Hospital-Manifested SARS-CoV-2 Infection in Brazil: Clinical Characteristics, Outcomes and Risk Factors for Mortality

Background: Some patients manifest COVID-19 symptoms while admitted for other reasons. Thus, we aimed to analyze clinical characteristics and outcomes of patients who developed COVID-19 symptoms during hospitalization when compared to those of patients hospitalized due to COVID-19; and to evaluate the risk factors related to mortality in the first population.Methods: This retrospective study included adult COVID-19 patients, hospitalized between March/2020 and September/2020. Demographic data, clinical characteristics and outcomes were extracted from medical records. Patients who manifested in-hospital COVID-19 (study group) and those who were admitted due to COVID-19 (control group) were matched by propensity score model. Logistic regression models were used to verify the risk factors for mortality, in the study group.Findings: Among 7,710 patients, 7·2% developed COVID-19 symptoms while admitted for other reasons. The most common causes of hospitalization were cardiovascular diseases (20·0%), and propaedeutics (19·5). The study group had a higher prevalence of alcoholism (8·8% vs. 2·8%), chronic renal disease (3·5% vs. 1·7%), and cancer (19·2% vs. 10·8%) when compared to controls (p<0·05 for all), as well as a higher rate of intensive care unit requirement (45·1% vs. 35·2%), sepsis (23·8% vs 14·5%), and death (35·8% vs. 22·5%), respectively (p<0·05 for all). The factors independently associated with increased mortality in the study group were increasing age, male sex, number of comorbidities and cancer.Interpretation: COVID-19 in-hospital manifestation was associated with worse outcomes. Older age, male sex, number of comorbidities, and cancer were independent risk factors for mortality.Funding Information: This study was supported in part by Minas Gerais State Agency for Research and Development (Fundação de Amparo à Pesquisa do Estado de Minas Gerais - FAPEMIG) [grant number APQ-01154-21], National Institute of Science and Technology for Health Technology Assessment (Instituto de Avaliação de Tecnologias em Saúde – IATS)/ National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq) [grant number 465518/2014-1], and CAPES Foundation (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) [grant number 88887.507149/2020-00]. Declaration of Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.Ethics Approval Statement: The study protocol was approved by the National Commission for Research Ethics (CAAE: 30350820.5.1001.0008).