A retrospective cohort study of 238,000 COVID-19 hospitalizations and deaths in Brazil

Abstract

The coronavirus disease (COVID-19) pandemic has overwhelmed health care systems in many countries and bed availability has become a concern. In this context, the present study aimed to analyze the hospitalization and intensive care unit (ICU) times in patients diagnosed with COVID-19. The study covered 55,563 ICU admissions and 238,075 hospitalizations in Brazilian Health System units from February 22, 2020, to June 7, 2021. All the patients had a positive COVID-19 diagnosis. The symptoms analyzed included: fever, dyspnea, low oxygen saturation (SpO2 < 95%), cough, respiratory distress, fatigue, sore throat, diarrhea, vomiting, loss of taste, loss of smell, and abdominal pain. We performed Cox regression in two models (ICU and hospitalization times). Hazard ratios (HRs) and survival curves were calculated by age group. The average stay was 14.4 days for hospitalized patients and 12.4 days for ICU patients. For hospitalized cases, the highest hazard mean values, with a positive correlation, were for symptoms of dyspnea (HR = 1.249; 95% confidence interval [CI], 1.225–1.273) and low oxygen saturation (HR = 1.157; 95% CI 1.137–1.178). In the ICU, the highest hazard mean values were for respiratory discomfort (HR = 1.194; 95% CI 1.161–1.227) and abdominal pain (HR = 1.100; 95% CI 1.047–1.156). Survival decreased by an average of 2.27% per day for hospitalization and 3.27% per day for ICU stay. Survival by age group curves indicated that younger patients were more resistant to prolonged hospital stay than older patients. Hospitalization was also lower in younger patients. The mortality rate was higher in males than females. Symptoms related to the respiratory tract were associated with longer hospital stay. This is the first study carried out with a sample of 238,000 COVID-19 positive participants, covering the main symptoms and evaluating the hospitalization and ICU times.

Excess maternal mortality in Brazil: Regional inequalities and trajectories during the COVID-19 epidemic

“…Despite considerable variation between the regions and trimesters assessed, our general results for Brazil showed that the COVID-19 epidemic's impact on maternal mortality in the 10-24-year-old age stratum was substantially smaller than in the rest of the age strata assessed, aligning with studies that point to a lower susceptibility to SARS-CoV-2 infection [51] in younger groups, as well as less time in a hospital bed and an ICU [29] or a smaller occurrence of deaths from the disease [51].…”

“…The elevated burden of maternal deaths in the COVID-19 epidemic suggests that timely access to healthcare services and the quality of services provided have deteriorated, especially at the time of the epidemic's greatest impact. More than two years after notification of the first case of COVID-19, Brazil remains among countries most seriously affected by the direct effects of the pandemic [29], with close to 677,000 confirmed deaths by the disease, or 11% of total deaths globally [4]. The pandemic's indirect effects on other causes of mortality have also been observed in the country [20,30] and the general pattern of excess maternal mortality reinforces the epidemic's dramatic development, compromising Brazil's efforts to reach Sustainable Development Goal (SDG) 3 by reducing maternal mortality and guaranteeing universal access to sexual and reproductive health for women by 2030 [3].…”

Patient care in rapid-expansion intensive care units during the COVID-19 pandemic crisis

“…In 2020, global ICU mortality was 35% to 41.6% [ 18 – 20 ]. There was, however, marked differences among countries: from 23.4% in Japan [ 21 ] to 57—59.6% in Brazil [ 22 , 23 ]. Among patient receiving mechanical ventilation (and presumably therefore in an ICU), mortality has shown marked variability: United Arab Emirates—20.2% [ 24 ], Netherlands – 38% [ 25 ], Italy – 51.7% [ 26 ], Germany – 52.8% [ 27 ], Russia – 65.4% [ 28 ], United Kingdom – 69% [ 29 ], Mexico -73.7% [ 30 ], and Romania 95% [ 31 ].…”

The Impact of Cardiovascular Risk Factors and Renal Disease on Outcomes in Patients Hospitalized with COVID-19: An Observational Study from Two Public Hospitals in Brazil

“…Another Brazilian registry, published recently, found an overall in-hospital lethality slightly lower than our study. 27 Among 238000 hospitalizations, 32% of the patients died. Again, the predictors of outcome were not established, and data on comorbidities were not collected.…”