Factors associated with Severe Acute Respiratory Syndrome in a Brazilian central region

Araujo, Kamilla Lelis Rodrigues de; Aquino, Érika Carvalho de; Silva, Lara Lívia Santos da; Ternes, Yves Mauro Fernandes

doi:10.1590/1413-812320202510.2.26802020

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ARTICLE • Ciênc. saúde coletiva 25 (suppl 2) • Oct 2020 • https://doi.org/10.1590/1413-812320202510.2.26802020 copy

Factors associated with Severe Acute Respiratory Syndrome in a Brazilian central region

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Severe Acute Respiratory Infection (SARI) is a notifiable syndrome that must be investigated. This study aimed to analyze the epidemiological profile and factors associated with SARI-related hospitalization and deaths reported in Goiás. Retrospective cohort study, with data from the investigation files of the Notifiable Diseases Information System’s Influenza Web. Multivariate analysis methods were employed to verify the association between exposure variables with the outcomes of ICU admission and death. A total of 4,832 SARI cases were reported in Goiás from 2013 to 2018. The primary etiological diagnosis was Influenza A (22.3%) with the predominant subtype A (H1N1pdm09), followed by the Respiratory Syncytial Virus. A total of 34.6% of the patients required ICU admission, and 19% died. A longer time to start treatment with antivirals was associated with a higher likelihood to have an ICU admission, while a previous non-vaccination against Influenza, longer time to start treatment, and older age were associated with a higher likelihood to suffer death. The study showed a high frequency of respiratory diseases caused by the Influenza virus in Goiás and that the severity of the syndrome, characterized by ICU admission and deaths, is associated with the start of antiviral treatment vaccine status, and patient’s age.

Key words
Human Influenza; Surveillance; Epidemiology; Severe Acute Respiratory Infection

Characteristics	N	%
Gender
Male	2,250	46.6%
Female	2,581	53.4%
Unknown	1	0.0%
Age group
0-5 years	1,381	28.6%
6-19 years	512	10.6%
20-59 years	2,213	45.8%
60 years and over	724	15.0%
Unknown	2	0.0%
Pregnancy
1º trimester	47	1.0%
2º trimester	104	2.2%
3º trimester	125	2.6%
Unknown gestational age	5	0.1%
No	1,236	25.6%
Not applicable	3,147	65.1%
Unknown	168	3.5%
Skin color
White	1,471	30.4%
Black	235	4.9%
Yellow	53	1.1%
Brown	2,438	50.5%
Indigenous	5	0.1%
Unknown	630	13.0%
Schooling
No schooling	110	2.3%
Elementary School	809	16.7%
Secondary School	800	16.6%
Higher Education	311	6.4%
Not applicable	1,423	29.4%
Unknown	1,379	28.5%
Prevention, treatment and evolution
Prior vaccination
Yes	998	20.7%
No	2,854	59.1%
Unknown	980	20.3%
Use of antivirals
Yes	3,416	70.7%
No	1,203	24.9%
Unknown	213	4.4%
Hospitalization
Yes	4,797	99.3%
No	30	0.6%
Unknown	5	0.1%
ICU admission
Yes	1,670	34.6%
No	2,969	61.4%
Unknown	193	4.0%
Development
Discharge	3,740	77.4%
Death	920	19.0%
Unknown	172	3.6%

