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. 2022 Sep 28;17(9):e0275212.
doi: 10.1371/journal.pone.0275212. eCollection 2022.

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

Izabel Marcilio  1 , Felippe Lazar Neto  2 , Andre Lazzeri Cortez  1 , Anna Miethke-Morais  1 , Hillegonda Maria Dutilh Novaes  3 , Heraldo Possolo de Sousa  2 , Carlos Roberto Ribeiro de Carvalho  4 , Anna Sara Shafferman Levin  1 , Juliana Carvalho Ferreira  4 , Nelson Gouveia  3 ; HCFMUSP COVID-19 Study Group
Affiliations

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

Izabel Marcilio et al. PLoS One. .

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.

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Conflict of interest statement

Dr Ferreira received speaker fees from Medtronic, outside of the submitted work. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Study participant flow.
Flow of potentially eligible participants in the study, and final numbers included and analyzed.
Fig 2
Fig 2. Hospital mortality according to admission period.
Overall mortality probability during hospitalization according to admission period, classified as early (March and April 2020), peak (May and June 2020) and late (July and August 2020), and adjusted for need for mechanical ventilation, Charlson Comorbidity Index, sex, and age group.
See this image and copyright information in PMC

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