Mortalidade, sintomas persistentes e excesso de peso após a alta hospitalar por covid-19

Abstract

Although a wide range of studies on clinical manifestations, lethality, and risk factors associated with Covid-19, little is still known about the long-term functional sequelae beyond the evolution to death after the hospitalization period. Objective: To analyze persistent symptoms of Covid-19 according to excess weight and factors associated with mortality after hospital discharge. Methods: This is a two-way cohort study with a 12-month follow-up, with one of the manuscripts of this dissertation conducted with a retrospective phase. Patients hospitalized for Covid-19 and discharged between October 2021 and March 2022 in Cuiabá had their data collected from medical records and were interviewed by phone after 6 and 12 months post-hospital discharge. To identify excess weight, the Body Mass Index (BMI) was used, calculated by dividing the body weight (kg) by the square of the height (m) at the time of admission, obtained from the medical records, and classified according to the World Health Organization as normal weight, overweight, and obesity. Sociodemographic and economic characteristics, as well as hospitalization and health-related characteristics, were assessed, and the symptom class was constructed from the literature. Analyses were performed using Stata software, version 16. Variables were described using absolute and relative frequencies, chisquare test, Fisher's exact test, and ANOVA. For the assessment of the risk of death after hospital discharge, only medical record information was considered. Deaths were identified through the Mortality Information System by the Municipal Health Department of Cuiabá. Variables were described using absolute and relative frequencies, mean, and standard deviation. Mortality after hospital discharge was calculated in relation to the total number of hospitalized patients and the follow-up time, both multiplied by 100. The risk ratio (RR) and its 95% CI were estimated using the Poisson regression model with the logarithm of the follow-up time. The follow-up time was defined as the time elapsed between the date of hospital discharge and the date of the interview or death, considered in months. Results: In the first manuscript, it was found that 42.0% were classified as overweight, and 28.7% were obese at the time of admission. The persistence of 3 or more symptoms was 36.1% at 6 months and 10.6% after 12 months of hospitalization, with no significant difference according to BMI classification. Regarding deaths, evaluated in the second manuscript, a higher proportion of deaths was observed among adults up to two months after discharge (57.1%) and among the elderly after 7 months. There was a higher risk of death with increasing age among the elderly group (RR: 1.07; 95% CI: 1.01;1.12). Conclusion: Although there was no significant difference in the proportion of patients with persistent symptoms according to BMI classification, a significant proportion simultaneously presented muscle and neuropsychiatric symptoms after 6 and 12 months among those overweight and obese. Furthermore, it was found that age was a risk factor for death after the acute phase of Covid-19; however, among adults, the severity of the disease in the acute phase seems to be the main determinant.