Prevalência de anticorpos IGG anti proteína do nucleocapsídeo e IGM anti proteína S de SARS-cov-2 após 6 meses do diagnóstico de covid-19 entre profissionais de saúde de hospital terciário e fatores associados

Base teórica: diversos testes sorológicos voltados para a detecção de anticorpos contra SARS-CoV- 2 estão disponíveis comercialmente e seu uso tem sido descrito principalmente na avaliação da taxa cumulativa de infecção. Prevalência maior do que 90% é reportada para IgG positivo em períodos tardios após o episódio de COVID-19, mas prevalência menor é observada para IgM. A capacidade de detecção de anticorpos pelos diferentes testes sorológicos disponíveis parece ser heterogênea, especialmente em períodos tardios após a doença. Profissionais de saúde constituem uma população em risco para infecção por SARS-CoV-2 e seu adoecimento impacta diretamente a capacidade de resposta dos sistemas de saúde. Objetivo: determinar a prevalência de teste sorológico para COVID-19 positivo entre profissionais de saúde diagnosticados com COVID-19 há 6 meses ou mais e avaliar fatores clínicos, demográficos e ocupacionais associados. Métodos: estudo transversal conduzido em hospital terciário brasileiro. Foram incluídos profissionais que tenham realizado teste sorológico 6 meses ou mais após o diagnóstico de COVID-19 definido por teste RTPCR (Reverse Transcription Polymerase Chain Reaction) positivo. Características clínicas e resultado dos testes para detecção de IgG anti nucleocapsídeo e de IgM anti proteína S por imunoensaio de micropartículas por quimioluminescência (CMIA) foram obtidos em prontuário médico. Variáveis categóricas foram descritas em frequência e porcentagem e contínuas em mediana e percentis 25% e 75%. Foram calculadas as prevalências e IC 95% de testes IgG e IgM positivos. Regressão de Poisson com variância robusta foi utilizada para avaliar fatores associados a teste positivo por meio do cálculo de razão de prevalência (RP) e IC 95%. Foi adotado um nível de significância de 5%. Resultados: Foram avaliados 339 indivíduos, com mediana de idade de 41 (34-49) anos, sendo 72,9% mulheres. Apenas 8,6% necessitaram hospitalização por COVID-19. A maior parte dos indivíduos exercia atividade assistencial (73,7%) e atuava em local de trabalho não dedicado a pacientes com COVID-19 (56,2%). O tempo entre RT-PCR positivo e a realização do teste sorológico foi de 30 (28,2-32,8) semanas. A prevalência de IgG positivo foi de 38,6% (IC 95%: 33,2-44) e de IgM foi de 37,7% (IC 95%: 32,6-42,8), com baixa concordância entre os testes (Kappa=0,28). Prevalência de IgG positivo foi maior em indivíduos com mais idade (RP para aumento de cada ano de vida: 1,03; 1,01-1,04) e entre aqueles com história de hospitalização por COVID-19 (RP: 2,02; 1,49-2,75). Prevalência de IgM positivo foi maior em indivíduos com maior índice de massa corporal (IMC) (RP para cada aumento de 1 Kg/m² de IMC: 1,03; 1,00-1,06). Quanto maior o tempo entre o diagnóstico de COVID-19 e a realização do teste sorológico, menor a prevalência de IgG (RP para aumento de cada semana após o diagnóstico: 0,94; 0,91-0,98) e de IgM (RP para aumento cada semana após o diagnóstico: 0,95; 0,91-0,99) positivos. Conclusão: a baixa soroprevalência de IgG anti nucleocapsídeo avaliada por imunoensaio de quimioluminescência de micropartículas resultou em subestimação da taxa cumulativa de infecção. Além disso, IgM antiproteína S como marcador de infecção recente pode levar a conclusões equivocadas, pois está presente por longos períodos após a infecção por COVID-19.Theoretical basis: Several serological tests aimed at detecting antibodies against SARS-CoV-2 are commercially available and their use has been mainly described in the assessment of the cumulative rate of infection. A prevalence greater than 90% is reported for positive IgG in later periods after the COVID-19 episode, but a lower prevalence is observed for IgM. The ability to detect antibodies by the different serological tests available seems to be heterogeneous, especially in late periods after the disease. Health professionals constitute a population at risk for SARS-CoV-2 infection and their illness directly impacts the response capacity of health systems. Objective: to determine the prevalence of positive COVID-19 serological test 6 months or more after the diagnosis of COVID- 19 among health professionals and to assess associated clinical, demographic and occupational factors. Methods: cross-sectional study conducted in a Brazilian tertiary hospital. Professionals who had performed serological testing 6 months or more after the diagnosis of COVID-19, defined by a positive RT-PCR (Reverse Transcription Polymerase Chain Reaction) test, were included. Clinical characteristics and test results for anti nucleocapsid IgG and anti protein S IgM evaluated by chemiluminescence microparticle immunoassay (CMIA) were retrieved from medical records. Categorical variables were described as frequency and percentage and continuous variables as median and 25% and 75% percentiles. Prevalence and 95% CI of positive IgG and IgM tests were calculated. Poisson regression with robust variance was used to assess factors associated with positive testing by calculating the prevalence ratio (PR) and 95% CI. A significance level of 5% was adopted. Results: A total of 339 individuals were evaluated, with a median age of 41 (34-49) years, 72.9% women. Only 8.6% required hospitalization for COVID-19. Most individuals worked in assistencial care (73.7%) and in a work area not dedicated to patients with COVID-19 (56.2%). The period of time between positive RT-PCR and serological testing was 30 weeks (28.2-32.8). The prevalence of positive IgG was 38.6% (95% CI: 33.2-44) and of positive IgM was 37.7% (95% CI: 32.6-42.8), with low agreement between the tests (Kappa=0.28). Prevalence of positive IgG was higher in older individuals (PR for increase in each year of life: 1.03; 1.01-1.04) and in those with a history of hospitalization for COVID-19 (PR: 2.02; 1.49-2.75). Prevalence of positive IgM was higher in individuals with higher body mass index (BMI) (PR for each increase of 1 Kg/m² in BMI: 1.03; 1.00-1.06). The longer the time between diagnosis and serological testing, the lower the prevalence of positive IgG (PR for each week after diagnosis: 0.94; 0.91-0.98) and positive IgM (PR for each week after diagnosis: 0.95; 0.91-0.99). Conclusion: the low seroprevalence of IgG anti nucleocapsid assessed by microparticle chemiluminescence immunoassay leads to underestimation of the cumulative rate of infection. Furthermore, IgM anti protein S as a marker of recent infection may lead to wrong conclusions, considering the presence of positive IgM after a long period of COVID-19 infection

