Trends in mortality of hospitalised COVID-19 patients: A single centre observational cohort study from Spain

García-Vidal, Carolina; Cózar-Llistó, Alberto; Meira, Fernanda; Dueñas, Gerard; Puerta‐Alcalde, Pedro; Cillóniz, Catia; García‐Poutón, Nicole; Chumbita, Mariana; Cardozo, Celia; Hernández, Marta Cabrero; Rico, Verónica; Bodro, Marta; Morata, Laura; Castro, Pedro; Almuedo-Riera, Alex; García, Felipe; Mensa, Josep; Martínez, José Antonio; Sanjuan, Gemma; Nicolás, José M.; Soriano, Álex

doi:10.1016/j.lanepe.2021.100041

Cited by 48 publications

(57 citation statements)

References 23 publications

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“…The downward trend we detected is in line with what most of the literature has been indicating recently. In a cohort of over 1,600 hospitalized patients in Spain admitted between March and September 2020, mortality decreased from 11.6% to 1.4% in the last month [15]. A similar period was analysed in the United States and indicated a drop in adjusted mortality from 25.6% in March to 7.6% in August [7].…”

Section: Discussionmentioning

confidence: 78%

“…In France, time analysis of hospital CFR also showed a decrease over time, globally and in almost all districts [3]. Although the reasons for this reduction in hospital CFR are unknown since there is no specific treatment for COVID-19, some studies have raised potential reasons, such as a higher proportion of younger patients with fewer comorbidities over time; health workers have become more skilled at the management of severe patients during the epidemic; and early use of remdesivir to patients not requiring mechanical ventilation and dexamethasone to those requiring supplemental oxygen or on mechanical ventilation [3,8,15,16]. Nevertheless, as much as Brazil has shown a decreasing trend as other countries, it is concerning that despite presenting an important relative drop (approximately 33%), it remained at a high level at week 40 -an age-standardized rate around 18%.…”

Section: Discussionmentioning

confidence: 99%

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Trends in COVID-19 case-fatality rates in Brazilian public hospitals: A longitudinal cohort of 398,063 hospital admissions from 1st March to 3rd October 2020

et al. 2021

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Background Almost 200,000 deaths from COVID-19 were reported in Brazil in 2020. The case fatality rate of a new infectious disease can vary by different risk factors and over time. We analysed the trends and associated factors of COVID-19 case fatality rates in Brazilian public hospital admissions during the first wave of the pandemic. Methods A retrospective cohort of all COVID-19-related admissions between epidemiological weeks 10–40 in the Brazilian Public Health System (SUS) was delimited from available reimbursement records. Smoothing time series and survival analyses were conducted to evaluate the trends of hospital case fatality rates (CFR) and the probability of death according to factors such as sex, age, ethnicity, comorbidities, length of stay and ICU use. Results With 398,063 admissions and 86,452 (21.7%) deaths, the overall age-standardized hospital CFR trend decreased throughout the period, varying from 31.8% (95%CI: 31.2 to 32.5%) in week 10 to 18.2% (95%CI: 17.6 to 18.8%) in week 40. This decreasing trend was observed in all sex, age, ethnic groups, length of stay and ICU admissions. Consistently, later admission (from July to September) was an independent protective factor. Patients 80+ year old had a hazard ratio of 8.18 (95% CI: 7.51 to 8.91). Ethnicity, comorbidities, and ICU need were also associated with the death risk. Although also decreasing, the CFR was always around 40–50% in people who needed an ICU admission. Conclusions The overall hospital CFR of COVID-19 has decreased in Brazilian public hospitals during the first wave of the pandemic in 2020. Nevertheless, during the entire period, the CFR was still very high, suggesting the need for improving COVID-19 hospital care in Brazil.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Trends in COVID-19 case-fatality rates in Brazilian public hospitals: A longitudinal cohort of 398,063 hospital admissions from 1st March to 3rd October 2020

et al. 2021

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“…Ninety-day post-admission outcomes have been reported from various European countries, albeit often for single hospitals. The 90-day mortality rate ranged from 11% in Spain [ 13 ] to 29% in Denmark [ 14 ] (both single-centre studies) for all hospitalized patients, and was 27% in Sweden [ 15 ], 31% in Belgium, France and Switzerland (both multi-centre studies) [ 16 ], and 35% in a Danish single-centre study for patients treated in the ICU [ 14 ]. An analysis of more than 100,000 hospitalized COVID-19 patients in the United States revealed a readmission rate of 9% to the same hospital 6 months post-discharge [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

6-month mortality and readmissions of hospitalized COVID-19 patients: A nationwide cohort study of 8,679 patients in Germany

