ABSTRACT
BACKGROUND: The emergence of SARS-CoV-2 variants led to subsequent waves of COVID-19 worldwide. In many countries, the second wave of COVID-19 was marked by record deaths, raising the concern that variants associated with that wave might be more deadly. Our aim was to compare outcomes of critically-ill patients of the first two waves of COVID-19. METHODS: This retrospective cohort included critically-ill patients admitted between March-June 2020 and April-July 2021 in the largest academic hospital in Brazil, which has free-access universal health care system. We compared admission characteristics and hospital outcomes. The main outcome was 60-day survival and we built multivariable Cox model based on a conceptual causal diagram in the format of directed acyclic graph (DAG). RESULTS: We included 1583 patients (1315 in the first and 268 in the second wave). Patients in the second wave were younger, had lower severity scores, used prone and non-invasive ventilatory support more often, and fewer patients required mechanical ventilation (70% vs 80%, p<0.001), vasopressors (60 vs 74%, p<0.001), and dialysis (22% vs 37%, p<0.001). Survival was higher in the second wave (HR 0.61, 95%CI 0.50-0.76). In the multivariable model, admission during the second wave, adjusted for age, SAPS3 and vaccination, was not associated with survival (aHR 0.85, 95%CI 0.65-1.12). CONCLUSIONS: In this cohort study, patients with COVID-19 admitted to the ICU in the second wave were younger and had better prognostic scores. Adjusted survival was similar in the two waves, contrasting with record number of hospitalizations, daily deaths and health system collapse seen across the country in the second wave. Our findings suggest that the combination of the burden of severe cases and factors such as resource allocation and health disparities may have had an impact in the excess mortality found in many countries in the second wave.
Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , SARS-CoV-2 , Critical Illness , Cohort Studies , Retrospective Studies , Renal DialysisABSTRACT
CONTEXTO: A autopercepção de saúde contempla vários aspectos da saúde física, cognição e capacidade funcional. OBJETIVO: Comparar idosos com e sem evidência de declínio cognitivo/demência quanto a autopercepção de saúde e variáveis sociodemográficas, destacando as variáveis associadas à autopercepção de saúde positiva e negativa dentro destes grupos. MÉTODOS: Noventa e oito idosos residentes na comunidade foram avaliados em visitas domiciliares para este trabalho. A avaliação cognitiva e funcional foi feita por meio da aplicação do Mini-Exame do Estado Mental (MEEM), do Teste do Desenho do Relógio (TDR), da Escala de Demência de Blessed (EDB) e do Questionário do Informante de Declínio Cognitivo em Idosos (IQCODE). A autopercepção da saúde foi avaliada por intermédio de um questionário adaptado do Brazil Old Age Schedule. RESULTADOS: Vinte e seis idosos (26 por cento) apresentaram quadro de declínio cognitivo. Autopercepção de saúde negativa e menor participação em atividades físicas e recreativas se associaram significativamente a declínio cognitivo nesta amostra (p = 0,006, p = 0,05, p = 0,03, respectivamente). No grupo de sujeitos sem evidência de declínio cognitivo, a história prévia de eventos cerebrovasculares se relacionou à maior frequência de autopercepção negativa da saúde. CONCLUSÃO: A autopercepção negativa da saúde está relacionada ao provável diagnóstico de demência. Nos idosos com declínio cognitivo, a autopercepção positiva de saúde associa-se a quadros mais graves, refletindo possivelmente menor insight quanto ao estado mórbido.
BACKGROUND: The self-perception of health can approach several aspects of physical health, cognition and functional abilities. OBJECTIVE: To compare elderly subjects wit and without evidence of cognitive decline in relation to health self-perception and socio-demographic variables, highlighting the variables associated with positive or negative health self-perception in these groups. METHODS: Ninety eight community-dwelling subjects were assessed in this study. Cognitive and functional abilities were tested using the Mini-Mental State Examination (MMSE), the Clock Drawing Test (CDT), the Blessed Dementia Scale (BDS), and the Informant Questionnaire of Cognitive Decline in the Elderly (IQCODE). Self-perception of health evaluation was performed with the use of an adapted questionnaire of the Brazil Old Age Schedule. RESULTS: Twenty-six subjects (26 percent) had evidence of cognitive decline in this sample. Negative health self-perception and lower levels of physical and leisure activity were significantly associated with cognitive decline in this sample (p = 0.006, p = 0.05, p = 0.03, respectively). In the group of subjects without evidence of dementia, history of cerebrovascular disease was associated with negative health perception. DISCUSSION: Dementia was associated with worse health self-perception evaluation. In addition, elders with evidence of dementia and good health self-perception evaluation had higher IQCODE scores, suggesting lack of judgment regarding health status.
