Clinical Profile and Risk Factors for Severe COVID-19 in Hospitalized Patients from Rio de Janeiro, Brazil: Comparison between the First and Second Pandemic Waves

Abstract

Since COVID-19 was declared a pandemic, Brazil has become one of the countries most affected by this disease. A year into the pandemic, a second wave of COVID-19 emerged, with a rapid spread of a new SARS-CoV-2 lineage of concern. Several vaccines have been granted emergency-use authorization, leading to a decrease in mortality and severe cases in many countries. However, the emergence of SARS-CoV-2 variants raises the alert for potential new waves of transmission and an increase in pathogenicity. We compared the demographic and clinical data of critically ill patients infected with COVID-19 hospitalized in Rio de Janeiro during the first and second waves between July 2020 and October 2021. In total, 106 participants were included in this study; among them, 88% had at least one comorbidity, and 37% developed severe disease. Disease severity was associated with older age, pre-existing neurological comorbidities, higher viral load, and dyspnea. Laboratory biomarkers related to white blood cells, coagulation, cellular injury, inflammation, renal, and liver injuries were significantly associated with severe COVID-19. During the second wave of the pandemic, the necessity of invasive respiratory support was higher, and more individuals with COVID-19 developed acute hepatitis, suggesting that the progression of the second wave resulted in an increase in severe cases. These results can contribute to understanding the behavior of the COVID-19 pandemic in Brazil and may be helpful in predicting disease severity, which is a pivotal for guiding clinical care, improving patient outcomes, and defining public policies.

Analyzing the Outcomes of COVID-19 Infection on Patients With Comorbidities: Insights From Hospital-Based Study

“…In either of the groups fever was the most common symptom and presentation which is followed by cough and respiratory distress. This frequency of symptoms in the presentation of COVID-19 is in accordance with previous studies, but there are good numbers of studies that differ from this finding of frequency of clinical presentations, in a study in Brazil first common symptom is dyspnea [ 8 - 10 ]. The variability in the frequency of symptom presentation can be attributed to several factors, including disparities in the timing of studies, ethnic demographics, and the emergence of diverse COVID-19 variants across different waves of the pandemic.…”

High Levels of NfL, GFAP, TAU, and UCH-L1 as Potential Predictor Biomarkers of Severity and Lethality in Acute COVID-19

“…Interestingly, even analyzing other outcomes (neurological involvement), significant elevations in TAU, NfL, and GFAP levels were also observed among hospitalized patients with and without neurological manifestations of SARS-CoV-2 infection [ 28 ]. These findings probably reinforce the early role of nervous system involvement as marker of disease severity [ 29 ], as we previously demonstrated [ 4 , 10 ]. TAU levels have also been associated to critically illness polyneuropathy/myopathy [ 29 ], a relevant biomarker of severe axonal damage [ 30 ].…”

“…SARS-CoV-2 viral loads may be an important factor which is not clear yet if it is directly related to stronger inflammatory response and disease severity or not [ 6 , 7 ]. Also, serum biomarkers may also be important tools for predicting worse outcome; for example, serum Ferritin levels (peak) have been associated to longer severe disease and death [ 8 – 10 ]. Therefore, it is important to consider such factors combined to have a clearer picture of both the whole scenario and each individual infection course, mostly when it comes to poor prognosis and COVID-19 severe and fatal cases.…”

COVID-19 in three waves in a tertiary referral hospital in Belgium: a comparison of patient characteristics, management, and outcome

“…Despite the retrospective design, data collection was standardized and of high quality (few missing data) during the entire study period. Our results are however specific for our regional setting, and not necessarily generalizable to other (similar) socio-geographical regions [ 28 , 29 ]. Healthcare and policy may differ, as well as circulating infectious strains, uptake of vaccinations and infection control measurements, and preparedness.…”