• Bruna Cuoco Provenzano, Thiago Bartholo, Marcelo Ribeiro-Alves, Ana Paula Gomes Dos Santos, Thiago Thomaz Mafort, Marcos Cesar Santos de Castro, Jose Gustavo Pugliese de Oliveira, Leonardo Palermo Bruno, Agnaldo José Lopes, Claudia Henrique da Costa, and Rogerio Rufino.
• Universidade do Estado do Rio de Janeiro, Department of Pneumology and Tisiology - Rio de Janeiro (RJ), Brazil.
• Rev Assoc Med Bras (1992). 2021 Jul 1; 67 (7): 997-1002.

ObjectiveThis study aims to analyze the risk factors for in-hospital mortality in a cohort of patients admitted to a newly adapted intensive care unit in a public hospital in Rio de Janeiro.MethodsThis was an observational, retrospective, and descriptive study. Data were obtained from electronic medical records. Coronavirus disease 2019 (COVID-19) was diagnosed by detecting viral ribonucleic acid using reverse transcription polymerase chain reaction. Factors associated with the risk/protection from death were determined using the odds ratio and adjusted odds ratio.ResultsFifty-one patients were admitted to the hospital. The median age of the patients was 63 years, 60% were male patients, and 54% were white patients. Sixty-seven percent of the patients were diagnosed with COVID-19. Sepsis at admission increased the chance of in-hospital death by 21 times (adjusted odds ratio=21.06 [0.79-555.2]; p=0.06). The strongest risk factor for death was the development of septic shock during hospitalization (adjusted odds ratio=98.56 [2.75-352.5]; p=0.01), and one in four patients had multidrug-resistant bacteria. Mechanical ventilation, vasopressors, neuromuscular blockers, and sedatives were also the risk factors for in-hospital mortality. The in-hospital mortality rate was 41%, and the mortality rate of patients on mechanical ventilation was 60%. The diagnosis of COVID-19 was not statistically related to the adverse outcomes.ConclusionsIn this cohort, the strongest risk factor for in-hospital death was the development of nosocomial septic shock. Healthcare-associated infections have a significant impact on mortality rates. Therefore, to have a better outcome, it is important to consider not only the availability of beds but also the way healthcare is delivered.

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