Comorbidities and in-hospital death of viral pneumonia adults admitted to SUS (2002–2015)

Piazza, Thais; Moreira, Daniela Pena; Rocha, Hugo André da; Lana, Agner Pereira; Reis, Ilka Afonso; Santos, Marcos Antônio da Cunha; Guerra-Júnior, Augusto Afonso; Cherchiglia, Mariangela Leal

doi:10.11606/s1518-8787.2021055003109

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Original Article • Rev. Saúde Pública 55 • 2021 • https://doi.org/10.11606/s1518-8787.2021055003109 copy

Comorbidities and in-hospital death of viral pneumonia adults admitted to SUS (2002–2015)

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To identify demographic and clinical characteristics of adult patients hospitalized in the Brazilian Unified Health System (SUS) due to viral pneumonia and investigate the association between some comorbidities and death during hospitalization.

METHODS

This retrospective cohort study was conducted with secondary data of adults admitted to SUS due to viral pneumonia between 2002 and 2015. Patient profile was characterized based on demographic and clinical variables. The association between the ten Elixhauser comorbidities and in-hospital death was investigated using Poisson regression models with robust standard errors. Results were quantified as incidence rate ratio (IRR) with 95% confidence intervals (CI), and we built five models using successive inclusion of variables blocks.

RESULTS

Hospital admissions for viral pneumonias decreased throughout the study period, and it was observed that 5.8% of hospitalized patients had an in-hospital death. We observed significant differences in demographic and clinical characteristics by comparing individuals who died during hospitalization with those who did not, with the occurrence of one or more comorbidities being more expressive among patients who died. Although not considered risk factors for in-hospital death, chronic pulmonary disease and congestive heart failure were the most common comorbidities. Conversely, IRR for in-hospital death increased with other neurological disorders, diabetes, cancer, obesity, and especially with HIV/AIDS.

CONCLUSIONS

Individuals presenting with pulmonary and cardiovascular diseases require proper attention during hospitalization, as well as those with other neurological diseases, diabetes, cancer, obesity, and especially HIV/AIDS. Understanding the influence of chronic diseases on viral infections may support the healthcare system in achieving better outcomes.

Pneumonia, Viral, epidemiology; Risk Factors; Comorbidity; Hospitalization; Hospital Mortality

	All patients		In-hospital death

			No		Yes

	Number of patients (n = 629,026)	%	Number of patients (n = 592,458)	%	Number of patients (n = 36,568)	%	p
Demographic Characteristic
Male	307,662	48.9	287,871	48.6	19,791	54.1	< 0.001
Age [median (IQR)]	57	(37.0–74.0)	55	(36.0–73.0)	75	(62.0–84.0)	< 0.001
Age range							< 0.001
18–59 years	338,628	53.8	330,661	55.8	7,967	21.8
60–79 years	191,750	30.5	177,255	29.9	14,495	39.6
80–100 years	98,648	15.7	84,542	14.3	14,106	38.6
Race/skin color							< 0.001
Informed	394,631	62.7	360,152	60.9	34,479	94.2
Not informed	234,395	37.3	232,306	39.1	2,089	5.8
Brazilian geographic region							< 0.001
North	50,795	8.1	49,415	8.3	1,380	3.8
Northeastern	207,266	33.0	199,559	33.7	7,707	21.1
Southeastern	175,685	27.9	160,514	27.1	15,171	41.5
South	143,539	22.8	133,303	22.5	10,236	28.0
Midwest	51,741	8.2	49,667	8.4	2,074	5.7
Classification of location of residence							< 0.001
Urban	380,303	60.5	351,525	59.3	28,778	78.7
Rural	176,143	28.0	170,806	28.8	5,337	14.6
Intermediary	72,580	11.5	70,127	11.8	2,453	6.7
Clinical Characteristic
Comorbidities (yes %)
Chronic pulmonary disease	110,430	17.6	103,419	17.5	7,011	19.2	< 0.001
Congestive heart failure	82,191	13.1	75,936	12.8	6,255	17.1	< 0.001
Cancer	53,532	8.5	48,229	8.1	5,303	14.5	< 0.001
Hypertension	51,060	8.1	47,639	8.0	3,421	9.4	< 0.001
Diabetes	30,981	4.9	28,030	4.7	2,951	8.1	< 0.001
Weight loss	22,467	3.6	19,960	3.4	2,507	6.9	< 0.001
Other neurological disorders	14,983	2.4	13,430	2.3	1,553	4.2	< 0.001
Renal failure	14,016	2.2	12,658	2.1	1,358	3.7	< 0.001
Cardiac arrhythmias	13,729	2.2	12,420	2.1	1,309	3.6	< 0.001
Liver disease	13,559	2.2	12,742	2.2	817	2.2	0.294
Fluid and electrolyte disorders	12,958	2.1	11,490	1.9	1,468	4.0	< 0.001
Alcohol abuse	12,726	2.0	11,804	2.0	922	2.5	< 0.001
AIDS/HIV	10,358	1.6	9,421	1.6	937	2.6	< 0.001
Peripheral vascular disorders	9,377	1.5	8,582	1.4	795	2.2	< 0.001
Psychoses	8,195	1.3	7,653	1.3	542	1.5	0.002
Rheumatoid arthritis/collagen vascular diseases	7,371	1.2	6,953	1.2	418	1.1	0.616
Pulmonary circulation disorders	7,316	1.2	6,662	1.1	654	1.8	< 0.001
Deficiency anaemia	7,266	1.2	6,692	1.1	574	1.6	< 0.001
Obesity	547	0.9	479	0.1	68	0.2	< 0.001
Others^a	21,743	3.5	20,595	3.5	1,148	3.1	0.001
Number of comorbidities							< 0.001
None	335,300	53.3	323,648	54.6	11,652	31.9
1	160,009	25.4	145,641	24.6	14,368	39.3
≥ 2	133,717	21.3	123,169	20.8	10,548	28.8
Number of previous hospitalizations by VP							< 0.001
None	573,661	91.2	541,812	91.5	31,849	87.1
1 or 2	51,307	8.2	46,930	7.9	4,377	12.0
≥ 3	4,058	0.6	3,716	0.6	342	0.9

