Tratamento medicamentoso de pacientes hospitalizados com Covid-19: análise em um hospital público do Tocantins

Abstract

The 2019 coronavirus disease (Covid-19) pandemic, caused by SARS-CoV-2, emerged globally in December 2019, and was declared a pandemic by the World Health Organization (WHO) in March 2020. In Brazil, the first case was reported in February 2020, and the disease rapidly spread. In the initial context of the pandemic, therapeutic interventions were often empirical, leading to intense debates about the efficacy of drug treatments to prevent the progression of severe disease. This study is justified by the need to understand the drug treatments used in the management of Covid-19, especially in the regional context of Tocantins, during the first months of the pandemic. The general objective was to evaluate the drug treatment used in hospitalized patients with Covid-19 infection in the first months of the pandemic, in a public hospital in the State of Tocantins, considering the relationship between the administered therapeutic classes and the clinical outcomes. This is a quantitative, descriptive, and retrospective study, based on the documentary analysis of secondary data from medical records. Data collection took place at Hospital Geral de Palmas (HGP), a reference unit for Covid-19 in Tocantins, from April to December 2020. The sample was a census, including all available medical records of patients with a confirmed diagnosis of Covid-19 over 18 years of age and with complete clinical records. The analyzed variables included sociodemographic, clinical (length of hospitalization, clinical outcome), and therapeutic characteristics (use and duration of drug administration). Descriptive statistical analysis used absolute and relative frequencies, means, medians, and standard deviations. To assess the associations between drug use and clinical outcome (death), Cox Regression with the Forward Stepwise method was applied. Statistical significance was established at a p-value less than 0.05. Of the 197 medical records analyzed, 66.5% belonged to male patients, and the most common age group was 40 to 79 years. The average length of hospitalization was 10 days, ranging from 1 to 48 days. Regarding outcomes, 73 patients (37.1%) progressed to death. The use of up to ten drug classes was identified, with a prevalence of polypharmacy in 64% of cases. Antibiotics were the most used (98.5%), followed by corticosteroids (85.8%), anticoagulants (84.8%), and mucolytics (62.4%). The use of antivirals (12.2%) and antiparasitics (48.2%) was less frequent and associated with short duration, reflecting uncertainties about their efficacy. Analysis of administration time indicated that antibiotics were used, on average, for 15 days, while corticosteroids and anticoagulants were used for about 6 days. Other classes, such as analgesics, bronchodilators, sedatives, and vasoactive drugs, showed a median of 0 days, suggesting punctual use. Cox regression revealed an association between the use of certain classes and the time to death, especially in the case of vasoactive and sedative drugs, which reflect greater clinical severity.