patients COVID19 admis en Réanimation au Centre Hospitalier Universitaire (CHU) de Libreville. Patients et méthodes. Il s’agit d’une étude transversale rétrospective, descriptive et analytique qui s’est déroulée sur une période de 16 mois allant d’avril 2020 à juillet 2021. Etaient inclus les patients dont le diagnostic de pneumopathie à SARS CoV2 avait été retenu. Les variables étudiées étaient l’âge, le sexe, les comorbidités, les signes cliniques et paracliniques, les modalités thérapeutiques et évolutives. Résultats. 187 patients ont été inclus. L’âge moyen était de 53,5 ± 15,5 ans avec un sex ratio de 1,36. L’hypertension artérielle, l’obésité, le diabète étaient les comorbidités plus retrouvées. La détresse respiratoire était le motif d’admission le plus fréquent. Près de la moitié des patients avaient des lésions pulmonaires de plus de 50% à la tomodensitométrie thoracique. 16,6% des patients étaient intubés. Le taux de mortalité était de 41,7%. La durée moyenne d’hospitalisation était de 8,5± 6,5 jours. Les facteurs de mauvais pronostic étaient : l’âge, le diabète, le score de Glasgow, le score quick SOFA, les D-dimères, l’insuffisance rénale, l’hyperleucocytose, la lymphopénie, l’atteinte pulmonaire, la ventilation non invasive (VNI) et l’intubation. Conclusion. La Covid-19 est une pathologie dont la forme grave est associée à plusieurs facteurs de mauvais pronostic à l’origine d’une mortalité élevée. Une prise en charge précoce et bien codifiée doit être réalisée afin d’améliorer l’issue de cette affection.
ABSTRACT
Objective. To describe the epidemiology and establish the poor prognostic factors of COVID19 patients admitted to the Intensive Care Unit of the University Hospital of Libreville. Patients and methods. This was a cross sectional retrospective, descriptive and analytical study which took place over a period of 16 months from April 2020 to July 2021. Patients with a diagnosis of SARS Cov2 pneumonia were included. The variables studied were age, sex, comorbidities, clinical and paraclinical signs, therapeutic and evolutionary modalities. Results. 187 patients were included. The mean age was 53.5 ± 15.5 years with a sex ratio of 1.36. Arterial hypertension, obesity and diabetes were the most common comorbidities. Respiratory distress was the most frequent reason for admission. Almost half of the patients had lung lesions of more than 50% on chest CT. 16.6% of patients were intubated. The mortality rate was 41.7%. The average length of hospitalization was 8.5± 6.5 days. Poor prognostic factors were: age, diabetes, Glasgow score, quick SOFA score, D-dimer, renal failure, hyperleukocytosis, lymphopenia, pulmonary involvement, non-invasive ventilation (NIV) and intubation. Conclusion. Covid-19 is a pathology whose severe form is associated with several poor prognostic factors leading to a high mortality. An early and well codified management must be performed to improve the outcome of this condition.

Keywords

COVID-19 risk factors resuscitation Libreville Covid-19 facteurs de risque réanimation Libreville

Article Details

How to Cite
Ngomas JF, Ifoudji Makao A, Nze Obiang PC, Nyangui DEM, Manga F, Bitegue L, ila UD, Igala M, Ayo Bivigou E, Essola-Rerambiah L, & Sima Zué A. (2022). Aspects Epidémiologiques et Facteurs de Mauvais Pronostic des Patients Atteints de COVID-19 Admis en Réanimation au Centre Hospitalier Universitaire de Libreville au Cours des Trois Premières Vagues de la Pandémie: Epidemiology and poor prognostic factors of patients with COVID-19 admitted in the intensive care unit of the University Teaching Hospital of Libreville during the first three waves of the pandemic. HEALTH SCIENCES AND DISEASE, 23(6). Retrieved from https://hsd-fmsb.org/index.php/hsd/article/view/3668

