Análisis multinivel para identificar los factores asociados a la detección del VRS en lactantes ingresados por bronquiolitis vírica en la era de la pandemia COVID-19
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2023
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Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
Department of Pediatric Pulmonology, School of Medicine, Universidad El Bosque, Bogota, Colombia
Department of Pediatric Pulmonology, HOMI, Fundación Hospital Pediátrico la Misericordia, Bogotá, Colombia
Ministry of Health and Social Protection, Investigation Group Epidemiology and Evaluation in Public Health, Universidad Nacional de Colombia, Bogota, Colombia
Department of Pediatric Infectious Diseases, HOMI, Fundación hospital pediátrico la Misericordia, Bogotá, Colombia
Department of Infectious Diseases, Fundación Hospital Infantil Universitario de San José, Bogotá, Colombia
Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
Department of Pediatric Pulmonology, School of Medicine, Universidad El Bosque, Bogota, Colombia
Department of Pediatric Pulmonology, HOMI, Fundación Hospital Pediátrico la Misericordia, Bogotá, Colombia
Ministry of Health and Social Protection, Investigation Group Epidemiology and Evaluation in Public Health, Universidad Nacional de Colombia, Bogota, Colombia
Department of Pediatric Infectious Diseases, HOMI, Fundación hospital pediátrico la Misericordia, Bogotá, Colombia
Department of Infectious Diseases, Fundación Hospital Infantil Universitario de San José, Bogotá, Colombia
Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
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Objetivos: Identificar los factores asociados de forma independiente con la detección del virus sincitial respiratorio (VSR) en lactantes ingresados por bronquiolitis viral durante 3 años consecutivos, antes y durante la pandemia de COVID-19, en Bogotá, Colombia, un país de ingresos medios con clima de altiplano subtropical. Métodos: Se realizó un estudio transversal analítico antes y durante la pandemia COVID-19, incluyendo pacientes con diagnóstico de bronquiolitis viral ingresados en todos los hospitales de la ciudad entre enero de 2019 y noviembre de 2021. Se evaluó un conjunto de variables predictoras seleccionadas a priori que incluían variables individuales, del sistema sanitario, meteorológicas, de contaminantes atmosféricos y del COVID-19. Dado que las variables analizadas son de naturaleza jerárquica, se utilizó la modelización multinivel para identificar los factores asociados de forma independiente con la detección del VRS como agente causal de la bronquiolitis viral. Resultados: Un total de 13.177 pacientes fueron incluidos en el estudio. 07), las precipitaciones (OR 1,003; IC del 95%: 1,001; 1,005), el NO2 (OR 0,97; IC del 95%: 0,95-0,99), el CO (OR 0,99; IC del 95%: 0,99-0,99) y el periodo de pandemia de COVID-19 (OR 0,84; IC del 95%: 0,71-0,99) se asociaron de forma independiente con la detección del VRS en nuestra muestra de pacientes. Conclusiones: Los factores identificados asociados con la detección del VSR proporcionan evidencia científica adicional que puede ser útil en el desarrollo de intervenciones específicas dirigidas a mejorar o prevenir el impacto del VSR en Bogotá y probablemente en otros países similares de ingresos bajos a medios en lactantes de alto riesgo. 2023 Wiley Periodicals LLC.
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Abstract
Objectives: To identify factors independently associated with respiratory syncytial virus (RSV) detection in infants admitted for viral bronchiolitis during 3 consecutive years, before and during the COVID-19 pandemic, in Bogota, Colombia, a middle-income country with a subtropical highland climate. Methods: An analytical cross-sectional study was conducted before and during the COVID-19 pandemic, including patients with a diagnosis of viral bronchiolitis admitted to all the hospitals of the city between January 2019 and November 2021. We evaluated a set of a priori-selected predictor variables that included individual, healthcare system, meteorological, air pollutant, and COVID-19 variables. Since the variables analyzed are hierarchical in nature, multilevel modeling was used to identify factors independently associated with detection of RSV as the causative agent of viral bronchiolitis. Results: A total of 13,177 patients were included in the study. After controlling for potential confounders, it was found that age (odds ratio [OR] 0.86; 95% confidence interval [CI] 0.76–0.97), a third level of medical care institution (OR 3.05; 95% CI 1.61–5.76), temperature (OR 1.60; 95% CI 1.24–2.07), rainfall (OR 1.003, 95% CI 1.001, 1.005), NO2 (OR 0.97; 95% CI 0.95–0.99), CO (OR 0.99; 95% CI 0.99–0.99), and COVID-19 pandemic period (OR 0.84, 95% CI 0.71–0.99) were independently associated with RSV detection in our sample of patients. Conclusions: The identified factors associated with RSV detection provide additional scientific evidence that may be useful in the development of specific interventions aimed at ameliorating or preventing the impact of RSV in Bogota and probably other similar low- to middle-income countries in high-risk infants. © 2023 Wiley Periodicals LLC.
Palabras clave
Infecciones respiratorias agudas, Contaminación atmosférica, Países de renta media-baja, Factores meteorológicos, Virus respiratorio sincitial
Keywords
Acute respiratory infections, Air pollution, Low-to-middle income countrie, Meteorological factors, Respiratory syncytial virus