Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Pulmonary Division, Heart Institute, Faculty of Medicine, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil; Tecgraf Institute, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil.
Lancet Respir Med. 2021 Apr;9(4):407-418. doi: 10.1016/S2213-2600(20)30560-9. Epub 2021 Jan 15.
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.
大多数中低收入国家（LMIC）几乎没有或将很少有数据纳入国家监测系统，以确定 COVID-19 住院患者的特征或结局，以及 COVID-19 大流行对其国家卫生系统的影响。我们旨在分析巴西 COVID-19 住院患者的特征，并研究 COVID-19 对医疗资源和院内死亡率的影响。
我们对 20 岁或以上、经定量 RT-PCR（RT-qPCR）确认为 COVID-19 的患者进行了回顾性分析，这些患者于 2020 年 2 月 16 日至 8 月 15 日期间在巴西全国监测数据库 SIVEP-Gripe 中住院并登记，时间跨度为流行病学第 8-33 周。我们还检查了 COVID-19 大流行在这一时间段内的三个 4 周期间的进展情况（流行病学第 8-12、19-22 和 27-30 周）。主要结局是院内死亡率。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住院负担。我们分析了来自全国及其五个地区（北部、东北部、中西部、东南部和南部）的数据。
2020 年 2 月 16 日至 8 月 15 日期间，有 254288 例经 RT-qPCR 确认为 COVID-19 的患者住院并在 SIVEP-Gripe 中登记。患者的平均年龄为 60 岁（标准差 17 岁），254288 例患者中年龄小于 60 岁的有 119657 例（47%），143521 例（56%）为男性，90829 例（16%）无合并症。病例数量在三个 4 周期间逐渐增加：第 19-22 周期间，病例集中在北部、东北部和东南部；第 27-30 周期间，病例已蔓延到中西部和南部地区。在导出数据时，254288 例患者中有 232036 例（91%）有明确的住院结局；总的院内死亡率为 38%（232036 例患者中有 87515 例），重症监护病房（ICU）入院患者的死亡率为 59%（79687 例患者中有 47002 例），机械通气患者的死亡率为 80%（45205 例患者中有 36046 例）。ICU 床位每间 ICU 床位的 ICU 入住负担在北部、东南部和东北部更为明显，而在中西部和南部则不明显。在东北部，9960 例患者中有 1545 例（16%）在 ICU 外接受了有创机械通气，而在南部，5388 例患者中有 431 例（8%）。在东北部，年龄小于 60 岁的患者的院内死亡率为 31%（13468 例患者中有 4204 例），而在南部，年龄小于 60 岁的患者的院内死亡率为 15%（11196 例患者中有 1694 例）。
我们观察到 COVID-19 在巴西所有地区广泛传播，导致整体疾病负担很高。院内死亡率很高，即使是年龄小于 60 岁的患者，而且由于卫生系统内部现有的区域差异，死亡率进一步恶化。COVID-19 大流行突显了需要改善对患有 COVID-19 的重症住院患者的高质量护理的获取，特别是在中低收入国家。
国家科学技术发展委员会（CNPq）、高级研究生培训协调机构（CAPES）、里约热内卢州卡洛斯·查加斯研究支持基金会（FAPERJ）和西班牙卡洛斯三世卫生研究所。
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