	All patients		In-hospital death

			No		Yes

	Number of patients (n = 629,026)	%	Number of patients (n = 592,458)	%	Number of patients (n = 36,568)	%	p
Diagnosis at hospital admission							< 0.001
J12.8 Other viral pneumonia	417,190	66.3	392,153	66.2	25,037	68.5
J10.0 Influenza with pneumonia, seasonal influenza virus identified	105,659	16.8	99,093	16.7	6,566	18.0
J11.0 Influenza with pneumonia, virus not identified	86,228	13.7	82,500	13.9	3,728	10.2
J12.0 Adenoviral pneumonia	10,360	1.6	9,773	1.6	587	1.6
J12.1 Respiratory syncytial virus pneumonia	5,116	0.8	4,751	0.8	365	1.0
J12.2 Parainfluenza virus pneumonia	4,473	0.7	4,188	0.7	285	0.8
No. of patients with mixed bacterial pneumonia at admission	311	0.05	283	0.05	28	0.1	0.022
Total length of stay in days							< 0.001
Mean (SD)	5.3	(7.0)	5.1	(6.7)	7.6	(10.2)
Median (IQR)	4	(3.0–6.0)	4	(3.0–5.0)	5	(2.0–9.0)
No. of patients admitted to ICU	16,582	2.6	10,240	1.7	6,342	17.3	< 0.001
Total length of ICU stay in days [median (IQR)]	5.0	(2.0–9.0)	5.0	(2.0–9.0)	5.0	(2.0–9.0)	< 0.001

	Model 0	Model 1	Model 2	Model 3	Model 4

	IRR (95%CI)	IRR (95%CI)	IRR (95%CI)	IRR (95%CI)	IRR (95%CI)
Chronic pulmonary disease	1.09 (1.06–1.11)	0.84 (0.82–0.87)	0.84 (0.82–0.86)	0.80 (0.80–0.84)	0.84 (0.82–0.86)
Congestive heart failure	1.29 (1.25–1.32)	0.86 (0.84–0.88)	0.86 (0.83–0.88)	0.85 (0.83–0.87)	0.88 (0.86–0.91)
Cancer	1.49 (1.45–1.53)	1.21 (1.17–1.24)	1.19 (1.16–1.23)	1.19 (1.16–1.23)	1.18 (1.15–1.22)
Hypertension	1.11 (1.07–1.15)	0.84 (0.81–0.87)	0.83 (0.80–0.86)	0.83 (0.80–0.86)	0.84 (0.81–0.87)
Diabetes	1.49 (1.44–1.55)	1.18 (1.13–1.22)	1.15 (1.11–1.20)	1.15 (1.10–1.19)	1.18 (1.14–1.23)
Renal failure	1.33 (1.26–1.41)	1.07 (1.02–1.13)	1.05 (0.99–1.11)	1.05 (0.99–1.10)	1.04 (0.98–1.10)
Liver disease	0.90 (0.84–0.96)	1.07 (1.00–1.15)	1.06 (0.99–1.13)	1.05 (0.98–1.13)	0.97 (0.90–1.04)
Other neurological disorders	1.46 (1.39–1.54)	1.22 (1.16–1.28)	1.18 (1.12–1.24)	1.17 (1.11–1.23)	1.14 (1.08–1.20)
HIV/AIDS	1.19 (1.12–1.27)	2.37 (2.21–2.54)	2.33 (2.18-2.50)	2.31 (2.16–2.47)	2.26 (2.11–2.43)
Obesity	1.91 (1.51–2.43)	2.27 (1.73–2.99)	2.11 (1.59-2.79)	2.06 (1.53–2.79)	1.87 (1.37–2.54)

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[1] Correspondence: Thais Piazza Av. Professor Alfredo Balena, 190 30130-100 - Santa Efigênia Belo Horizonte, MG, Brasil E-mail: piazzathais@gmail.com