Mortality over time among COVID-19 patients hospitalized during the first surge of the pandemic: A large cohort study

Abstract

Background Capacity strain negatively impacts patient outcome, and the effects of patient surge are a continuous threat during the COVID-19 pandemic. Evaluating changes in mortality over time enables evidence-based resource planning, thus improving patient outcome. Our aim was to describe baseline risk factors associated with mortality among COVID-19 hospitalized patients and to compare mortality rates over time. Methods We conducted a retrospective cohort study in the largest referral hospital for COVID-19 patients in Sao Paulo, Brazil. We investigated risk factors associated with mortality during hospitalization. Independent variables included age group, sex, the Charlson Comorbidity Index, admission period according to the stage of the first wave of the epidemic (early, peak, and late), and intubation. Results We included 2949 consecutive COVID-19 patients. 1895 of them were admitted to the ICU, and 1473 required mechanical ventilation. Median length of stay in the ICU was 10 (IQR 5–17) days. Overall mortality rate was 35%, and the adjusted odds ratios for mortality increased with age, male sex, higher Charlson Comorbidity index, need for mechanical ventilation, and being admitted to the hospital during the wave peak of the epidemic. Being admitted to the hospital during the wave peak was associated with a 33% higher risk of mortality. Conclusions In-hospital mortality was independently affected by the epidemic period. The recognition of modifiable operational variables associated with patient outcome highlights the importance of a preparedness plan and institutional protocols that include evidence-based practices and allocation of resources.

Data-driven, cross-disciplinary collaboration: lessons learned at the largest academic health center in Latin America during the COVID-19 pandemic

“…Upon completion of the database and case validation, the possibility of accessing the institutional database above was widely advertised in successive calls open to HC-FMUSP-based research groups. Thus far, the database has been used in 17 published studies, attracting several research groups (36,(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53) (see Supplementary Table S3). The hospitalization database is currently being used for a few additional analyses, and it will continue to be accessible for new studies proposed in the near future.…”

Estimates of hospitalisations and deaths in patients with COVID-19 associated with undiagnosed diabetes during the first phase of the pandemic in eight low-income and middle-income countries: a modelling study

“…However, patient co-morbidities were self-reported in several health centre and surveillance studies. 7 , 8 , 9 Considering that many studies were conducted in settings where health systems were overwhelmed with patients with COVID-19, 10 , 11 it is likely that rates of diagnostic testing for diabetes were low. There are a few health centre studies that focus specially on previously undiagnosed diabetes in patients with COVID-19.…”

Custos hospitalares relacionados ao tratamento de pacientes com COVID-19 e o impacto de fatores clínicos e demográficos.

“…Portanto, no processo de abertura e monitoramento de unidades para pacientes com COVID-19, era realizado um planejamento integrado entre administração e assistência, que pôde garantir a chegada dos pacientes de forma segura, a disponibilidade de equipes para atendimento, além da infraestrutura hospitalar necessária para recebê-los, fornecendo o melhor atendimento possível, levando em conta o cenário de sobrecarga do sistema de saúde no pico da pandemia (47) .…”

“…Na COVID-19, como um número significativo de pacientes precisou ser hospitalizado, uma avaliação econômica na perspectiva do hospital é relevante, uma vez que compreende uma parte importante do impacto econômico da pandemia no sistema de saúde (47,64) .…”