Tesis doctoral por compendio de publicaciones: Clinical characteristics and mortality associated with COVID-19 at high altitude: a cohort of 5161 patients in Bogotá, Colombia, Prediction model for in-hospital mortality in patients at high altitudes with ARDS due to COVID-19, Resilience and quality of life in patients who underwent mechanical ventilation due to COVID-19 one year after discharge: a cross- sectional study
Esta tesis doctoral examina el impacto del Síndrome de Distrés Respiratorio Agudo (SDRA) por COVID-19 en gran altitud, evaluando sus características clínicas, factores de mortalidad y calidad de vida en pacientes ventilados mecánicamente. Se basa en tres publicaciones científicas que abordan distint...
- Autores:
- Tipo de recurso:
- Fecha de publicación:
- 2025
- Institución:
- Universidad del Rosario
- Repositorio:
- Repositorio EdocUR - U. Rosario
- Idioma:
- eng
- OAI Identifier:
- oai:repository.urosario.edu.co:10336/45052
- Acceso en línea:
- https://doi.org/10.1186/s12245-022-00426-4
https://doi.org/10.1186/s41687-024-00748-2
https://doi.org/10.1371/journal.pone.0293476
https://repository.urosario.edu.co/handle/10336/45052
- Palabra clave:
- SDRA
Altura
Ventilación mecánica
Calidad de vida
Modelos de predicción
Mortalidad
ARDS
High Altitude
Mechanical Ventilation
Quality of Life
Mortality Prediction Models
- Rights
- License
- Attribution-NoDerivatives 4.0 International
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Tesis doctoral por compendio de publicaciones: Clinical characteristics and mortality associated with COVID-19 at high altitude: a cohort of 5161 patients in Bogotá, Colombia, Prediction model for in-hospital mortality in patients at high altitudes with ARDS due to COVID-19, Resilience and quality of life in patients who underwent mechanical ventilation due to COVID-19 one year after discharge: a cross- sectional study |
| dc.title.TranslatedTitle.none.fl_str_mv |
Tesis doctoral por compendio de publicaciones: Características clínicas y mortalidad asociadas con COVID-19 en gran altitud: una cohorte de 5161 pacientes en Bogotá, Colombia, Modelo de predicción para la mortalidad intrahospitalaria en pacientes a gran altitud con SDRA debido a COVID-19, Resiliencia y calidad de vida en pacientes que recibieron ventilación mecánica debido a COVID-19 un año después del alta: un estudio transversal |
| dc.title.alternative.none.fl_str_mv |
SDRA por COVID-19 en gran altitud: descripción clínica, predicción de mortalidad y calidad de vida |
| title |
Tesis doctoral por compendio de publicaciones: Clinical characteristics and mortality associated with COVID-19 at high altitude: a cohort of 5161 patients in Bogotá, Colombia, Prediction model for in-hospital mortality in patients at high altitudes with ARDS due to COVID-19, Resilience and quality of life in patients who underwent mechanical ventilation due to COVID-19 one year after discharge: a cross- sectional study |
| spellingShingle |
Tesis doctoral por compendio de publicaciones: Clinical characteristics and mortality associated with COVID-19 at high altitude: a cohort of 5161 patients in Bogotá, Colombia, Prediction model for in-hospital mortality in patients at high altitudes with ARDS due to COVID-19, Resilience and quality of life in patients who underwent mechanical ventilation due to COVID-19 one year after discharge: a cross- sectional study SDRA Altura Ventilación mecánica Calidad de vida Modelos de predicción Mortalidad ARDS High Altitude Mechanical Ventilation Quality of Life Mortality Prediction Models |
| title_short |
Tesis doctoral por compendio de publicaciones: Clinical characteristics and mortality associated with COVID-19 at high altitude: a cohort of 5161 patients in Bogotá, Colombia, Prediction model for in-hospital mortality in patients at high altitudes with ARDS due to COVID-19, Resilience and quality of life in patients who underwent mechanical ventilation due to COVID-19 one year after discharge: a cross- sectional study |
| title_full |
