tetano
Editor, Senior Moderator
Lancet Reg Health Am
. 2022 Jul;11:100244.
doi: 10.1016/j.lana.2022.100244. Epub 2022 Apr 12.
In-hospital mortality and severe outcomes after hospital discharge due to COVID-19: A prospective multicenter study from Brazil
Hugo Perazzo[SUP] 1 [/SUP], Sandra W Cardoso[SUP] 1 [/SUP], Maria Pia D Ribeiro[SUP] 1 [/SUP], Rodrigo Moreira[SUP] 1 [/SUP], Lara E Coelho[SUP] 1 [/SUP], Emilia M Jalil[SUP] 1 [/SUP], André Miguel Japiassú[SUP] 1 [/SUP], Elias Pimentel Gouvêa[SUP] 1 [/SUP], Estevão Portela Nunes[SUP] 1 [/SUP], Hugo Boechat Andrade[SUP] 1 [/SUP], Luciano Barros Gouvêa[SUP] 1 [/SUP], Marcel Treptow Ferreira[SUP] 1 [/SUP], Pedro Mendes de Azambuja Rodrigues[SUP] 1 [/SUP], Ronaldo Moreira[SUP] 1 [/SUP], Kim Geraldo[SUP] 1 [/SUP], Lucilene Freitas[SUP] 1 [/SUP], Vinicius V Pacheco[SUP] 1 [/SUP], Esau Custódio João[SUP] 2 [/SUP], Trevon Fuller[SUP] 2 [/SUP], Verônica Diniz Rocha[SUP] 3 [/SUP], Ceuci de Lima Xavier Nunes[SUP] 3 [/SUP], Tâmara Newman Lobato Souza[SUP] 4 [/SUP], Ana Luiza Castro Conde Toscano[SUP] 4 [/SUP], Alexandre Vargas Schwarzbold[SUP] 5 [/SUP], Helena Carolina Noal[SUP] 5 [/SUP], Gustavo de Araujo Pinto[SUP] 6 [/SUP], Paula Macedo de Oliveira Lemos[SUP] 6 [/SUP], Carla Santos[SUP] 7 [/SUP], Fernanda Carvalho de Queiroz Mello[SUP] 7 [/SUP], Valdilea G Veloso[SUP] 1 [/SUP], Beatriz Grinsztejn[SUP] 1 [/SUP], RECOVER-SUS Brasil Group
Affiliations
Abstract
Background: We evaluated in-hospital mortality and outcomes incidence after hospital discharge due to COVID-19 in a Brazilian multicenter cohort.
Methods: This prospective multicenter study (RECOVER-SUS, NCT04807699) included COVID-19 patients hospitalized in public tertiary hospitals in Brazil from June 2020 to March 2021. Clinical assessment and blood samples were performed at hospital admission, with post-hospital discharge remote visits. Hospitalized participants were followed-up until March 31, 2021. The outcomes were in-hospital mortality and incidence of rehospitalization or death after hospital discharge. Kaplan-Meier curves and Cox proportional-hazard models were performed.
Findings: 1589 participants [54.5% male, age=62 (IQR 50-70) years; BMI=28.4 (IQR,24.9-32.9) Kg/m² and 51.9% with diabetes] were included. A total of 429 individuals [27.0% (95%CI,24.8-29.2)] died during hospitalization (median time 14 (IQR,9-24) days). Older age [vs<40 years; age=60-69 years-aHR=1.89 (95%CI,1.08-3.32); age=70-79 years-aHR=2.52 (95%CI,1.42-4.45); age≥80-aHR=2.90 (95%CI 1.54-5.47)]; noninvasive or mechanical ventilation at admission [vs facial-mask or none; aHR=1.69 (95%CI 1.30-2.19)]; SAPS-III score≥57 [vs<57; aHR=1.47 (95%CI 1.13-1.92)] and SOFA score≥10 [vs <10; aHR=1.51 (95%CI 1.08-2.10)] were independently associated with in-hospital mortality. A total of 65 individuals [6.7% (95%CI 5.3-8.4)] had a rehospitalization or death [rate=323 (95%CI 250-417) per 1000 person-years] in a median time of 52 (range 1-280) days post-hospital discharge. Age ≥ 60 years [vs <60, aHR=2.13 (95%CI 1.15-3.94)] and SAPS-III ≥57 at admission [vs <57, aHR=2.37 (95%CI 1.22-4.59)] were independently associated with rehospitalization or death after hospital discharge.
Interpretation: High in-hospital mortality rates due to COVID-19 were observed and elderly people remained at high risk of rehospitalization and death after hospital discharge.
Funding: Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Programa INOVA-FIOCRUZ.
Keywords: ALT, alanine aminotransferase; AST, aspartate aminotransferase BMI, body mass index; CI, confidence interval; COVID-19; COVID-19, Coronavirus disease 2019; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; ICU, intensive care unit; INR, international normalized ratio; IQR, interquartile range; In-hospital mortality; NIV, non-invasive ventilation; PD, person-days; PY, person-years; Post-COVID-19; REDCap, research electronic data capture; SAPS-III, simplified acute physiology score III; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; SOFA, sequential organ failure assessment; VIF, variance inflation factor; VOC, variant of concern; WHO, World Health Organization; aHR, adjusted-hazard ratio.