Günster¹,

Busse

Spoden³

et al. 2021

PLoS ONE

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Background COVID-19 frequently necessitates in-patient treatment and in-patient mortality is high. Less is known about the long-term outcomes in terms of mortality and readmissions following in-patient treatment. Aim The aim of this paper is to provide a detailed account of hospitalized COVID-19 patients up to 180 days after their initial hospital admission. Methods An observational study with claims data from the German Local Health Care Funds of adult patients hospitalized in Germany between February 1 and April 30, 2020, with PCR-confirmed COVID-19 and a related principal diagnosis, for whom 6-month all-cause mortality and readmission rates for 180 days after admission or until death were available. A multivariable logistic regression model identified independent risk factors for 180-day all-cause mortality in this cohort. Results Of the 8,679 patients with a median age of 72 years, 2,161 (24.9%) died during the index hospitalization. The 30-day all-cause mortality rate was 23.9% (2,073/8,679), the 90-day rate was 27.9% (2,425/8,679), and the 180-day rate, 29.6% (2,566/8,679). The latter was 52.3% (1,472/2,817) for patients aged ≥80 years 23.6% (1,621/6,865) if not ventilated during index hospitalization, but 53.0% in case of those ventilated invasively (853/1,608). Risk factors for the 180-day all-cause mortality included coagulopathy, BMI ≥ 40, and age, while the female sex was a protective factor beyond a fewer prevalence of comorbidities. Of the 6,235 patients discharged alive, 1,668 were readmitted a total of 2,551 times within 180 days, resulting in an overall readmission rate of 26.8%. Conclusions The 180-day follow-up data of hospitalized COVID-19 patients in a nationwide cohort representing almost one-third of the German population show significant long-term, all-cause mortality and readmission rates, especially among patients with coagulopathy, whereas women have a profoundly better and long-lasting clinical outcome compared to men.

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“…Predictive models for COVID-19 severe disease should include symptoms to help with medical decision making, resource planning and improvements in monitoring of COVID-19 patients [35] (i.e., the number of symptoms is predictive of disease duration [36,37]). This study identified cough, fever, sore throat, dyspnea, anosmia, loss of taste, diarrhea and fatigue as symptoms significantly associated with COVID-19 SARS and death.…”

Section: Discussionmentioning

confidence: 99%

What most influences severity and death of COVID-19 patients in Brazil? Is it clinical, social, or demographic factors? An observational study

Mafra

Vieira

Monteiro

et al. 2021

Preprint

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Objective: This study aimed to assess the space distribution and factors associated with the risk of severe acute respiratory syndrome (SARS) and death in COVID-19 patients, based on routine register data; and to develop and validate a predictive model of the risk of death from COVID-19. Methods: A cross-sectional, epidemiological study of positive SARS-CoV-2 cases, reported in the south region of the city of São Paulo, SP, Brazil, from March 2020 to February 2021. Data were obtained from the official reporting databases of the Brazilian Ministry of Health for influenza-like illness (ILI) (esus-VE, in Portuguese) and for patients hospitalized for SARS (SIVEP-Gripe). The space distribution of cases is described by 2D kernel density. To assess potential factors associated with the outcomes of interest, generalized linear and additive logistic models were adjusted. To evaluate the discriminatory power of each variable studied as well as the final model, C-statistic was used (area under the receiver operating characteristics curve). Moreover, a predictive model for risk of death was developed and validated with accuracy measurements in the development, internal and temporal (March and April 2021) validation samples. Results: A total of 16,061 patients with confirmed COVID-19 were enrolled. Morbidities associated with a higher risk of SARS were obesity (OR=25.32) and immunodepression (OR=12.15). Morbidities associated with a higher risk of death were renal disease (OR=11.8) and obesity (OR=8.49), and clinical and demographic data were more important than the territory per se. Based on the data, a calculator was developed to predict the risk of death from COVID-19, with 92.2% accuracy in the development sample, 92.3% in the internal validation sample, and 80.0% in the temporal validation sample. Conclusions: The risk factors for SARS and death in COVID-19 patients seeking health care, in order of relevance, were age, comorbidities, and socioeconomic factors, considering each discriminatory power.

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Trends in mortality of hospitalised COVID-19 patients: A single centre observational cohort study from Spain

Cited by 48 publications

References 23 publications

Trends in COVID-19 case-fatality rates in Brazilian public hospitals: A longitudinal cohort of 398,063 hospital admissions from 1st March to 3rd October 2020

Trends in COVID-19 case-fatality rates in Brazilian public hospitals: A longitudinal cohort of 398,063 hospital admissions from 1st March to 3rd October 2020

6-month mortality and readmissions of hospitalized COVID-19 patients: A nationwide cohort study of 8,679 patients in Germany

What most influences severity and death of COVID-19 patients in Brazil? Is it clinical, social, or demographic factors? An observational study

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