Hospital characteristics associated with COVID-19 mortality: data from the multicenter cohort Brazilian Registry.

Autor: Souza-Silva MVR; Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, sala 246, Belo Horizonte, Minas Gerais, Brazil. mairavsouza@gmail.com., Ziegelmann PK; Departament of Statistics, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul, Brazil., Nobre V; Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, sala 246, Belo Horizonte, Minas Gerais, Brazil., Gomes VMR; Centro Universitário de Belo Horizonte (UniBH), Belo Horizonte, Minas Gerais, Brazil., Etges APBDS; Institute for Health Technology Assessment (IATS/ CNPq), Porto Alegre, Rio Grande do Sul, Brazil., Schwarzbold AV; Hospital Universitário de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil., Nunes AGS; Hospital UNIMED, Belo Horizonte, Minas Gerais, Brazil., Maurílio AO; Hospital São João de Deus, Divinópolis, Minas Gerais, Brazil., Scotton ALBA; Hospital Regional Antônio Dias, Patos de Minas, Minas Gerais, Brazil., Costa ASM; Hospitais da Rede Mater Dei, Belo Horizonte, Minas Gerais, Brazil., Glaeser AB; Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil., Farace BL; Hospital Risoleta Tolentino Neves, Belo Horizonte, Minas Gerais, Brazil., Ribeiro BN; Hospital Márcio Cunha, Ipatinga, Minas Gerais, Brazil., Ramos CM; Hospital Júlia Kubistchek, Belo Horizonte, Minas Gerais, Brazil., Cimini CCR; Hospital Santa Rosália, Teófilo Otoni, Minas Gerais, Brazil., de Carvalho CA; Hospital João XXIII, Belo Horizonte, Minas Gerais, Brazil., Rempel C; Universidade Do Vale Do Taquari, Lajeado, Rio Grande do Sul, Brazil., Silveira DV; Hospital UNIMED, Belo Horizonte, Minas Gerais, Brazil., Carazai DDR; Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil., Ponce D; Medical School, Universidade Estadual Paulista 'Júlio de Mesquita Filho', Botucatu, São Paulo, Brazil., Pereira EC; Hospital SOS Cárdio, Florianópolis, Santa Catarina, Brazil., Kroger EMS; Hospital Júlia Kubistchek, Belo Horizonte, Minas Gerais, Brazil., Manenti ERF; Hospital Mãe de Deus, Porto Alegre, Rio Grande do Sul, Brazil., Cenci EPA; Hospital Universitário de Canoas, Canoas, Rio Grande do Sul, Brazil., Lucas FB; Hospital Santo Antônio, Curvelo, Minas Gerais, Brazil., Dos Santos FC; Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil., Anschau F; Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil., Botoni FA; Hospital Júlia Kubistchek, Belo Horizonte, Minas Gerais, Brazil., Aranha FG; Hospital SOS Cárdio, Florianópolis, Santa Catarina, Brazil., de Aguiar FC; University Hospital, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil., Bartolazzi F; Hospital Santo Antônio, Curvelo, Minas Gerais, Brazil., Crestani GP; Hospital Mãe de Deus, Porto Alegre, Rio Grande do Sul, Brazil., Vietta GG; Hospital SOS Cárdio, Florianópolis, Santa Catarina, Brazil., Nascimento GF; Hospital UNIMED, Belo Horizonte, Minas Gerais, Brazil., Noal HC; Hospital Universitário de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil., Duani H; Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, sala 246, Belo Horizonte, Minas Gerais, Brazil., Vianna HR; Faculdade de Ciências Médicas de Minas Gerais, University Hospital, Belo Horizonte, Minas Gerais, Brazil., Guimarães HC; Hospital Risoleta Tolentino Neves, Belo Horizonte, Minas Gerais, Brazil., de Alvarenga JC; Hospital João XXIII, Belo Horizonte, Minas Gerais, Brazil., Chatkin JM; Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, Rio Grande do Sul, Brazil., de Morais JDP; Faculdade de Ciências Médicas de Minas Gerais, University Hospital, Belo Horizonte, Minas Gerais, Brazil., Carvalho JDSN; University Hospital, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil., Rugolo JM; Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, São Paulo, Brazil., Ruschel KB; Hospital Mãe de Deus, Porto Alegre, Rio Grande do Sul, Brazil., Gomes LBW; Faculdade de Saúde E Ecologia Humana (FASEH), Vespasiano, Minas Gerais, Brazil., de Oliveira LS; Hospital Santa Rosália, Teófilo Otoni, Minas Gerais, Brazil., Zandoná LB; Universidade Do Vale Do Taquari, Lajeado, Rio Grande do Sul, Brazil., Pinheiro LS; Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Teófilo Otoni, Minas Gerais, Brazil., Pacheco LS; Hospital Universitário de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil., Menezes LDSM; Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, sala 246, Belo Horizonte, Minas Gerais, Brazil., Sousa LD; Hospital Regional Antônio Dias, Patos de Minas, Minas Gerais, Brazil., de Moura LCS; Hospital Tacchini, Bento Gonçalves, Rio Grande do Sul, Brazil., Santos LEA; Centro Universitário de Patos de Minas, Patos de Minas, Minas Gerais, Brazil., Nasi LA; Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil., Cabral MAS; Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, sala 246, Belo Horizonte, Minas Gerais, Brazil., Floriani MA; Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil., Souza MD; Hospital Metropolitano Odilon Behrens, Belo Horizonte, Minas Gerais, Brazil., Carneiro M; Hospital Santa Cruz, Santa Cruz do Sul, Rio Grande do Sul, Brazil., de Godoy MF; Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, Rio