Tesis doctoral por compendio de publicaciones: Clinical characteristics and mortality associated with COVID-19 at high altitude: a cohort of 5161 patients in Bogotá, Colombia, Prediction model for in-hospital mortality in patients at high altitudes with ARDS due to COVID-19, Resilience and quality of life in patients who underwent mechanical ventilation due to COVID-19 one year after discharge: a cross- sectional study |
| title_fullStr |
Tesis doctoral por compendio de publicaciones: Clinical characteristics and mortality associated with COVID-19 at high altitude: a cohort of 5161 patients in Bogotá, Colombia, Prediction model for in-hospital mortality in patients at high altitudes with ARDS due to COVID-19, Resilience and quality of life in patients who underwent mechanical ventilation due to COVID-19 one year after discharge: a cross- sectional study |
| title_full_unstemmed |
Tesis doctoral por compendio de publicaciones: Clinical characteristics and mortality associated with COVID-19 at high altitude: a cohort of 5161 patients in Bogotá, Colombia, Prediction model for in-hospital mortality in patients at high altitudes with ARDS due to COVID-19, Resilience and quality of life in patients who underwent mechanical ventilation due to COVID-19 one year after discharge: a cross- sectional study |
| title_sort |
Tesis doctoral por compendio de publicaciones: Clinical characteristics and mortality associated with COVID-19 at high altitude: a cohort of 5161 patients in Bogotá, Colombia, Prediction model for in-hospital mortality in patients at high altitudes with ARDS due to COVID-19, Resilience and quality of life in patients who underwent mechanical ventilation due to COVID-19 one year after discharge: a cross- sectional study |
| dc.contributor.advisor.none.fl_str_mv |
Pinzón Rondón, Ángela María Ruiz Sternberg, Ángela María |
| dc.contributor.gruplac.none.fl_str_mv |
Grupo de Investigación Clínica |
| dc.contributor.other.none.fl_str_mv |
Molano González, Nicolás |
| dc.subject.none.fl_str_mv |
SDRA Altura Ventilación mecánica Calidad de vida Modelos de predicción Mortalidad |
| topic |
SDRA Altura Ventilación mecánica Calidad de vida Modelos de predicción Mortalidad ARDS High Altitude Mechanical Ventilation Quality of Life Mortality Prediction Models |
| dc.subject.keyword.none.fl_str_mv |
ARDS High Altitude Mechanical Ventilation Quality of Life Mortality Prediction Models |
| description |
Esta tesis doctoral examina el impacto del Síndrome de Distrés Respiratorio Agudo (SDRA) por COVID-19 en gran altitud, evaluando sus características clínicas, factores de mortalidad y calidad de vida en pacientes ventilados mecánicamente. Se basa en tres publicaciones científicas que abordan distintos aspectos de la enfermedad en Bogotá, Colombia (2500 msnm). 1. Características clínicas y mortalidad del SDRA por COVID-19 en la altitud El estudio incluyó 5161 pacientes hospitalizados por COVID-19 y encontró que, aunque la hipoxemia hipobárica es común en Bogotá, la necesidad de hospitalización y ventilación mecánica invasiva (VMI) fue similar a la de otras regiones a menor altitud. Sin embargo, la mortalidad en pacientes ventilados permaneció alta durante toda la pandemia, a diferencia de países de altos ingresos, lo que sugiere que la disponibilidad de recursos influye más que la hipoxia de la altura en los desenlaces clínicos. Se identificó la necesidad de ajustar los umbrales de PaO₂/FiO₂ para la toma de decisiones terapéuticas en pacientes a gran altitud. 2. Modelo de predicción de mortalidad intrahospitalaria en pacientes con SDRA Se desarrolló un modelo predictivo en 2210 pacientes con SDRA por COVID-19 para evaluar el riesgo de mortalidad hospitalaria utilizando variables clínicas y de laboratorio al ingreso. Se compararon dos enfoques: uno con la PaO₂/FiO₂ sin ajustar y otro con PaO₂/FiO₂ ajustado por altitud. No se encontró diferencia significativa en la capacidad predictiva de ambos modelos, lo que indica que el ajuste por altitud no mejora la estratificación del riesgo en estos pacientes. 