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

• Published in: PloS one 2022-09, Vol.17 (9), p.e0275212-e0275212
• Main Authors: Marcilio, Izabel, Lazar Neto, Felippe, Lazzeri Cortez, Andre, Miethke-Morais, Anna, Dutilh Novaes, Hillegonda Maria, Possolo de Sousa, Heraldo, de Carvalho, Carlos Roberto Ribeiro, Shafferman Levin, Anna Sara, Ferreira, Juliana Carvalho, Gouveia, Nelson
• Format: Article
• Language: English
• Subjects: Age; Biology and Life Sciences; Cohort analysis; Comorbidity; Coronaviruses; COVID-19; Dyspnea; Earth Sciences; Electronic health records; Emergency preparedness; Epidemics; Health aspects; Health risks; Hospital patients; Hospitalization; Independent variables; Intubation; Mechanical ventilation; Medicine and Health Sciences; Mortality; Palliative care; Pandemics; Patients; People and places; Regression analysis; Resource allocation; Risk analysis; Risk factors; Serology; Severe acute respiratory syndrome coronavirus 2; Sex; Social Sciences; Teaching hospitals; Variables; Ventilation; Ventilators
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0275212

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. 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. 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. 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.