On the analysis of mortality risk factors for hospitalized COVID-19 patients: A data-driven study using the major Brazilian database

  1. Fernanda Sumika Hojo de Souza
  2. Natália Satchiko Hojo-Souza
  3. Ben Dêivide de Oliveira Batista
  4. Cristiano Maciel da Silva
  5. Daniel Ludovico Guidoni

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Abstract

Brazil became the epicenter of the COVID-19 epidemic in a brief period of a few months after the first officially registered case. The knowledge of the epidemiological/clinical profile and the risk factors of Brazilian COVID-19 patients can assist in the decision making of physicians in the implementation of early and most appropriate measures for poor prognosis patients. However, these reports are missing. Here we present a comprehensive study that addresses this demand.

Methods

This data-driven study was based on the Brazilian Ministry of Health Database (SIVEP-Gripe) regarding notified cases of hospitalized COVID-19 patients during the period from February 26th to August 10th, 2020. Demographic data, clinical symptoms, comorbidities and other additional information of patients were analyzed.

Results

The hospitalization rate was higher for male gender (56.56%) and for older age patients of both sexes. Overall, the lethality rate was quite high (41.28%) among hospitalized patients, especially those over 60 years of age. Most prevalent symptoms were cough, dyspnoea, fever, low oxygen saturation and respiratory distress. Cardiac disease, diabetes, obesity, kidney disease, neurological disease, and pneumopathy were the most prevalent comorbidities. A high prevalence of hospitalized COVID-19 patients with cardiac disease (65.7%) and diabetes (53.55%) and with a high lethality rate of around 50% was observed. The intensive care unit (ICU) admission rate was 39.37% and of these 62.4% died. 24.4% of patients required invasive mechanical ventilation (IMV), with high mortality among them (82.98%). The main mortality risk predictors were older age and IMV requirement. In addition, socioeconomic conditions have been shown to significantly influence the disease outcome, regardless of age and comorbidities.

Conclusion

Our study provides a comprehensive overview of the hospitalized Brazilian COVID-19 patients profile and the mortality risk factors. The analysis also evidenced that the disease outcome is influenced by multiple factors, as unequally affects different segments of population.

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  1. Version published to 10.1371/journal.pone.0248580
  2. ScreenIT

    SciScore for 10.1101/2020.09.24.20200766: (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
    All analyses were performed using Python (version 3.6.9) and the statistical package lifelines (version 0.24.16) [17].
    Python
    suggested: (IPython, RRID:SCR_001658)

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Among the limitations of the study, we highlight the absence of data from biochemical tests of patients in SIVEP-GRIPE Database, which are relevant in prognostic studies. Another aspect is the notification data of only hospitalized COVID-19 patients, so that we were unable to trace the profile of outpatients. However, our previous study using a dataset from Espírito Santo state [34] can be used for comparative purposes, as it involved COVID-19 outpatients. Taken together, our study provides a comprehensive overview of the epidemiological and clinical profile of Brazilian hospitalized COVID-19 patients and the analysis of the risk factors for mortality. We verified that older age and IMV requirement were the most significant risk factors for mortality, besides male gender and the presence of comorbidities. In the absence of vaccines or specific therapeutic drugs, prevention is the best strategy to protect people, specially this most vulnerable segment of the population. The identification of groups at risk for severe COVID-19 is also important to establish priority groups for vaccination as soon as the vaccine is available, since the initial supply should be restricted. We believe this is the first comprehensive study that profiles COVID-19 patients in Brazil and highlights mortality risk factors during hospitalization.

    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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  3. Version published to 10.1101/2020.09.24.20200766v1 on medRxiv