3. Resiliencia y calidad de vida en pacientes ventilados por COVID-19 Se evaluó la calidad de vida y resiliencia en pacientes que requirieron VMI por COVID-19, un año después del alta hospitalaria. Se encontró que el 38% de los pacientes reportó una calidad de vida deteriorada, y aquellos con mayor resiliencia mostraron mejores resultados en las escalas de evaluación. Se validó el uso de herramientas como la Escala de Estado Funcional Post-COVID-19 (PCFS) y el cuestionario EuroQol (EQ-5D-3L) para la medición de calidad de vida en esta población. Conclusión General Los hallazgos resaltan que la hipoxemia hipobárica en la altitud afecta la clasificación y el manejo del SDRA, pero no explica por sí sola las altas tasas de mortalidad. La falta de recursos y las condiciones locales tienen un impacto significativo en los desenlaces. Se destaca la necesidad de nuevas herramientas de estratificación de riesgo específicas para ciudades a más de 1000 msnm, con el fin de optimizar el tratamiento y mejorar la supervivencia y calidad de vida de los pacientes con SDRA por COVID-19. Implicaciones Clínicas - Adaptación de los criterios de SDRA en altitud. - Implementación de modelos predictivos de mortalidad temprana. - Evaluación post-hospitalaria de resiliencia y calidad de vida. Estos resultados tienen el potencial de mejorar el manejo clínico de pacientes con SDRA en regiones de gran altitud. |
| publishDate |
2025 |
| dc.date.accessioned.none.fl_str_mv |
2025-03-03T13:02:47Z |
| dc.date.available.none.fl_str_mv |
2025-03-03T13:02:47Z |
| dc.date.created.none.fl_str_mv |
2025-02-28 |
| dc.type.none.fl_str_mv |
doctoralThesis |
| dc.type.coarversion.fl_str_mv |
http://purl.org/coar/version/c_970fb48d4fbd8a85 |
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http://purl.org/coar/resource_type/c_db06 |
| dc.type.spa.none.fl_str_mv |
Tesis |
| dc.identifier.doi.none.fl_str_mv |
https://doi.org/10.1186/s12245-022-00426-4 https://doi.org/10.1186/s41687-024-00748-2 https://doi.org/10.1371/journal.pone.0293476 |
| dc.identifier.uri.none.fl_str_mv |
https://repository.urosario.edu.co/handle/10336/45052 |
| url |
https://doi.org/10.1186/s12245-022-00426-4 https://doi.org/10.1186/s41687-024-00748-2 https://doi.org/10.1371/journal.pone.0293476 https://repository.urosario.edu.co/handle/10336/45052 |
| dc.language.iso.none.fl_str_mv |
eng |
| language |
eng |
| dc.relation.uri.none.fl_str_mv |
https://doi.org/10.1186/s12245-022-00426-4 |
| dc.rights.*.fl_str_mv |
Attribution-NoDerivatives 4.0 International |
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http://purl.org/coar/access_right/c_abf2 |
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Abierto (Texto Completo) |
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http://creativecommons.org/licenses/by-nd/4.0/ |
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Attribution-NoDerivatives 4.0 International Abierto (Texto Completo) http://creativecommons.org/licenses/by-nd/4.0/ http://purl.org/coar/access_right/c_abf2 |
| dc.format.extent.none.fl_str_mv |
26 pp |
| dc.format.mimetype.none.fl_str_mv |
application/pdf |
| dc.publisher.none.fl_str_mv |
Universidad del Rosario |
| dc.publisher.department.none.fl_str_mv |
Escuela de Medicina y Ciencias de la Salud |
| dc.publisher.program.none.fl_str_mv |
Doctorado en Investigación Clínica |
| publisher.none.fl_str_mv |
Universidad del Rosario |
| institution |
Universidad del Rosario |
| dc.source.bibliographicCitation.none.fl_str_mv |