. 2022 Jul;11:100244.
doi: 10.1016/j.lana.2022.100244. Epub 2022 Apr 12.
In-hospital mortality and severe outcomes after hospital discharge due to COVID-19: A prospective multicenter study from Brazil
Hugo Perazzo[SUP] 1 [/SUP], Sandra W Cardoso[SUP] 1 [/SUP], Maria Pia D Ribeiro[SUP] 1 [/SUP], Rodrigo Moreira[SUP] 1 [/SUP], Lara E Coelho[SUP] 1 [/SUP], Emilia M Jalil[SUP] 1 [/SUP], André Miguel Japiassú[SUP] 1 [/SUP], Elias Pimentel Gouvêa[SUP] 1 [/SUP], Estevão Portela Nunes[SUP] 1 [/SUP], Hugo Boechat Andrade[SUP] 1 [/SUP], Luciano Barros Gouvêa[SUP] 1 [/SUP], Marcel Treptow Ferreira[SUP] 1 [/SUP], Pedro Mendes de Azambuja Rodrigues[SUP] 1 [/SUP], Ronaldo Moreira[SUP] 1 [/SUP], Kim Geraldo[SUP] 1 [/SUP], Lucilene Freitas[SUP] 1 [/SUP], Vinicius V Pacheco[SUP] 1 [/SUP], Esau Custódio João[SUP] 2 [/SUP], Trevon Fuller[SUP] 2 [/SUP], Verônica Diniz Rocha[SUP] 3 [/SUP], Ceuci de Lima Xavier Nunes[SUP] 3 [/SUP], Tâmara Newman Lobato Souza[SUP] 4 [/SUP], Ana Luiza Castro Conde Toscano[SUP] 4 [/SUP], Alexandre Vargas Schwarzbold[SUP] 5 [/SUP], Helena Carolina Noal[SUP] 5 [/SUP], Gustavo de Araujo Pinto[SUP] 6 [/SUP], Paula Macedo de Oliveira Lemos[SUP] 6 [/SUP], Carla Santos[SUP] 7 [/SUP], Fernanda Carvalho de Queiroz Mello[SUP] 7 [/SUP], Valdilea G Veloso[SUP] 1 [/SUP], Beatriz Grinsztejn[SUP] 1 [/SUP], RECOVER-SUS Brasil Group
Affiliations
- PMID: 35434696
- PMCID: PMC9001143
- DOI: 10.1016/j.lana.2022.100244
Abstract
Background: We evaluated in-hospital mortality and outcomes incidence after hospital discharge due to COVID-19 in a Brazilian multicenter cohort.
Methods: This prospective multicenter study (RECOVER-SUS, NCT04807699) included COVID-19 patients hospitalized in public tertiary hospitals in Brazil from June 2020 to March 2021. Clinical assessment and blood samples were performed at hospital admission, with post-hospital discharge remote visits. Hospitalized participants were followed-up until March 31, 2021. The outcomes were in-hospital mortality and incidence of rehospitalization or death after hospital discharge. Kaplan-Meier curves and Cox proportional-hazard models were performed.
Findings: 1589 participants [54.5% male, age=62 (IQR 50-70) years; BMI=28.4 (IQR,24.9-32.9) Kg/m² and 51.9% with diabetes] were included. A total of 429 individuals [27.0% (95%CI,24.8-29.2)] died during hospitalization (median time 14 (IQR,9-24) days). Older age [vs<40 years; age=60-69 years-aHR=1.89 (95%CI,1.08-3.32); age=70-79 years-aHR=2.52 (95%CI,1.42-4.45); age≥80-aHR=2.90 (95%CI 1.54-5.47)]; noninvasive or mechanical ventilation at admission [vs facial-mask or none; aHR=1.69 (95%CI 1.30-2.19)]; SAPS-III score≥57 [vs<57; aHR=1.47 (95%CI 1.13-1.92)] and SOFA score≥10 [vs <10; aHR=1.51 (95%CI 1.08-2.10)] were independently associated with in-hospital mortality. A total of 65 individuals [6.7% (95%CI 5.3-8.4)] had a rehospitalization or death [rate=323 (95%CI 250-417) per 1000 person-years] in a median time of 52 (range 1-280) days post-hospital discharge. Age ≥ 60 years [vs <60, aHR=2.13 (95%CI 1.15-3.94)] and SAPS-III ≥57 at admission [vs <57, aHR=2.37 (95%CI 1.22-4.59)] were independently associated with rehospitalization or death after hospital discharge.
Interpretation: High in-hospital mortality rates due to COVID-19 were observed and elderly people remained at high risk of rehospitalization and death after hospital discharge.
Funding: Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Programa INOVA-FIOCRUZ.
Keywords: ALT, alanine aminotransferase; AST, aspartate aminotransferase BMI, body mass index; CI, confidence interval; COVID-19; COVID-19, Coronavirus disease 2019; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; ICU, intensive care unit; INR, international normalized ratio; IQR, interquartile range; In-hospital mortality; NIV, non-invasive ventilation; PD, person-days; PY, person-years; Post-COVID-19; REDCap, research electronic data capture; SAPS-III, simplified acute physiology score III; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; SOFA, sequential organ failure assessment; VIF, variance inflation factor; VOC, variant of concern; WHO, World Health Organization; aHR, adjusted-hazard ratio.