Grande do Sul, Brazil., Cardoso MMA; Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, São Paulo, Brazil., Nogueira MCA; Hospitais da Rede Mater Dei, Belo Horizonte, Minas Gerais, Brazil., Lima MOSS; Hospital Márcio Cunha, Ipatinga, Minas Gerais, Brazil., de Figueiredo MP; Hospital Santo Antônio, Curvelo, Minas Gerais, Brazil., Guimarães-Júnior MH; Hospital Márcio Cunha, Ipatinga, Minas Gerais, Brazil., Sampaio NDCS; Hospital Eduardo de Menezes, Belo Horizonte, Minas Gerais, Brazil., de Oliveira NR; Hospital Eduardo de Menezes, Belo Horizonte, Minas Gerais, Brazil., Andrade PGS; Hospital Semper, Belo Horizonte, Minas Gerais, Brazil., Assaf PL; Hospital Metropolitano Doutor Célio de Castro, Belo Horizonte, Minas Gerais, Brazil., Martelli PJL; University Hospital, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil., Martins RC; Hospital Tacchini, Bento Gonçalves, Rio Grande do Sul, Brazil., Valacio RA; Hospital Metropolitano Odilon Behrens, Belo Horizonte, Minas Gerais, Brazil., Pozza R; Hospital Tacchini, Bento Gonçalves, Rio Grande do Sul, Brazil., Menezes RM; Hospital Santa Cruz, Santa Cruz do Sul, Rio Grande do Sul, Brazil., Mourato RLS; Hospital São João de Deus, Divinópolis, Minas Gerais, Brazil., de Abreu RM; Hospital Metropolitano Doutor Célio de Castro, Belo Horizonte, Minas Gerais, Brazil., Silva RF; Hospital São João de Deus, Divinópolis, Minas Gerais, Brazil., Francisco SC; Hospital Metropolitano Doutor Célio de Castro, Belo Horizonte, Minas Gerais, Brazil., Guimarães SMM; Hospital Semper, Belo Horizonte, Minas Gerais, Brazil., Araújo SF; Hospital Semper, Belo Horizonte, Minas Gerais, Brazil., Oliveira TF; Hospital Metropolitano Odilon Behrens, Belo Horizonte, Minas Gerais, Brazil., Kurtz T; Hospital Santa Cruz, Santa Cruz do Sul, Rio Grande do Sul, Brazil., Fereguetti TO; Hospital Eduardo de Menezes, Belo Horizonte, Minas Gerais, Brazil., de Oliveira TC; Hospital Universitário de Canoas, Canoas, Rio Grande do Sul, Brazil., Ribeiro YCNMB; Hospital Metropolitano Doutor Célio de Castro, Belo Horizonte, Minas Gerais, Brazil., Ramires YC; Hospital Bruno Born, Lajeado, Rio Grande do Sul, Brazil., Polanczyk CA; Institute for Health Technology Assessment (IATS/ CNPq), Porto Alegre, Rio Grande do Sul, Brazil.; Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil., Marcolino MS; Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, sala 246, Belo Horizonte, Minas Gerais, Brazil.
Jazyk: angličtina
Zdroj: Internal and emergency medicine [Intern Emerg Med] 2022 Nov; Vol. 17 (8), pp. 2299-2313. Date of Electronic Publication: 2022 Sep 25.
DOI: 10.1007/s11739-022-03092-9
Abstrakt: The COVID-19 pandemic caused unprecedented pressure over health care systems worldwide. Hospital-level data that may influence the prognosis in COVID-19 patients still needs to be better investigated. Therefore, this study analyzed regional socioeconomic, hospital, and intensive care units (ICU) characteristics associated with in-hospital mortality in COVID-19 patients admitted to Brazilian institutions. This multicenter retrospective cohort study is part of the Brazilian COVID-19 Registry. We enrolled patients ≥ 18 years old with laboratory-confirmed COVID-19 admitted to the participating hospitals from March to September 2020. Patients' data were obtained through hospital records. Hospitals' data were collected through forms filled in loco and through open national databases. Generalized linear mixed models with logit link function were used for pooling mortality and to assess the association between hospital characteristics and mortality estimates. We built two models, one tested general hospital characteristics while the other tested ICU characteristics. All analyses were adjusted for the proportion of high-risk patients at admission. Thirty-one hospitals were included. The mean number of beds was 320.4 ± 186.6. These hospitals had eligible 6556 COVID-19 admissions during the study period. Estimated in-hospital mortality ranged from 9.0 to 48.0%. The first model included all 31 hospitals and showed that a private source of funding (β = - 0.37; 95% CI - 0.71 to - 0.04; p = 0.029) and location in areas with a high gross domestic product (GDP) per capita (β = - 0.40; 95% CI - 0.72 to - 0.08; p = 0.014) were independently associated with a lower mortality. The second model included 23 hospitals and showed that hospitals with an ICU work shift composed of more than 50% of intensivists (β = - 0.59; 95% CI - 0.98 to - 0.20; p = 0.003) had lower mortality while hospitals with a higher proportion of less experienced medical professionals had higher mortality (β = 0.40; 95% CI 0.11-0.68; p = 0.006). The impact of those association increased according to the proportion of high-risk patients at admission. In-hospital mortality varied significantly among Brazilian hospitals. Private-funded hospitals and those located in municipalities with a high GDP had a lower mortality. When analyzing ICU-specific characteristics, hospitals with more experienced ICU teams had a reduced mortality.
(© 2022. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)
Databáze: MEDLINE
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