COVID-19 among healthcare workers in a Southern Brazilian Hospital and evaluation of a diagnostic strategy based on the RT-PCR test and retest for Sars-CoV-2

OBJECTIVE: Healthcare workers are at risk for COVID-19 contamination. It is important to protect them in order to reduce nosocomial transmission and maintain the assistance capacity of health systems. To evaluate the diagnostic test and retest strategy with RT-PCR for SARS-CoV-2 and factors associated with the diagnosis of COVID-19 among healthcare workers. PATIENTS AND METHODS: Cross-sectional study carried out in a Brazilian hospital. From April 27 to June 16, 2020, symptomatic healthcare workers underwent an RT-PCR test on upper respiratory tract specimens as soon as possible and, if negative, it was repeated close to the 5th day of symptom evolution. Working areas were divided into assistance areas dedicated or not dedicated to COVID-19 and non-assistance areas. The type of activity was divided into assistance or non-assistance activity. RESULTS: 775 individuals were evaluated. 114 were diagnosed with COVID-19, of whom 101 followed the testing protocol. A second RT-PCR identified five (4.9%) of the positive cases. Working in an area dedicated to patients with COVID-19 was more prevalent among positive cases (35.1% x 19.8%, p=0.001) as well as working in an assistance activity (80.7% x 70.8%, p=0.031). CONCLUSIONS: A second RT-PCR test after the 5th day of symptom evolution showed limited diagnostic improvement. The adoption of a single test-based strategy, carried out at the right time after the onset of symptoms, allows the optimal use of resources. Working in a COVID-19 dedicated area and in direct contact with patients is related to a higher prevalence of COVID-19 among symptomatic healthcare workers

Reduction in COVID-19 prevalence in healthcare workers in a university hospital in southern Brazil after the start of vaccination

