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Lomba GSB, da Silva PHA, do Rosário NF, Medeiros T, Alves LS, Silva AA, Almeida JR, Lugon JR. Post-discharge all-cause mortality in COVID-19 recovered patients hospitalized in 2020: the impact of chronic kidney disease. Rev Inst Med Trop Sao Paulo 2024; 66:e1. [PMID: 38198374 PMCID: PMC10768652 DOI: 10.1590/s1678-9946202466001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/16/2023] [Indexed: 01/12/2024] Open
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.
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Affiliation(s)
| | | | - Natalia Fonseca do Rosário
- Universidade Federal Fluminense, Faculdade de Medicina, Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Niterói, Rio de Janeiro, Brazil
| | - Thalia Medeiros
- Universidade Federal Fluminense, Faculdade de Medicina, Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Niterói, Rio de Janeiro, Brazil
- Universidade Federal Fluminense, Faculdade de Medicina, Departamento de Patologia, Niterói, Rio de Janeiro, Brazil
| | - Lilian Santos Alves
- Universidade Federal Fluminense, Faculdade de Medicina, Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Niterói, Rio de Janeiro, Brazil
| | - Andrea Alice Silva
- Universidade Federal Fluminense, Faculdade de Medicina, Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Niterói, Rio de Janeiro, Brazil
- Universidade Federal Fluminense, Faculdade de Medicina, Departamento de Patologia, Niterói, Rio de Janeiro, Brazil
| | - Jorge Reis Almeida
- Universidade Federal Fluminense, Faculdade de Medicina, Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Niterói, Rio de Janeiro, Brazil
- Universidade Federal Fluminense, Faculdade de Medicina, Departamento de Medicina Clínica, Divisão de Nefrologia, Niterói, Rio de Janeiro, Brazil
| | - Jocemir Ronaldo Lugon
- Universidade Federal Fluminense, Faculdade de Medicina, Departamento de Medicina Clínica, Divisão de Nefrologia, Niterói, Rio de Janeiro, Brazil
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da Silva PHA, Garcia AS, Alves FA, Dos Santos ALS, Sodré CL. COVID-19 and Diabetes Mellitus: Potential Metabolic Associations. Curr Top Med Chem 2021; 21:929-936. [PMID: 34126900 DOI: 10.2174/1568026621666210612025938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/22/2022]
Abstract
The COVID-19 pandemic turned the SARS-CoV-2 into the main target of scientific research all around the world. Many advances have already been made, but there is still a long way to go to solve the molecular mechanisms related to the process of the SARS-CoV-2 infection, as well as the particularities of the disease, its course and the complex host-pathogen relationships. However, a lot has been theorized and associated with COVID-19, like the worst prognosis of the disease among individuals with some comorbidities, like diabetes mellitus. In this perspective, diabetic patients are repeatedly associated with more severe cases of COVID-19 when compared to non-diabetic patients. Even though ACE2 (angiotensin-converting enzyme 2) was recognized as the host cell receptor for both binding and entering of SARS-CoV-2 particles, it was also pointed out that this enzyme plays an important protective role against pulmonary damage. Therefore, paradoxically as it may seem, the low baseline level of this receptor in diabetics is directly linked to a more expressive loss of ACE2 protective effect, which could be one of the possible factors for the worst prognosis of COVID-19. Still, COVID-19 may also have a diabetogenic effect. From this point of view, the main topics that will be highlighted are (i) the mechanism of the viral entry, with special attention to the cellular receptor (ACE2) and the viral binding protein (spike), (ii) the relationship among the renin-angiotensin system, the infection process and the patients' prognosis, (iii) the glucose control and the medicines used in this event, and (iv) a brief analysis on diabetes triggered by COVID-19.
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Affiliation(s)
- Pedro Henrique Abreu da Silva
- Departamento de Biologia Celular e Molecular (GCM), Instituto de Biologia (IB), Universidade Federal Fluminense (UFF), Niteroi-RJ, Brazil
| | - Andressa Santos Garcia
- Departamento de Biologia Celular e Molecular (GCM), Instituto de Biologia (IB), Universidade Federal Fluminense (UFF), Niteroi-RJ, Brazil
| | - Fábio Aguiar Alves
- Laboratorio de Epidemiologia Molecular e Biotecnologia (LEMB), Programa de Pos-Graduacao em Patologia, Programa de Pos-Graduacao em Microbiologia e Parasitologia, Universidade Federal Fluminense (UFF), Niteroi-RJ, Brazil
| | - André Luis Souza Dos Santos
- Laboratorio de Estudos Avancados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Goes (IMPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Cátia Lacerda Sodré
- Departamento de Biologia Celular e Molecular (GCM), Instituto de Biologia (IB), Universidade Federal Fluminense (UFF), Niteroi-RJ, Brazil
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