References

  1. - Wuhan Municipal Health Commission. Report of clustering pneumonia of unknown etiology in Wuhan City. 2019. www.who.int/emergencies/disease-outbreak-news/item/2020-DON229. Consulté le 18/02/2022.
  2. - Zhu N, Zhang D, Wang W et al. A Novel Coronavirus from patients with pneumonia in China, 2019. Engl J Med. 2020 ; 382 (8) : 727-733
  3. - Rissassy Makulo JR. Particularités de la 3e vague de la pandémie à COVID-19 en Afrique sub-Saharienne, cas de la République Démocratique du Congo comme exemple. 2021 ; Annales africaines de médecine : 14(4).
  4. - Verity R, Okell L, Dorigatti I, et al. 2020. Estimates of the Severity of Coronavirus Disease 2019: A Model-Based Analysis. The Lancet Infectious Diseases. 2020 ;20 : 669-77
  5. - Collienne C, Castanares-Zapatero D, Apraxine M, et al. Prise en charge aux soins intensifs des patients pour insuffisance respiratoire liée au COVID-19. Louvain Med. 2020 ; 139 (05-06) : 383-389
  6. - Krahenbuhl M, Oddo M, Piquilloud L, et al. COVID- 19 : prise en charge aux soins intensifs. Rev Med Suisse. 2020 ; 16 : 863-8
  7. - Liu J, Zhang S, Wu Z, et al. Clinical outcomes of COVID-19 in Wuhan, China : a large cohort study. Ann Intensive Care. 2020 ; 10 : 99
  8. - Chen R, Liang W, Jiang M, et al. Risk factors of fatal outcome in hospitalized subjects with Coronavirus Disease 2019 from a nationwide analysis in China. Chest. 2020 ; 158 (1): 97-105
  9. - Muscogiuri G, Pugliese G, Barrea L, et al. Obesity: The «Achilles heel» for COVID-19? Metabolism 2020; 108:154251
  10. - Kosinski C, Zanchi A, Wojtusciszyn A. Diabète et infection à COVID-19. Rev Med Suisse 2020;16:939-43
  11. - Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel Coronavirus-infected Pneumonia in Wuhan, China. JAMA. 2020 ; 323(11):1061-9
  12. - Abobaker A, Raba A, Alzwi A. Extrapulmonary and atypical clinical presentations of COVID-19. J Med Virol, 92 (2020), pp. 2458-2554
  13. - Baj J, Karakuła-Juchnowicz H, Teresiński G, et al.COVID-19: Specific and Non-Specific Clinical Manifestations and Symptoms: The Current State of Knowledge. J Clin Med, 9 (2020), p. 1753
  14. - Bein B, Bachmann M, Huggett S, et al. SRAS CoV-2/COVID-19 : evidence-based recommendation on diagnosis and therapy. Anasthesiol Intensivmed Notfallmed Schmerzther. 2020 ; 55 : 257-65
  15. - Hoffmann M, Kleine-Weber H, Krüger N, et al. The novel coronavirus 2019 (2019-nCoV) uses the SARS-coronavirus receptor ACE2 and the cellular protease TMPRSS2 for entry into target cells. BioRxiv 2020 ; 929042
  16. - Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult in patients with COVID 19 in Wuhan, China : a retrospective cohort study. Lancet. 2020 ; 395 :1054-62
  17. - Pelaia C, Tinello C, Vatrella A, et al. Lung under attack by COVID-19-induced cytokine storm: pathogenic mechanisms and therapeutic implications. Ther Adv Respir Dis. 2020 ; 14
  18. - Zhou Y, Fu B, Zheng X, et al. Pathogenic T-cells and inflammatory monocytes incite inflammatory storms in severe COVID-19 patients. Natl Sci Rev.2020 ; (7) pp. 998-1002
  19. - Luo X, Zhou W, Yan X, et al. Prognostic value of C-reactive protein in patients with COVID-19. Infectious Diseases (except HIV/AIDS) ; 2020.
  20. - Igala M, Ayo Bivigou E, Kombila UD et al. Complete Blood Count Parameters, C-Reactive Protein and the Severity of Coronavirus Disease. Clin Lab. 2021 ; 67 : 8p.
  21. - Cavalcanti A B, Suzumura E A, Laranjeira L N, et al. Writing Group for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) Investigators. Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome: a randomized clinical trial. 2017 ; JAMA, 318(14), 1335-1345.
  22. - Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China : a single-centered, retrospective, observational study. The Lancet Respiratory Medicine, 2020;8:475-81
  23. - Wali A, Rizzo V, Bille A, et al. Pneumomediastinum following intubation in COVID-19 patients : a case series. Anesthesia Published Online First : 6 May 2020
  24. - Zareifopoulos N, Lagadinou M, Karela A, et al. Management of COVID-19: the risks associated with treatment are clear, but the benefits remain uncertain. Monaldi Archives for Chest Disease, 2020 ; 90(2).
  25. - Meng L, Qiu H, Wan L, et al. Intubation and ventilation amid the COVID-19 outbreak: Wuhan’s experience. Anesthesiology, 2020 ; 132(6), 1317-1332.