Characteristics		Death			Bivariate logistic regression			Multivariate logistic regression
Characteristics		Yes (n=920)	No (n=3740)	Unknown (n=172)	OR	95%CI	p	OR	95%CI	p
Vaccine	No	391	2353	110	1.19	0.96-1.49	0.117	1.49	1.10-2.03	0.011
	Yes	118	847	33	ref	-	-	ref	-	-
	Unknown	411	540	29
Antiviral	No	298	857	51	1.83	1.56-2.15	<0.001	2.54	0.63-10.21	0.189
	Yes	528	2784	103	ref	-	-	ref	-	-
	Unknown	94	99	18
Influenza A or B	Positive	275	884	32	1.36	1.15-1.60	<0.001	1.17	0.89-1.54	0.247
	Negative	550	2401	56	ref	-	-	ref	-	-
	Unknown	95	455	84
RSV	Positive	29	429	8	0.25	0.17-0.36	<0.001	0.73	0.41-1.30	0.285
	Negative	746	2706	73	ref	-	-	ref	-	-
	Unknown	145	605	91
Other respiratory viruses	Positive	69	617	12	0.41	0.32-1.01	0.462	-	-	-
	Negative	840	3112	86	ref	-	-	ref	-	-
	Unknown	11	11	74
Treatment start time	0-2 days	145	1091	48	ref	-	-	ref	-	-
	3-5 days	189	991	32	1.43	1.13-1.81	0.002	1.4	1.02-1.91	0.035
	6-8 days	110	402	11	2.06	1.57- 2.70	<0.001	1.99	1.38-2.88	<0.001
	9 days and over	74	268	11	2.08	1.52-2.8	<0.001	1.73	1.13-2.66	0.012
	Unknown	402	988	70
Age group	0-5 years	116	1213	52	ref	-	-	ref	-	-
	6-19 years	63	432	17	1.52	1.10-2.11	0.011	1.09	0.59-2.01	0.776
	20-59 years	507	1625	81	3.26	2.63-4.04	<0.001	2.49	1.65-3.76	<0.001
	60 years and over	234	468	22	5.23	4.08-6.69	<0.001	5.21	3.29-8.26	<0.001
	Unknown	0	2	0

Characteristics		ICU admission			Bivariate logistic regression			Multivariate logistic regression^* * Collinearity statistics: tolerance > 0.1 and VIF < 10; Hosmer-Lemeshow Test: p = 0.167; Nagelkerke R2 = 0.032; RSV=Respiratory Syncytial Virus.
Characteristics		Yes (n=1670)	No (n=2969)	Unknown (n=193)	OR	95%CI	p	OR	95%CI	p
Vaccine	No	874	1890	90	1.01	0.86-1.18	0.938	-	-	-
	Yes	301	655	42	ref	-	-	ref	-	-
	Unknown	495	424	61
Antiviral	No	375	789	42	0.83	0.72-0.95	0.009	0.7	0.18-2.74	0.611
	Yes	1212	2109	94	ref	-	-	ref	-	-
	Unknown	83	71	57
Influenza A or B	Positive	390	761	40	0.79	0.68-0.91	0.001	0.79	0.65-0.95	0.014
	Negative	1140	1756	111	ref	-	-	ref	-	-
	Unknown	140	452	42
RSV	Positive	124	331	11	0.57	0.46-0.71	<0.001	0.56	0.41-0.75	<0.001
	Negative	1351	2050	124	ref	-	-	ref	-	-
	Unknown	195	588	58
Other respiratory viruses	Positive	221	462	15	0.82	0.67-1.06	0.02	0.69	0.55-1.32	0.06
	Negative	1422	2460	156	ref	-	-	ref	-	-
	Unknown	27	47	22
Treatment start time	0-2 days	385	861	38	ref	-	-	ref	-	-
	3-5 days	437	744	31	1.31	1.11-1.55	0.002	1.27	1.04-1.55	0.019
	6-8 days	232	276	15	1.88	1.52-2.32	<0.001	1.94	1.51-2.49	<0.001
	9 days and over	144	200	9	1.61	1.26-2.05	<0.001	1.53	1.14-2.06	0.005
	Unknown	472	888	100
Age group	0-5 years	469	875	37	ref	-	-
	6-19 years	187	307	18	1.14	0.92-1.41	0.241
	20-59 years	764	1345	104	1.06	0.92-1.22	0.427
	60 years and over	250	440	34	1.06	0.87; 1.28	0.551
	Unknown	0	2	0

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[1] Collaborations

KLR Araujo and YMF Ternes participated in the conception, design and writing of the article. EC Aquino, LLS Silva and YMF Ternes participated in the statistical analysis and interpretation of the data. All authors participated in the critical review and approval of the version to be published.