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J Clin Invest. 1 de agosto de 2012;122(8):2731-40. Janz DR, Ware LB. Approach to the Patient with the Acute Respiratory Distress Syndrome. Clin Chest Med. diciembre de 2014;35(4):685-96. Katzenstein ALA, Bloor CM, Leibow AA. Diffuse Alveolar Damage-The Role of Oxygen, Shock, and Related Factors. 1976;85(1):20. Ashbaugh DG, Bigelow DB, Levine BE. ACUTE RESPIRATORY DISTRESS IN ADULTS. :5. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. marzo de 1994;149(3):818-24. Acute Respiratory Distress Syndrome: The Berlin Definition. JAMA [Internet]. 20 de junio de 2012 [citado 25 de abril de 2021];307(23). Disponible en: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2012.5669 on behalf of the ALIEN Network, Villar J, Blanco J, Añón JM, Santos-Bouza A, Blanch L, et al. The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation. Intensive Care Med. diciembre de 2011;37(12):1932-41. for the ALIVE Study Group, Brun-Buisson C, Minelli C, Bertolini G, Brazzi L, Pimentel J, et al. Epidemiology and outcome of acute lung injury in European intensive care units: Results from the ALIVE study. Intensive Care Med. enero de 2004;30(1):51-61. Rubenfeld GD, Weaver J, Stern EJ. Incidence and Outcomes of Acute Lung Injury. N Engl J Med. 2005;9. Villar J, Blanco J, Kacmarek RM. Current incidence and outcome of the acute respiratory distress syndrome. Respir Syst. 2016;22(1):6. Caser EB, Zandonade E, Pereira E, Gama AMC, Barbas CSV. Impact of Distinct Definitions of Acute Lung Injury on Its Incidence and Outcomes in Brazilian ICUs: Prospective Evaluation of 7,133 Patients*. Crit Care Med. marzo de 2014;42(3):574-82. The ERICC (Epidemiology of Respiratory Insufficiency in Critical Care) investigators, Azevedo LC, Park M, Salluh JI, Rea-Neto A, Souza-Dantas VC, et al. Clinical outcomes of patients requiring ventilatory support in Brazilian intensive care units: a multicenter, prospective, cohort study. Crit Care. abril de 2013;17(2):R63. Munster VJ, Koopmans M. A Novel Coronavirus Emerging in China — Key Questions for Impact Assessment. N Engl J Med. 2020;3. Ji W, Wang W, Zhao X, Zai J, Li X. Cross‐species transmission of the newly identified coronavirus 2019‐nCoV. J Med Virol. abril de 2020;92(4):433-40. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 20 de febrero de 2020;382(8):727-33. Mahase E. Coronavirus: covid-19 has killed more people than SARS and MERS combined, despite lower case fatality rate. BMJ. 18 de febrero de 2020;m641. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 7 de abril de 2020;323(13):1239. Riou J, Althaus CL. Pattern of early human-to-human transmission of Wuhan 2019 novel coronavirus (2019-nCoV), December 2019 to January 2020. Eurosurveillance [Internet]. 30 de enero de 2020 [citado 25 de abril de 2021];25(4). Disponible en: https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.4.2000058 https://www.ins.gov.co/Noticias/paginas/coronavirus.aspx. Livingston E, Bucher K. Coronavirus Disease 2019 (COVID-19) in Italy. JAMA. 14 de abril de 2020;323(14):1335. Porcheddu R, Serra C, Kelvin D, Kelvin N, Rubino S. Similarity in Case Fatality Rates (CFR) of COVID-19/SARS-COV-2 in Italy and China. J Infect Dev Ctries. 29 de febrero de 2020;14(02):125-8. Gibson PG, Qin L, Puah SH. 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Cardozo BM, Ramírez Sierra CA, Valvuena Benítez S, Muñoz Marrugo L, Hincapíe Díaz GA, Bastidas Goyes AR. Saturación de oxígeno/fracción inspirada de oxígeno como predictor de mortalidad en pacientes con exacerbación de EPOC atendidos en el Hospital Militar Central. Acta Médica Colomb. 15 de diciembre de 2017;42(4):215-23. Pandharipande PP, Shintani AK, Hagerman HE, St Jacques PJ, Rice TW, Sanders NW, et al. Derivation and validation of Spo2/Fio2 ratio to impute for Pao2/Fio2 ratio in the respiratory component of the Sequential Organ Failure Assessment score*: Crit Care Med. abril de 2009;37(4):1317-21. Matthay MA, Arabi Y, Arroliga AC, Bernard GR, Bersten AD, Brochard LJ, et al. A New Global Definition of Acute Respiratory Distress Syndrome. En: D16 ADVANCING THE SCIENCE OF ARDS AND ACUTE RESPIRATORY FAILURE [Internet]. American Thoracic Society; 2023 [citado 8 de junio de 2023]. p. A6229-A6229. Disponible en: https://www.atsjournals.org/doi/10.1164/ajrccm-conference.2023.207.1_MeetingAbstracts.A6229 Varón-Vega FA, Uribe Hernández AM, Palacios Rojas JO. Epidemiología, diferencias clínicas y desenlaces de pacientes con SDRA en unidades de cuidado intensivo de Colombia. Acta Colomb