Introduction: The quick spread of SARS-CoV-2 led to the development of vaccines that are capable of reducing infection and the number of more severe COVID-19 cases. Aim: To assess COVID-19 prevalence among healthcare workers (HCWs) after vaccination against SARS-CoV-2. Methods: This was a cross-sectional study on the prevalence of COVID-19 diagnosis among 7523 HCWs vaccinated against SARS-CoV-2 with CoronaVac and ChAdOx1 nCoV-19 in a university hospital, in southern Brazil, between January 18 and March 18, 2021.The variables evaluated were: sex, age, work area, role, source of infection, previous diagnosis of COVID-19, date of vaccine administration, type of vaccine, and need for hospitalization. The statistical analysis used Poisson regression and Fisher's exact test with SPSS software version 25, and a level of significance set at 5%. Results: 813 vaccinated HCWs showed symptoms suggestive of COVID-19, of whom 35.4% (288) had a detectable result after undergoing RT-PCR for SARS-CoV-2. There was a reduction of 62% in new cases of COVID-19 among HCWs in the institution 7 weeks after the start of vaccine rollout. Conclusion: Our data suggest that the vaccines used by the institution reduced the number of COVID-19 cases among healthcare workers, demonstrating the effectiveness of the vaccines

Analysis of risk scores to predict mortality in patients undergoing cardiac surgery for endocarditis

Fundamento: Escores de risco estão disponíveis para uso na prática clínica diária, mas saber qual deles escolher é ainda incerto. Objetivos: Avaliar o EuroSCORE logístico, o EuroSCORE II e os escores específicos para endocardite infecciosa STSIE, PALSUSE, AEPEI, EndoSCORE e RISK-E na predição de mortalidade hospitalar de pacientes submetidos à cirurgia cardíaca por endocardite ativa em um hospital terciário de ensino do sul do Brasil. Métodos: Estudo de coorte retrospectivo incluindo todos os pacientes com idade ≥ 18 anos submetidos à cirurgia cardíaca por endocardite ativa no centro do estudo entre 2007 e 2016. Foram realizadas análises de calibração (razão de mortalidade observada/esperada, O/E) e de discriminação (área sob a curva ROC, ASC), sendo a comparação das ASC realizada pelo teste de DeLong. P < 0,05 foi considerado estatisticamente significativo Resultados: Foram incluídos 107 pacientes, sendo a mortalidade hospitalar de 29,0% (IC95%: 20.4-37.6%). A melhor razão de mortalidade O/E foi obtida pelo escore PALSUSE (1,01, IC95%: 0,70-1,42), seguido pelo EuroSCORE logístico (1,3, IC95%: 0,92-1,87). O EuroSCORE logístico apresentou o maior poder discriminatório (ASC 0,77), significativamente superior ao EuroSCORE II (p = 0,03), STS-IE (p = 0,03), PALSUSE (p = 0,03), AEPEI (p = 0,03) e RISK-E (p = 0,02). Conclusões: Apesar da disponibilidade dos recentes escores específicos, o EuroSCORE logístico foi o melhor preditor de mortalidade em nossa coorte, considerando-se análise de calibração (mortalidade O/E: 1,3) e de discriminação (ASC 0,77). A validação local dos escores específicos é necessária para uma melhor avaliação do risco cirúrgico.Background: Risk scores are available for use in daily clinical practice, but knowing which one to choose is still fraught with uncertainty. Objectives: To assess the logistic EuroSCORE, EuroSCORE II, and the infective endocarditis (IE)-specific scores STS-IE, PALSUSE, AEPEI, EndoSCORE and RISK-E, as predictors of hospital mortality in patients undergoing cardiac surgery for active IE at a tertiary teaching hospital in Southern Brazil. Methods: Retrospective cohort study including all patients aged ≥ 18 years who underwent cardiac surgery for active IE at the study facility from 2007-2016. The scores were assessed by calibration evaluation (observed/expected [O/E] mortality ratio) and discrimination (area under the ROC curve [AUC]). Comparison of AUC was performed by the DeLong test. A p < 0.05 was considered statistically significant. Results: A total of 107 patients were included. Overall hospital mortality was 29.0% (95%CI: 20.4-37.6%). The best O/E mortality ratio was achieved by the PALSUSE score (1.01, 95%CI: 0.70-1.42), followed by the logistic EuroSCORE (1.3, 95%CI: 0.92-1.87). The logistic EuroSCORE had the highest discriminatory power (AUC 0.77), which was significantly superior to EuroSCORE II (p = 0.03), STS-IE (p = 0.03), PALSUSE (p = 0.03), AEPEI (p = 0.03), and RISK-E (p = 0.02). Conclusions: Despite the availability of recent IE-specific scores, and considering the trade-off between the indexes, the logistic EuroSCORE seemed to be the best predictor of mortality risk in our cohort, taking calibration (O/E mortality ratio: 1.3) and discrimination (AUC 0.77) into account. Local validation of IE-specific scores is needed to better assess preoperative surgical risk