Sansone Nathália Mariana Santos, Boschiero Matheus Negri, Marson Fernando Augusto Lima
Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, Brazil.
Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, Brazil.
Front Microbiol. 2022 Jul 1;13:911036. doi: 10.3389/fmicb.2022.911036. eCollection 2022.
The COVID-19 is a significant public health issue, and monitoring confirmed cases and deaths is an essential epidemiologic tool. We evaluated the features in Brazilian hospitalized patients due to severe acute respiratory infection (SARI) during the COVID-19 pandemic in Brazil. We grouped the patients into the following categories: Influenza virus infection (G1), other respiratory viruses' infection (G2), other known etiologic agents (G3), SARS-CoV-2 infection (patients with COVID-19, G4), and undefined etiological agent (G5).
We performed an epidemiological study using data from DataSUS (https://opendatasus.saude.gov.br/) from December 2019 to October 2021. The dataset included Brazilian hospitalized patients due to SARI. We considered the clinical evolution of the patients with SARI during the COVID-19 pandemic according to the SARI patient groups as the outcome. We performed the multivariate statistical analysis using logistic regression, and we adopted an Alpha error of 0.05.
A total of 2,740,272 patients were hospitalized due to SARI in Brazil, being the São Paulo state responsible for most of the cases [802,367 (29.3%)]. Most of the patients were male (1,495,416; 54.6%), aged between 25 and 60 years (1,269,398; 46.3%), and were White (1,105,123; 49.8%). A total of 1,577,279 (68.3%) patients recovered from SARI, whereas 701,607 (30.4%) died due to SARI, and 30,551 (1.3%) did not have their deaths related to SARI. A major part of the patients was grouped in G4 (1,817,098; 66.3%) and G5 (896,207; 32.7%). The other groups account for <1% of our sample [G1: 3,474 (0.1%), G2: 16,627 (0.6%), and G3: 6,866 (0.3%)]. The deaths related to SARI were more frequent in G4 (574,887; 34.7%); however, the deaths not related to SARI were more frequent among the patients categorized into the G3 (1,339; 21.3%) and G5 (25,829; 4.1%). In the multivariate analysis, the main predictors to classify the patients in the G5 when compared with G4 or G1-G4 were female sex, younger age, Black race, low educational level, rural place of residence, and the use of antiviral to treat the clinical signs. Furthermore, several features predict the risk of death by SARI, such as older age, race (Black, Indigenous, and multiracial background), low educational level, residence in a flu outbreak region, need for intensive care unit, and need for mechanical ventilatory support.
The possible COVID-19 underreporting (G5) might be associated with an enhanced mortality rate, more evident in distinct social groups. In addition, the patients' features are unequal between the patients' groups and can be used to determine the risk of possible COVID-19 underreporting in our population. Patients with a higher risk of death had a different epidemiological profile when compared with patients who recovered from SARI, like older age, Black, Indigenous, and multiracial background races, low educational level, residence in a flu outbreak region, need for intensive care unit and need for mechanical ventilatory support.
新型冠状病毒肺炎（COVID-19）是一个重大的公共卫生问题，监测确诊病例和死亡情况是一项重要的流行病学工具。我们评估了巴西COVID-19大流行期间因严重急性呼吸道感染（SARI）住院患者的特征。我们将患者分为以下几类：流感病毒感染（G1）、其他呼吸道病毒感染（G2）、其他已知病原体（G3）、严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染（COVID-19患者，G4）和病原体未明（G5）。
我们使用2019年12月至2021年10月巴西卫生部公开数据库（https://opendatasus.saude.gov.br/）的数据进行了一项流行病学研究。该数据集包括因SARI住院的巴西患者。我们将COVID-19大流行期间SARI患者的临床转归作为研究结果，根据SARI患者分组进行分析。我们采用逻辑回归进行多变量统计分析，设定α错误率为0.05。
巴西共有2740272例患者因SARI住院，其中圣保罗州病例最多[802367例（29.3%）]。大多数患者为男性（1495416例；54.6%），年龄在25至60岁之间（1269398例；46.3%），且为白人（1105123例；49.8%）。共有1577279例（68.3%）患者从SARI中康复，701607例（30.4%）患者因SARI死亡，30551例（1.3%）患者的死亡与SARI无关。大部分患者分为G4组（1817098例；66.3%）和G5组（896207例；32.7%）。其他组占样本的比例不到1%[G1组：3474例（0.1%），G2组：16627例（0.6%），G3组：6866例（0.3%）]。与SARI相关的死亡在G4组中更为常见（574887例；34.7%）；然而，与SARI无关的死亡在G3组（1339例；21.3%）和G5组（25829例；4.1%）的患者中更为常见。在多变量分析中，与G4组或G1-G4组相比，将患者分类为G5组的主要预测因素为女性、年龄较小、黑人种族、教育水平低、农村居住地以及使用抗病毒药物治疗临床症状。此外，一些特征可预测SARI导致的死亡风险，如年龄较大、种族（黑人、原住民和多民族背景）、教育水平低、居住在流感暴发地区、需要重症监护病房以及需要机械通气支持。
可能存在的COVID-19报告不足（G5）可能与死亡率增加有关，在不同社会群体中更为明显。此外，患者组之间的特征存在差异，可用于确定我国人群中可能存在的COVID-19报告不足的风险。与从SARI中康复的患者相比，死亡风险较高的患者具有不同的流行病学特征，如年龄较大、黑人、原住民和多民族背景种族、教育水平低、居住在流感暴发地区、需要重症监护病房以及需要机械通气支持。
