In-hospital mortality and severe outcomes after hospital discharge due to COVID-19: A prospective multicenter study from Brazil

Background We evaluated in-hospital mortality and outcomes incidence after hospital discharge due to COVID-19 in a Brazilian multicenter cohort. Methods This prospective multicenter study (RECOVER-SUS, NCT04807699) included COVID-19 patients hospitalized in public tertiary hospitals in Brazil from June 2020 to March 2021. Clinical assessment and blood samples were performed at hospital admission, with post-hospital discharge remote visits. Hospitalized participants were followed-up until March 31, 2021. The outcomes were in-hospital mortality and incidence of rehospitalization or death after hospital discharge. Kaplan- Meier curves and Cox proportional-hazard models were performed. Findings 1589 participants [54.5% male, age=62 (IQR 50-70) years; BMI=28.4 (IQR,24.9- 32.9) Kg/m(2) and 51.9% with diabetes] were included. A total of 429 individuals [27.0% (95%CI,24.8- 29.2)] died during hospitalization (median time 14 (IQR,9- 24) days). Older age [vs< 40 years; age=60- 69 years-aHR=1.89 (95%CI,1.08- 3.32); age=70-79 years-aHR=2.52 (95%CI,1.42-4.45); age >= 80-aHR=2.90 (95%CI 1.54-5.47)]; noninvasive or mechanical ventilation at admission [vs facial-mask or none; aHR=1.69 (95%CI 1.30-2.19)]; SAPS-III score >= 57 [vs<57; aHR=1.47 (95%CI 1.13-1.92)] and SOFA score >= 10 [vs <10; aHR=1.51 (95%CI 1.08-2.10)] were independently associated with in-hospital mortality. A total of 65 individuals [6.7% (95%CI 5.3-8.4)] had a rehospitalization or death [rate=323 (95%CI 250-417) per 1000 person-years] in a median time of 52 (range 1-280) days post-hospital discharge. Age >= 60 years [vs < 60, aHR=2.13 (95%CI 1.15-3.94)] and SAPS-III >= 57 at admission [vs < 57, aHR=2.37 (95%CI 1.22-4.59)] were independently associated with rehospitalization or death after hospital discharge. Interpretation High in-hospital mortality rates due to COVID-19 were observed and elderly people remained at high risk of rehospitalization and death after hospital discharge. Copyright (c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)