In-hospital mortality and severe outcomes after hospital discharge due to COVID-19: A prospective multicenter study from Brazil

• Main Authors: Hugo Perazzo (Author), Sandra W. Cardoso (Author), Maria Pia D. Ribeiro (Author), Rodrigo Moreira (Author), Lara E. Coelho (Author), Emilia M. Jalil (Author), André Miguel Japiassú (Author), Elias Pimentel Gouvêa (Author), Estevão Portela Nunes (Author), Hugo Boechat Andrade (Author), Luciano Barros Gouvêa (Author), Marcel Treptow Ferreira (Author), Pedro Mendes de Azambuja Rodrigues (Author), Ronaldo Moreira (Author), Kim Geraldo (Author), Lucilene Freitas (Author), Vinicius V. Pacheco (Author), Esau Custódio João (Author), Trevon Fuller (Author), Verônica Diniz Rocha (Author), Ceuci de Lima Xavier Nunes (Author), Tâmara Newman Lobato Souza (Author), Ana Luiza Castro Conde Toscano (Author), Alexandre Vargas Schwarzbold (Author), Helena Carolina Noal (Author), Gustavo de Araujo Pinto (Author), Paula Macedo de Oliveira Lemos (Author), Carla Santos (Author), Fernanda Carvalho de Queiroz Mello (Author), Valdilea G. Veloso (Author), Beatriz Grinsztejn (Author)
• Format: Book
• Published: Elsevier, 2022-07-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.

Summary

Summary: 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.

Item Description

2667-193X
10.1016/j.lana.2022.100244