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/m² 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. FUNDING: Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Programa INOVA-FIOCRUZ.