Post-discharge all-cause mortality in COVID-19 recovered patients hospitalized in 2020: the impact of chronic kidney disease

ABSTRACT In Brazil, the COVID-19 burden was substantial, and risk factors associated with higher in-hospital mortality rates have been extensively studied. However, information on short-term all-cause mortality and the factors associated with death in patients who survived the hospitalization period of acute SARS-CoV-2 infection is limited. We analyzed the six-month post-hospitalization mortality rate and possible risk factors of COVID-19 patients in a single center in Brazil. This is a retrospective cohort study focused on a six-month follow-up. The exclusion criteria were death during hospitalization, transference to another hospital, and age under 18. We collected data from the charts of all hospitalized patients from March 2020 to December 2020 with a positive RT-PCR test for SARS-CoV-2, resulting in a sample size of 106 patients. The main outcome was death after hospitalization, whereas comorbidities and demographics were evaluated as risk factors. The crude post-hospitalization death rate was 16%. The first 30 days of follow-up had the highest mortality rate. In a Cox regression model for post-hospitalization mortality, previous chronic kidney disease (HR, 4.06, 95%CI 1.46 - 11.30) and longer hospital stay (HR 1.01, 95%CI 1.00 - 1.02) were the only factors statistically associated with death. In conclusion, a high six-month all-cause mortality was observed. Within the six-month follow-up, a higher risk of death was observed for patients who had prior CKD and longer hospital stay. These findings highlight the importance of more intensive medical surveillance during this period.

Estresse oxidativo no lúpus eritematoso sistêmico / Oxidative stress in systemic lupus erythematosus

O lúpus eritematoso sistêmico (LES) é uma doença inflamatória crônica caracterizada pela elevada presença de autoanticorpos e por comprometer diversos órgãos e sistemas. O estresse oxidativo celular está envolvido no desenvolvimento das várias características clínicas observadas nesta doença, além de apresentar importante relação com a sua gênese e patogênese. Neste contexto, esse trabalho tem como objetivo fazer umlevantamento bibliográfico das principais moléculas envolvidas no estresse oxidativo no LES e correlacionar seus efeitos no acompanhamento da evolução e patogênese dessa doença, como ferramentas de diagnóstico e prognóstico. Os marcadores de estresse oxidativo mais comuns encontrados foram o malondialdeído, o 4-hidroxi-nonenal, a 8-hidroxideoxiguanosina, o radical hidroxila, o óxido nítrico, além da substância glutationa e enzimas antioxidantes, glutationa peroxidase, catalase e superóxido dismutase. Sendo assim, embora apareçam algumas divergências entre a correlação de alguns marcadoresde estresse oxidativo com a atividade da doença, a maioria dos estudos mostrou importante relação desses marcadores com o desenvolvimento e agravamento do LES. Apesar danecessidade de estudos longitudinais, podemos sugerir grande potencial das moléculas de estresse oxidativo como ferramenta no diagnóstico e prognóstico no LES.