Survival and predictors of deaths of patients hospitalized due to COVID-19 from a retrospective and multicenter cohort study in Brazil

  1. Marquiony M Santos
  2. Eudes ES Lucena
  3. Kenio C Lima
  4. Andiara AC Brito
  5. Monica B Bay
  6. Diego Bonfada

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Abstract

The epidemic caused by COVID-19 in Brazil is associated with an unfavorable political scenario, aggravated by intense social inequality and low number of available hospital beds. Therefore, this study aimed to analyze the survival of patients admitted to Brazilian hospitals due to the COVID-19 and estimate prognostic factors. This is a retrospective, multicenter cohort study, based on data from 46285 hospitalizations for COVID-19 in Brazil. Survival functions were calculated using the Kaplan-Meier’s method. The Log-rank test compared the survival functions for each variable and from that, hazard ratios were calculated and the proportional hazards model was used in Cox multiple regression. The smallest survival curves were the ones for patients at the age of 68 years or more, black / brown race, illiterate, living in the countryside, dyspnea, respiratory distress, influenza-like outbreak, O 2 saturation <95%, X-ray change, length of stay in the ICU, invasive ventilatory support, previous heart disease, pneumopathy, diabetes, down’s syndrome, neurological disease and kidney disease. Better survival was observed in the symptoms and in an asthmatic patient. The multiple model for increased risk of death when they were admitted to the ICU HR 1.28 (95% CI 1.21–1.35), diabetes HR 1.17 (95% CI 1.11–1.24), neurological disease HR 1.34 (95% CI 1.22–1.46), kidney disease HR 1.11 (95% CI 1.02–1.21), heart disease HR 1.14 (95% CI 1.08–1.20), black or brown race of HR 1.50 (95% CI 1.43–1.58), asthma HR 0.71 (95% CI 0.61–0.81) and pneumopathy HR 1.12 (95% CI 1.02–1.23). The overall survival time was low in hospitalizations for COVID-19 and this reinforces the importance of sociodemographic and clinical factors as a prognosis for death. The lack of a protocol for scientific clinical management puts a greater risk of death for about 80 million Brazilians, who are chronically ill or living in poverty. COVID-19 can promote selective mortality that borders the eugenics of specific social segments in Brazil.

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  1. ScreenIT

    SciScore for 10.1101/2020.06.07.20125047: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The data were analyzed using the STATA 12.0 program and in all analyzes the level of significance was considered equal to 5%.
    STATA
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Although the work with secondary data notification forms has its limitations, this problem is partially solved, mainly due to the country’s urgency to maintain more accurate data in the monitoring of COVID-19, so that health institutions are able to plan actions to control the epidemic. In some cases, there was incomplete documentation of the history and symptoms in the electronic database, even after making efforts regarding feedback and recollection. Some diagnoses of co-existing illnesses were originated in self-reports from patients at their admission, which might lead to recall bias. However, this study has a robust methodology, with appropriate data analysis and the first research in the country with all hospitalization in this gap of time. Furthermore, this research confirmed the importance of age and the presence of chronic diseases not only in the incidence of more serious cases of COVID-19, but also its effects on the drop in the survival curve of patients in hospital in Brazil. Nowadays this country is considered one of the worldwide epicenters to COVID-19. In conclusion, it is considered important that scientifically supported protocols are developed for the management of appropriate clinical care for patients in hospital due to the COVID-19, especially in the face of a scenario where there is no consensus on pharmacological treatment or even therapeutic management. It is worth mentioning the importance in the development of new studies, such as controlled and ran...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.06.07.20125047v1 on medRxiv
  3. Version published to 10.1017/s0950268820002034