Cuid Intensivo. abril de 2019;19(2):74-80. Machado-Alba JE, Valladales-Restrepo LF, Machado-Duque ME, Gaviria-Mendoza A, Sánchez-Ramírez N, Usma-Valencia AF, et al. Factors associated with admission to the intensive care unit and mortality in patients with COVID-19, Colombia. Tan W, editor. PLOS ONE. 19 de noviembre de 2021;16(11):e0260169. Arias Ramos D, Restrepo Rueda DL, Rios Quintero EV, Olaya Gómez JC, Cortés Bonilla I. Severe and critical COVID-19 in a tertiary center in Colombia, a retrospective cross-sectional study. BMC Infect Dis. diciembre de 2022;22(1):247. Díaz-Guio DA, Salazar-Ospina MA, Salazar-Palacio C, Díaz-Gómez AS, Díaz-Guio Y, Ricardo-Zapata A, et al. Characteristics and outcomes of patients with COVID-19 in intensive care in the first year of the pandemic: A Colombian observational study. Acta Colomb Cuid Intensivo. abril de 2023;23(2):95-104. Anesi GL, Jablonski J, Harhay MO, Atkins JH, Bajaj J, Baston C, et al. Characteristics, Outcomes, and Trends of Patients With COVID-19–Related Critical Illness at a Learning Health System in the United States. Ann Intern Med. mayo de 2021;174(5):613-21. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. mayo de 2020;8(5):475-81. Cummings MJ, Baldwin MR, Abrams D, Jacobson SD, Meyer BJ, Balough EM, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. 2020;395:9. Garibaldi BT, Fiksel J, Muschelli J, Robinson ML, Rouhizadeh M, Perin J, et al. Patient Trajectories Among Persons Hospitalized for COVID-19: A Cohort Study. Ann Intern Med. enero de 2021;174(1):33-41. Zhang XB, Hu L, Ming Q, Wei XJ, Zhang ZY, Chen LD, et al. Risk factors for mortality of coronavirus disease-2019 (COVID-19) patients in two centers of Hubei province, China: A retrospective analysis. Lucas A, editor. PLOS ONE. 28 de enero de 2021;16(1):e0246030. Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol. julio de 2020;146(1):110-8. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 26 de mayo de 2020;323(20):2052. Gu Y, Wang D, Chen C, Lu W, Liu H, Lv T, et al. PaO2/FiO2 and IL-6 are risk factors of mortality for intensive care COVID-19 patients. Sci Rep. diciembre de 2021;11(1):7334. Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 28 de abril de 2020;323(16):1574. COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators. Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med. enero de 2021;47(1):60-73. Robles AJ, Kornblith LZ, Hendrickson CM, Howard BM, Conroy AS, Moazed F, et al. Health care utilization and the cost of posttraumatic acute respiratory distress syndrome care. J Trauma Acute Care Surg. julio de 2018;85(1):148-54. Liu X, Pan C, Si L, Tong S, Niu Y, Qiu H, et al. Definition of Acute Respiratory Distress Syndrome on the Plateau of Xining, Qinghai: A Verification of the Berlin Definition Altitude-PaO2/FiO2-Corrected Criteria. Front Med. 23 de febrero de 2022;9:648835. Jibaja M, Roldan-Vasquez E, Rello J, Shen H, Maldonado N, Grunauer M, et al. Effect of High Altitude on the Survival of COVID-19 Patients in Intensive Care Unit: A Cohort Study. J Intensive Care Med. septiembre de 2022;37(9):1265-73. Villar J, González-Martín JM, Ambrós A, Mosteiro F, Martínez D, Fernández L, et al. Stratification for Identification of Prognostic Categories In the Acute RESpiratory Distress Syndrome (SPIRES) Score. Crit Care Med. octubre de 2021;49(10):e920-30. Zhang Z, Ni H. Prediction Model for Critically Ill Patients with Acute Respiratory Distress Syndrome. Lazzeri C, editor. PLOS ONE. 30 de marzo de 2015;10(3):e0120641. Machado FVC, Meys R, Delbressine JM, Vaes AW, Goërtz YMJ, Van Herck M, et al. Construct validity of the Post-COVID-19 Functional Status Scale in adult subjects with COVID-19. Health Qual Life Outcomes. diciembre de 2021;19(1):40. American Psychological Association A. APA Dictionary of Psychology [Internet]. APA Dictionary of Psychology. 2023. Disponible en: https://dictionary.apa.org/resilience Killgore WDS, Taylor EC, Cloonan SA, Dailey NS. Psychological resilience during the COVID-19 lockdown. Psychiatry Res [Internet]. septiembre de 2020 [citado 4 de junio de 2023];291:113216. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S016517812031742X Wright MO, Masten AS. Resilience Processes in Development. En: Goldstein S, Brooks RB, editores. Handbook of Resilience in Children [Internet]. Boston, MA: Springer US; 2005 [citado 7 de junio de 2023]. p. 17-37. Disponible en: http://link.springer.com/10.1007/0-306-48572-9_2 Campbell-Sills L, Stein MB. Psychometric analysis and refinement of the connor–davidson resilience scale (CD-RISC): Validation of a 10-item measure of resilience. J Trauma Stress [Internet]. diciembre de 2007 [citado 8 de junio de 2023];20(6):1019-28. Disponible en: https://onlinelibrary.wiley.com/doi/10.1002/jts.20271 Pérez-Gómez HR, González-Díaz E, Herrero M, De Santos-Ávila F, Vázquez-Castellanos JL, Juárez-Rodríguez P, et al. The Moderating Effect of Resilience on Mental Health Deterioration among COVID-19 Survivors in a Mexican Sample. Healthcare [Internet]. 5 de febrero de 2022 [citado 4 de junio de 2023];10(2):305. Disponible en: https://www.mdpi.com/2227-9032/10/2/305 The World Health Organization quality of life assessment (WHOQOL): Position paper from the World Health Organization. Soc Sci Med. noviembre de 1995;41(10):1403-9. De Jong CMM, Le YNJ, Boon GJAM, Barco S, Klok FA, Siegerink B. Eight lessons from two-year use of the Post-COVID-19 Functional Status scale. Eur Respir J. 20 de abril de 2023;2300416. Klok FA, Boon GJAM, Barco S, Endres M, Geelhoed JJM, Knauss S, et al. The Post-COVID-19 Functional Status scale: a tool to measure functional status over time after COVID-19. Eur Respir J. julio de 2020;56(1):2001494. Wu AW, Jacobson DL, Berzon RA, Revicki DA, van der Horst C, Fichtenbaum CJ, et al. The effect of mode of administration on medical outcomes study health ratings and EuroQol scores in AIDS. Qual Life Res Int J Qual Life Asp Treat Care Rehabil. enero de 1997;6(1):3-10. https://euroqol.org/euroqol/. Williamson T, Dyer F, Garvey D, Miers A, Morris C, Wells C, et al. P25 The effect of post COVID-19 rehabilitation on health status using the EQ-5D- 5L. En: Virtual monitoring in COVID-19 [Internet]. BMJ Publishing Group Ltd and British Thoracic Society; 2021 [citado 16 de junio de 2023]. p. A79.1-A79. Disponible en: https://thorax.bmj.com/lookup/doi/10.1136/thorax-2021-BTSabstracts.135 Ping W, Zheng J, Niu X, Guo C, Zhang J, Yang H, et al. Evaluation of health-related quality of life using EQ-5D in China during the COVID-19 pandemic. PloS One. 2020;15(6):e0234850. |
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Pinzón Rondón, Ángela María73e6025e-0540-4813-9d1f-9156d8bbde8d-1Ruiz Sternberg, Ángela Maríab9f4a2d4-f987-431b-a762-0425693684db-1Grupo de Investigación ClínicaMolano González, NicolásRodríguez Lima, David ReneDoctor en Investigación ClínicaDoctoradod1b0dea4-b9db-4490-b507-64420c1fcdcc-12025-03-03T13:02:47Z2025-03-03T13:02:47Z2025-02-28Esta tesis doctoral examina el impacto del Síndrome de Distrés Respiratorio Agudo (SDRA) por COVID-19 en gran altitud, evaluando sus características clínicas, factores de mortalidad y calidad de vida en pacientes ventilados mecánicamente. Se basa en tres publicaciones científicas que abordan distintos aspectos de la enfermedad en Bogotá, Colombia (2500 msnm). 1. Características clínicas y mortalidad del SDRA por COVID-19 en la altitud El estudio incluyó 5161 pacientes hospitalizados por COVID-19 y encontró que, aunque la hipoxemia hipobárica es común en Bogotá, la necesidad de hospitalización y ventilación mecánica invasiva (VMI) fue similar a la de otras regiones a menor altitud. Sin embargo, la mortalidad en pacientes ventilados permaneció alta durante toda la pandemia, a diferencia de países de altos ingresos, lo que sugiere que la disponibilidad de recursos influye más que la hipoxia de la altura en los desenlaces clínicos. Se identificó la necesidad de ajustar los umbrales de PaO₂/FiO₂ para la toma de decisiones terapéuticas en pacientes a gran altitud. 