Impact of COVID-19 In-hospital Mortality in Chagas Disease Patients

Abstract

The COVID-19 virus infection caused by the new SARS-CoV-2 was first identified in Rio de Janeiro (RJ), Brazil, in March 2020. Until the end of 2021, 504,399 COVID-19 cases were confirmed in RJ, and the total death toll reached 68,347. The Evandro Chagas National Institute of Infectious Diseases from Oswaldo Cruz Foundation (INI-Fiocruz) is a referral center for treatment and research of several infectious diseases, including COVID-19 and Chagas disease (CD). The present study aimed to evaluate the impact of COVID-19 on in-hospital mortality of patients with CD during the COVID-19 pandemic period. This observational, retrospective, longitudinal study evaluated all patients with CD hospitalized at INI-Fiocruz from May 1, 2020, to November 30, 2021. One hundred ten hospitalizations from 81 patients with CD (58% women; 68 ± 11 years) were evaluated. Death was the study's main outcome, which occurred in 20 cases. The mixed-effects logistic regression was performed with the following variables to test whether patients admitted to the hospital with a COVID-19 diagnosis would be more likely to die than those admitted with other diagnoses: admission diagnosis, sex, age, COVID-19 vaccination status, CD clinical classification, and the number of comorbidities. Results from multiple logistic regression analysis showed a higher risk of in-hospital mortality in patients diagnosed with COVID-19 (OR 6.37; 95% CI 1.78–22.86) compared to other causes of admissions. In conclusion, COVID-19 infection had a significant impact on the mortality risk of INI-Fiocruz CD patients, accounting for one-third of deaths overall. COVID-19 presented the highest percentage of death significantly higher than those admitted due to other causes during the COVID-19 pandemic.

Hospital case-fatality and mortality related to Chagas disease in Brazil over two decades

“…This is a mixed ecological study with a national population base, focusing on the outcome of death from CD based on analyses of temporal trends and spatial distribution in the period from 2000 to 2019. The study aimed to exclude the Covid-19 pandemic period to avoid any effects related to the reduction of coverage in the SUS care network that could mask patterns and trends [7]. Secondary databases from SIH-SUS were analysed, using variables contained in the HAA, and SIM, from the Death Certi cate (DC).…”

“…Approximately 12,000 CD-related deaths occur annually worldwide [1]. This scenario has been substantially aggravated since 2020, due to the SARS-CoV-2 pandemic and the impact of Covid-19, leading to increased poverty worldwide and critical restrictions on access to national healthcare systems [6,7]. This limitation to comprehensive care occurs at all levels of care, from primary health care (PHC) to medium and high complexity care, including reference hospitals [8].…”

Re: “Challenges of addressing neglected tropical diseases amidst the COVID-19 pandemic in Africa: A case of Chagas Disease”

“…Pradhan et al mention that they did a thorough review of articles published in indexed journals, but they do not indicate which period was studied, which databases were consulted or which keywords were used. Recent studies that addressed the Trypanosoma cruzi /covid 19 co-infection were not cited by the authors [ [5] , [6] , [7] ]. These studies suggest that the possible cardiovascular involvement in co-infected patients would not lead to a higher risk of hospitalization and increased mortality, as indicated by Pradhan et al…”