Avaliação de fatores de risco de óbito por COVID-19 de pacientes brasileiros internados no Sistema Único de Saúde

Abstract

Introduction: Advanced age, male gender and the presence of underlying diseases represent an increased risk for the occurrence of death in COVID-19 and are widely cited in publications. However, there is still a lack of consensus in the literature on the associations of these factors and, based on current evidence, they do not sufficiently explain the variability in disease severity and outcome. Objectives: To assess risk factors for death in COVID--19 in hospitalized patients (age, gender, underlying diseases, smoking), length of stay, methods of ventilatory support, laboratory and clinical tests on admission, complications and outcome (discharge or death). Material and Methods: This study is a historical cohort study with 160 hospitalized patients, laboratory confirmed by RT-PCR. The patients' treatments and clinical data were obtained through the analysis of medical records, collected from admission to the outcome, considered discharge or death. The study was carried out analyzing the death and non-death group. Results: Among the deaths, 65.5% were male, median of 68 years, 61.8% hypertensive, 32.7% heart disease, 27.3% diabetic type 2, 25.5% ex-smokers and 74,5% of the patients needed of invasive mechanical ventilation. No significant differences were observed between groups regarding previous diseases (all with p>0.05). Among deaths, previous heart disease showed a greater association with men (p=0.052) and advanced age (p=0.018). As for laboratory data, the factors that showed significant differences between the death and non-death groups were capillary blood glucose (DXT), oximetry, leukocytes, lymphocytes, D dimer, C-reactive protein (CRP), lactic dehydrogenase (DHL), creatinine, urea, lactate and prothrombin activity (AP) (all p<0.05). Oximetry, PCR, DHL and D-dimer were altered in both groups. On the other hand, prothrombin (AP), lactate and leukocyte activity were normal in both groups. The exams with significant and clinical differences that were altered in the death group and normal in the survivor group were lymphocytes, urea and creatinine, Complications were evident in the death group, such as thromboembolism, acute renal failure (ARF), dialysis, thrombocytopenia (all with p<0.001). Conclusion: Laboratory markers of lymphocytes, urea and creatinine, were clinically relevant. Among deaths, previous heart disease was more associated with male gender and advanced age. Thus, advanced age, current smoking and former smoking, previous heart disease and altered lymphocytes, urea and creatinine tests were variables associated with a fatal outcome. Therefore, it is recommended to carry out in-depth studies in subgroups, in order to better understand the risk factors and strengthen strategic health actions aimed at mitigating morbidity and mortality in these populations.