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

Hugo Perazzo; Sandra W Cardoso; Maria Pia D Ribeiro; Rodrigo Moreira; Lara E Coelho; Emilia M Jalil; André Miguel Japiassú; Elias Pimentel Gouvêa; Estevão Portela Nunes; Hugo Boechat Andrade; Luciano Barros Gouvêa; Marcel Treptow Ferreira; Pedro Mendes de Azambuja Rodrigues; Ronaldo Moreira; Kim Geraldo; Lucilene Freitas; Vinicius V Pacheco; Esau Custódio João; Trevon Fuller; Verônica Diniz Rocha; Ceuci de Lima Xavier Nunes; Tâmara Newman Lobato Souza; Ana Luiza Castro Conde Toscano; Alexandre Vargas Schwarzbold; Helena Carolina Noal; Gustavo de Araujo Pinto; Paula Macedo de Oliveira Lemos; Carla Santos; Fernanda Carvalho de Queiroz Mello; Valdilea G Veloso; Beatriz Grinsztejn; RECOVER-SUS Brasil Group

doi:10.1016/j.lana.2022.100244

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

Lancet Reg Health Am. 2022 Jul:11:100244. doi: 10.1016/j.lana.2022.100244. Epub 2022 Apr 12.

Authors

Hugo Perazzo¹, Sandra W Cardoso¹, Maria Pia D Ribeiro¹, Rodrigo Moreira¹, Lara E Coelho¹, Emilia M Jalil¹, André Miguel Japiassú¹, Elias Pimentel Gouvêa¹, Estevão Portela Nunes¹, Hugo Boechat Andrade¹, Luciano Barros Gouvêa¹, Marcel Treptow Ferreira¹, Pedro Mendes de Azambuja Rodrigues¹, Ronaldo Moreira¹, Kim Geraldo¹, Lucilene Freitas¹, Vinicius V Pacheco¹, Esau Custódio João², Trevon Fuller², Verônica Diniz Rocha³, Ceuci de Lima Xavier Nunes³, Tâmara Newman Lobato Souza⁴, Ana Luiza Castro Conde Toscano⁴, Alexandre Vargas Schwarzbold⁵, Helena Carolina Noal⁵, Gustavo de Araujo Pinto⁶, Paula Macedo de Oliveira Lemos⁶, Carla Santos⁷, Fernanda Carvalho de Queiroz Mello⁷, Valdilea G Veloso¹, Beatriz Grinsztejn¹; RECOVER-SUS Brasil Group

Affiliations

¹ Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
² Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.
³ Instituto Couto Maia, Secretaria Estadual de Saúde da Bahia, Salvador, BA, Brazil.
⁴ Instituto de Infectologia Emilio Ribas, São Paulo, SP, Brazil.
⁵ Universidade Federal de Santa Maria, RS, Brazil.
⁶ Hospital Regional São José, SC, Brazil.
⁷ Complexo Hospital Universitário Clementino Fraga Filho - Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

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.