Characterisation of the first 250,000 hospital admissions for COVID-19 in Brazil: a retrospective analysis of nationwide data.
Characterisation of the first 250,000 hospital admissions for COVID-19 in Brazil: a retrospective analysis of nationwide data.
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DOI：
10.1016/s2213-2600(20)30560-9
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发表时间：
2021-04
期刊：
影响因子：
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通讯作者：
Bozza FA
中科院分区：
文献类型：
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作者：
Ranzani OT;Bastos LSL;Gelli JGM;Marchesi JF;Baião F;Hamacher S;Bozza FA
大多数低收入和中等收入国家很少或根本没有整合到国家监测系统中的数据，以确定新冠肺炎入院人数的特征或结果以及新冠肺炎大流行对其国家卫生系统的影响。我们的目的是分析巴西新冠肺炎住院患者的特征，并检查新冠肺炎对医疗资源和住院死亡率的影响。我们对2020年2月16日至2020年8月15日(流行病学第8-33周)住院并在巴西全国监测数据库SIVEP-GRIPE登记的所有经定量RT-PCR(RT-qPCR)确认的新冠肺炎患者进行了回顾性分析。我们还检查了在此时间范围内的三个4周期间(流行病学周8-12、19-22和27-30)新冠肺炎大流行的进展情况。主要结果是住院死亡率。我们比较了按年龄、重症监护病房(ICU)入院和呼吸支持分层的地区住院负担。我们分析了全国及其五个地区：北方、东北、中西部、东南和南方的数据。在2020年2月16日至8月15日期间，共有2540名 确诊的新冠肺炎患者入院并在SIVEP-GRIPE注册。患者平均年龄60岁(SD 17)，其中119例 657例(47%)年龄在60岁以下，143例 521例(56%)为男性，14例 979例(16%)无合并症。在研究的三个4周期间，病例数量有所增加：到19-22周，病例集中在北部、东北部和东南部；到27-30周，病例已蔓延到中西部和南部地区。在输出数据时，234名 患者中有232名 036名(91%)有明确的住院结果；住院死亡率为38%(232名 036名患者中有87名 515名)，住进重症监护病房的患者中有59%(79名 687名中有47名 002名)，而在接受机械通气者中有80%(45名 205名中有36名 046名)。每张ICU床位的ICU入院总负担在北部、东南部和东北部比中西部和南部更明显。在东北部，9960名患者中有1545名(16%)在ICU外接受有创机械通气，而南部5388名患者中有431名(8%)。东北部60岁以下患者的住院死亡率为31%(13 468人中有4204人)，而南部为15%(11 196人中有1694人)。我们观察到新冠肺炎在巴西所有地区的广泛分布，导致总体疾病负担很高。住院死亡率很高，即使是在60岁以下的患者中也是如此，而且由于卫生系统内现有的地区差异而恶化。新冠肺炎疫情突出表明，需要改善因感染新冠肺炎而入院的危重病人获得高质量护理的机会，特别是在低收入中等收入国家。国家科学和技术发展委员会(CNPQ)、研究生高级培训协调机构(CAPES)、里约热内卢州卡洛斯·查加斯·菲略研究支助基金会(FAPERJ)和卡洛斯·德萨卢德·卡洛斯三世研究所。
Most low-income and middle-income countries (LMICs) have little or no data integrated into a national surveillance system to identify characteristics or outcomes of COVID-19 hospital admissions and the impact of the COVID-19 pandemic on their national health systems. We aimed to analyse characteristics of patients admitted to hospital with COVID-19 in Brazil, and to examine the impact of COVID-19 on health-care resources and in-hospital mortality. We did a retrospective analysis of all patients aged 20 years or older with quantitative RT-PCR (RT-qPCR)-confirmed COVID-19 who were admitted to hospital and registered in SIVEP-Gripe, a nationwide surveillance database in Brazil, between Feb 16 and Aug 15, 2020 (epidemiological weeks 8–33). We also examined the progression of the COVID-19 pandemic across three 4-week periods within this timeframe (epidemiological weeks 8–12, 19–22, and 27–30). The primary outcome was in-hospital mortality. We compared the regional burden of hospital admissions stratified by age, intensive care unit (ICU) admission, and respiratory support. We analysed data from the whole country and its five regions: North, Northeast, Central-West, Southeast, and South. Between Feb 16 and Aug 15, 2020, 254 288 patients with RT-qPCR-confirmed COVID-19 were admitted to hospital and registered in SIVEP-Gripe. The mean age of patients was 60 (SD 17) years, 119 657 (47%) of 254 288 were aged younger than 60 years, 143 521 (56%) of 254 243 were male, and 14 979 (16%) of 90 829 had no comorbidities. Case numbers increased across the three 4-week periods studied: by epidemiological weeks 19–22, cases were concentrated in the North, Northeast, and Southeast; by weeks 27–30, cases had spread to the Central-West and South regions. 232 036 (91%) of 254 288 patients had a defined hospital outcome when the data were exported; in-hospital mortality was 38% (87 515 of 232 036 patients) overall, 59% (47 002 of 79 687) among patients admitted to the ICU, and 80% (36 046 of 45 205) among those who were mechanically ventilated. The overall burden of ICU admissions per ICU beds was more pronounced in the North, Southeast, and Northeast, than in the Central-West and South. In the Northeast, 1545 (16%) of 9960 patients received invasive mechanical ventilation outside the ICU compared with 431 (8%) of 5388 in the South. In-hospital mortality among patients younger than 60 years was 31% (4204 of 13 468) in the Northeast versus 15% (1694 of 11 196) in the South. We observed a widespread distribution of COVID-19 across all regions in Brazil, resulting in a high overall disease burden. In-hospital mortality was high, even in patients younger than 60 years, and worsened by existing regional disparities within the health system. The COVID-19 pandemic highlights the need to improve access to high-quality care for critically ill patients admitted to hospital with COVID-19, particularly in LMICs. National Council for Scientific and Technological Development (CNPq), Coordinating Agency for Advanced Training of Graduate Personnel (CAPES), Carlos Chagas Filho Foundation for Research Support of the State of Rio de Janeiro (FAPERJ), and Instituto de Salud Carlos III.