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

Figure 1

Flow-chart of RECOVER-SUS participants included for in-hospital mortality and post-discharge analyses.

Figure 2

In-hospital survival. Overall RECOVER-SUS study survival is shown according to age (A) or year of admission (B) starting on admission day until March 31, 2021in participants hospitalized due to COVID-19.

Figure 3

Survival without severe outcomes after hospital discharge. Survival for COVID-19 patients without rehospitalization or death outcomes in the RECOVER-SUS study is shown for age groups ≤60 and ≥60 years from day of discharge until 9 months after hospital discharge.