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Hospital Characteristics Associated With COVID-19 Mortality: Data From the Multicenter Cohort Brazilian COVID-19 Registry

2021; RELX Group (Netherlands); Linguagem: Inglês

10.2139/ssrn.3979651

1556-5068

Maíra Viana Rego Souza-Silva, Patrícia Klarmann Ziegelmann, Vandack Nobre, Virgínia Mara Reis Gomes, Ana Paula Beck da Silva Etges, Alexandre Vargas Schwarzbold, Aline Gabrielle Sousa Nunes, Amanda de Oliveira Maurílio, Ana Luiza Bahia Alves Scotton, André Soares de Moura Costa, Andressa Barreto Glaeser, Bárbara Lopes Farace, Bruno Nunes Ribeiro, Carolina Marques Ramos, Christiane Corrêa Rodrigues Cimini, Cíntia Alcântara de Carvalho, Claudete Rempel, Daniel Vitório Silveira, Daniela dos Reis Carazai, Daniela Ponce, Elayne Crestani Pereira, Emanuele Marianne Souza Kroger, Euler Roberto Fernandes Manenti, Evelin Paola de Almeida Cenci, Fernanda Barbosa Lucas, Fernanda Costa dos Santos, Fernando Anschau, Fernando Antônio Botoni, Fernando Graça Aranha, Filipe Carrilho de Aguiar, Frederico Bartolazzi, Gabriela Petry Crestani, Giovanna Grünewald Vietta, Guilherme Fagundes Nascimento, Helena Carolina Noal, Helena Duani, Heloísa Reniers Vianna, Henrique Cerqueira Guimarães, Joice Coutinho de Alvarenga, José Miguel Chatkin, Júlia Drumond Parreiras de Morais, Juliana da Silva Nogueira Carvalho, Juliana Machado-Rugolo, Karen Brasil Ruschel, Lara de Barros Wanderley Gomes, Leonardo Seixas de Oliveira, Liege Barella Zandoná, Lílian Santos Pinheiro, Liliane Souto Pacheco, Luanna da Silva Monteiro, Lucas de Deus Sousa, Luis Cesar Souto de Moura, Luísa Elem Almeida Santos, Luiz Antônio Nasi, Máderson Alvares de Souza Cabral, Maiara Anschau Floriani, Maíra Dias Souza, Marcelo Carneiro, Mariana Frizzo de Godoy, Marília Mastrocolla de Almeida Cardoso, Matheus Carvalho Alves Nogueira, Mauro Oscar Soares de Souza Lima, Meire Pereira de Figueiredo, Milton Henriques Guimarães Júnior, Natália da Cunha Severino Sampaio, Neimy Ramos de Oliveira, Pedro Guido Soares Andrade, Pedro Ledic Assaf, Petrônio José de Lima Martelli, Raphael Castro Martins, Reginaldo Aparecido Valácio, Roberta Pozza, Rochele Mosmann Menezes, Rodolfo Lucas Silva Mourato, Roger Mendes de Abreu, Rufino de Freitas Silva, Saionara Cristina Francisco, Silvana Mangeon Mereilles Guimarães, Silvia Ferreira Araújo, Talita Fischer Oliveira, Tatiana Kurtz, Tatiani Oliveira Fereguetti, Thainara Conceição de Oliveira, Yara Cristina Neves Marques Barbosa Ribeiro, Yuri Carlotto Ramires, Carísi Anne Polanczyk, Milena Soriano Marcolino,

COVID-19 and healthcare impacts

Background:The COVID-19 pandemic caused unprecedented pressure over health care systems, but hospital-level data that may influence the prognosis are not well-studied. Therefore, this study analyzed regional socioeconomic, hospital, and intensive care units (ICU) characteristics associated with mortality in COVID-19 patients admitted to Brazilian institutions.Methods:This is a multicenter retrospective cohort. Patients with COVID-19 admitted from March to September 2020, were enrolled. Data were collected through hospital records, forms, and open databases. Generalized linear mixed models with logit link function were used to assess association between hospital characteristics and mortality. Two models were built, one testing hospital general characteristics and another testing ICU factors. All analysis were adjusted for the proportion of high-risk patients at admission.Findings:Thirty-one hospitals were included. Mortality ranged from 9·0% to 48·0%. In the first model, hospitals with private funding (β=-0·37; 95%CI: -0·71 to -0·04; p=0·029) and in municipalities with high gross domestic product (GDP) per capita (β=-0·40; 95%CI: -0·72 to -0·08; p=0·014) were independently associated with lower mortality. The second model included 23 hospitals and showed that ICUs with a work shift composed of less than 10% of medical residents (β=-0·40; 95%CI: -0·68 to -0·11; p=0.006) and those with more than 50% of intensivists (β=-0·59; 95%CI: -0·98 to -0·20; p=0·003) were independently associated with lower mortality.Interpretation: Funding, city-level GDP and the experience of the critical care medical team were independently associated with COVID-19 in-hospital mortality. Funding Information: Minas Gerais State Agency for Research and Development (FAPEMIG), Institute for Health Technology Assessment (IATS/CNPq) and CAPES Foundation.Declaration of Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.Ethics Approval Statement: This study followed the STROBE guidelines for reporting observational studies, and it is in accordance with the Declaration of Helsinki. The study protocol was approved by the Brazilian National Commission for Research Ethics (CAAE: 30350820·5·1001·0008). Individual informed consent was waived due to the severity of the pandemic situation and the use of deidentified data, based on medical chart review only.