2. Modelo de predicción de mortalidad intrahospitalaria en pacientes con SDRA Se desarrolló un modelo predictivo en 2210 pacientes con SDRA por COVID-19 para evaluar el riesgo de mortalidad hospitalaria utilizando variables clínicas y de laboratorio al ingreso. Se compararon dos enfoques: uno con la PaO₂/FiO₂ sin ajustar y otro con PaO₂/FiO₂ ajustado por altitud. No se encontró diferencia significativa en la capacidad predictiva de ambos modelos, lo que indica que el ajuste por altitud no mejora la estratificación del riesgo en estos pacientes. 3. Resiliencia y calidad de vida en pacientes ventilados por COVID-19 Se evaluó la calidad de vida y resiliencia en pacientes que requirieron VMI por COVID-19, un año después del alta hospitalaria. Se encontró que el 38% de los pacientes reportó una calidad de vida deteriorada, y aquellos con mayor resiliencia mostraron mejores resultados en las escalas de evaluación. Se validó el uso de herramientas como la Escala de Estado Funcional Post-COVID-19 (PCFS) y el cuestionario EuroQol (EQ-5D-3L) para la medición de calidad de vida en esta población. Conclusión General Los hallazgos resaltan que la hipoxemia hipobárica en la altitud afecta la clasificación y el manejo del SDRA, pero no explica por sí sola las altas tasas de mortalidad. La falta de recursos y las condiciones locales tienen un impacto significativo en los desenlaces. Se destaca la necesidad de nuevas herramientas de estratificación de riesgo específicas para ciudades a más de 1000 msnm, con el fin de optimizar el tratamiento y mejorar la supervivencia y calidad de vida de los pacientes con SDRA por COVID-19. Implicaciones Clínicas - Adaptación de los criterios de SDRA en altitud. - Implementación de modelos predictivos de mortalidad temprana. - Evaluación post-hospitalaria de resiliencia y calidad de vida. Estos resultados tienen el potencial de mejorar el manejo clínico de pacientes con SDRA en regiones de gran altitud.This doctoral thesis examines the impact of Acute Respiratory Distress Syndrome (ARDS) due to COVID-19 at high altitude, assessing its clinical characteristics, mortality factors, and quality of life in mechanically ventilated patients. It is based on three scientific publications addressing different aspects of the disease in Bogotá, Colombia (2500 meters above sea level). 1. Clinical characteristics and mortality of COVID-19 ARDS at high altitude The study included 5161 hospitalized COVID-19 patients and found that, although hypobaric hypoxemia is common in Bogotá, hospitalization and mechanical ventilation (MV) rates were similar to those in lower-altitude regions. However, mortality among ventilated patients remained high throughout the pandemic, unlike in high-income countries, suggesting that resource availability impacts clinical outcomes more than altitude-related hypoxia. The study highlighted the need to adjust PaO₂/FiO₂ thresholds for therapeutic decision-making in high-altitude patients. 2. Prediction model for in-hospital mortality in ARDS patients A predictive model was developed in 2210 ARDS patients with COVID-19 to assess in-hospital mortality risk using clinical and laboratory variables upon admission. Two approaches were compared: one using unadjusted PaO₂/FiO₂ and another using PaO₂/FiO₂ adjusted for altitude. No significant difference was found in the predictive ability of both models, indicating that adjusting for altitude does not improve risk stratification in these patients. 3. Resilience and quality of life in ventilated COVID-19 patients The quality of life and resilience of patients who required MV due to COVID-19 were assessed one year after hospital discharge. 