ABSTRACT
Background: Myocardial injury is a known complication of COVID-19 and is related to a worse prognosis on admission. However, its impact on 1-year mortality is unknown. Methods: Retrospective cohort study with patients admitted to intensive care and confirmed diagnosis of COVID-19 by RT-PCR and with at least one measurement of troponin during hospitalization. The study period was from March/2020 to June/2021. Clinical characteristics and the occurrence of myocardial were assessed between deaths and survivors using the chi-square test and Student's t-test. Variables with p<0.01 in the univariate analysis were included in the Cox regression model to identify predictor variables of 1-year mortality. Results: 1037 patients were included, with a mean follow-up of 1.06±0.58 years, mean age = 59.9±16.2 years, and 62.7% men. The prevalence of myocardial injury was 42.8% and occurred 204 deaths (19.7%). In the univariate analysis, the variables associated with 1-year mortality were: myocardial injury (OR 7.5;CI95% 5.2–10.9), age >60 years (OR 5.65;CI95% 3.9–8.2), arterial hypertension (OR 2.8;CI95% 2.0–3.9), diabetes (OR 2.3;CI95% 1.6–3.1), chronic kidney failure (OR 3.9;CI95% 2.2–6.8), dementia (OR 1.8;CI95% 1.2–2.6) and mechanical ventilation (OR 50.5;CI95% 33.9–77.3). In Cox regression, the predictor variables were: myocardial injury (HR 2.4;CI95% 1.7–3.5), age >60 years (HR 2.5;CI95% 1.8–3.6), chronic kidney disease (HR 1.9;CI95% 1.2–2.9), dementia (HR 3.2;CI95% 2.1–5.0) and mechanical ventilation (HR 17.5;CI95% 12.2–25.2). Conclusion: In patients admitted to intensive care by COVID-19, the detection of myocardial injury more than doubled the risk of death in 1 year. Funding Acknowledgement: Type of funding sources: None.Figure 1
ABSTRACT
Introduction: A disastrous disease, the COVID-19, continues its spread, this, coupled with its severity, led to a initial global lockdown. Early evidence identified Black counties where mortality risk was higher than in white counties, even more evident in Latin America. In Brazil, with multiple forms of social inequalities, where color/race takes high relevance in this debate, it is even more relevant in Rio de Janeiro. We aimed to analyze these socio economic factors and its correlation with COVID 19 mortality. Hypothesis: Patients hospitalized with COVID 19 with a high social vulnerable background would had greater in-hospital mortality Methods: Prospective study of 274 confirmed adult COVID 19 hospitalized patients in the UHCFF. Clinical features/blood chemistry information were obtained from the clinical record. Using the individual address, we correlated it with the Census Code Area (CCA), using a novel methodology, we geoprocessed each home on the Division map. Giving a high relevance to the socio-economic variables for inequity and vulnerability markers, also analyzing the fact to be transferred from another primary care institution, for its delay potential of advanced medical care. We performed a logistic regression, with in-hospital mortality as our primary outcomeResults: Patients living in low adequacy households(p=0.030) with high in-house individual agglomeration markers (p=0.017), and the fact to have been transferred from another primary care institution (p=0.047) presented high in-hospital mortality, with high ICU admission and Mechanical Ventilation rates. Conclusions: In hospital mortality due to COVID 19 was influenced by social individual background characteristics of vulnerability. Among other clinical parameters, these markers should be taken into account to predict the individual likelihood of complications related to the pandemic, prioritizing the attention and vaccination for those at higher risk should be paramount.