38% of patients reported impaired quality of life, and those with higher resilience showed better outcomes in assessment scales. The study validated the use of tools such as the Post-COVID-19 Functional Status (PCFS) Scale and the EuroQol (EQ-5D-3L) questionnaire to measure quality of life in this population. General Conclusion Findings highlight that hypobaric hypoxemia at high altitude affects ARDS classification and management but does not solely explain the high mortality rates. Limited resources and local conditions significantly impact outcomes. The study emphasizes the need for new risk stratification tools tailored for cities above 1000 meters above sea level to optimize treatment and improve survival and quality of life in COVID-19 ARDS patients. Clinical Implications - Adaptation of ARDS criteria at high altitude. - Implementation of early mortality predictive models. - Post-hospital assessment of resilience and quality of life. These findings have the potential to enhance clinical management of ARDS patients in high-altitude regions.26 ppapplication/pdfhttps://doi.org/10.1186/s12245-022-00426-4https://doi.org/10.1186/s41687-024-00748-2https://doi.org/10.1371/journal.pone.0293476https://repository.urosario.edu.co/handle/10336/45052engUniversidad del RosarioEscuela de Medicina y Ciencias de la SaludDoctorado en Investigación Clínicahttps://doi.org/10.1186/s12245-022-00426-4Attribution-NoDerivatives 4.0 InternationalAbierto (Texto Completo)http://creativecommons.org/licenses/by-nd/4.0/http://purl.org/coar/access_right/c_abf2Rodriguez Lima DR, Pinzón Rondón ÁM, Rubio Ramos C, Pinilla Rojas DI, Niño Orrego MJ, Díaz Quiroz MA, et al. 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Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 28 de abril de 2020;323(16):1574.COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators. Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med. enero de 2021;47(1):60-73.Robles AJ, Kornblith LZ, Hendrickson CM, Howard BM, Conroy AS, Moazed F, et al. Health care utilization and the cost of posttraumatic acute respiratory distress syndrome care. J Trauma Acute Care Surg. julio de 2018;85(1):148-54.Liu X, Pan C, Si L, Tong S, Niu Y, Qiu H, et al. Definition of Acute Respiratory Distress Syndrome on the Plateau of Xining, Qinghai: A Verification of the Berlin Definition Altitude-PaO2/FiO2-Corrected Criteria. Front Med. 23 de febrero de 2022;9:648835.Jibaja M, Roldan-Vasquez E, Rello J, Shen H, Maldonado N, Grunauer M, et al. Effect of High Altitude on the Survival of COVID-19 Patients in Intensive Care Unit: A Cohort Study. J Intensive Care Med. septiembre de 2022;37(9):1265-73.Villar J, González-Martín JM, Ambrós A, Mosteiro F, Martínez D, Fernández L, et al. Stratification for Identification of Prognostic Categories In the Acute RESpiratory Distress Syndrome (SPIRES) Score. Crit Care Med. octubre de 2021;49(10):e920-30.Zhang Z, Ni H. Prediction Model for Critically Ill Patients with Acute Respiratory Distress Syndrome. Lazzeri C, editor. PLOS ONE. 30 de marzo de 2015;10(3):e0120641.Machado FVC, Meys R, Delbressine JM, Vaes AW, Goërtz YMJ, Van Herck M, et al. Construct validity of the Post-COVID-19 Functional Status Scale in adult subjects with COVID-19. Health Qual Life Outcomes. diciembre de 2021;19(1):40.American Psychological Association A. APA Dictionary of Psychology [Internet]. APA Dictionary of Psychology. 2023. 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Eur Respir J. julio de 2020;56(1):2001494.Wu AW, Jacobson DL, Berzon RA, Revicki DA, van der Horst C, Fichtenbaum CJ, et al. The effect of mode of administration on medical outcomes study health ratings and EuroQol scores in AIDS. Qual Life Res Int J Qual Life Asp Treat Care Rehabil. enero de 1997;6(1):3-10.https://euroqol.org/euroqol/.Williamson T, Dyer F, Garvey D, Miers A, Morris C, Wells C, et al. P25 The effect of post COVID-19 rehabilitation on health status using the EQ-5D- 5L. En: Virtual monitoring in COVID-19 [Internet]. BMJ Publishing Group Ltd and British Thoracic Society; 2021 [citado 16 de junio de 2023]. p. A79.1-A79. Disponible en: https://thorax.bmj.com/lookup/doi/10.1136/thorax-2021-BTSabstracts.135Ping W, Zheng J, Niu X, Guo C, Zhang J, Yang H, et al. Evaluation of health-related quality of life using EQ-5D in China during the COVID-19 pandemic. 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