• Maira Viana Rego Souza-Silva, Patricia Klarmann Ziegelmann, Vandack Nobre, Virginia Mara Reis Gomes, Ana Paula Beck da Silva Etges, Alexandre Vargas Schwarzbold, Aline Gabrielle Sousa Nunes, Amanda de Oliveira Maurílio, Ana Luiza Bahia Alves Scotton, André Soares de Moura Costa, Andressa Barreto Glaeser, Bárbara Lopes Farace, Bruno Nunes Ribeiro, Carolina Marques Ramos, Christiane Corrêa Rodrigues Cimini, Cíntia Alcantara de Carvalho, Claudete Rempel, Daniel Vitório Silveira, Daniela Dos Reis Carazai, Daniela Ponce, Elayne Crestani Pereira, Emanuele Marianne Souza Kroger, Euler Roberto Fernandes Manenti, Evelin Paola de Almeida Cenci, Fernanda Barbosa Lucas, Fernanda Costa Dos Santos, Fernando Anschau, Fernando Antonio Botoni, Fernando Graça Aranha, Filipe Carrilho de Aguiar, Frederico Bartolazzi, Gabriela Petry Crestani, Giovanna Grunewald Vietta, Guilherme Fagundes Nascimento, Helena Carolina Noal, Helena Duani, Heloisa Reniers Vianna, Henrique Cerqueira Guimarães, Joice Coutinho de Alvarenga, José Miguel Chatkin, Júlia Drumond Parreiras de Morais, Juliana da Silva Nogueira Carvalho, Juliana Machado Rugolo, Karen Brasil Ruschel, Lara de Barros Wanderley Gomes, Leonardo Seixas de Oliveira, Liege Barella Zandoná, Lílian Santos Pinheiro, Liliane Souto Pacheco, Luanna da Silva Monteiro Menezes, Lucas de Deus Sousa, Luis Cesar Souto de Moura, Luisa Elem Almeida Santos, Luiz Antonio Nasi, Máderson Alvares de Souza Cabral, Maiara Anschau Floriani, Maíra Dias Souza, Marcelo Carneiro, Mariana Frizzo de Godoy, Marilia Mastrocolla de Almeida Cardoso, Matheus Carvalho Alves Nogueira, Mauro Oscar Soares de Souza Lima, Meire Pereira de Figueiredo, Milton Henriques Guimarães-Júnior, Natália da Cunha Severino Sampaio, Neimy Ramos de Oliveira, Pedro Guido Soares Andrade, Pedro Ledic Assaf, Petrônio José de Lima Martelli, Raphael Castro Martins, Reginaldo Aparecido Valacio, Roberta Pozza, Rochele Mosmann Menezes, Rodolfo Lucas Silva Mourato, Roger Mendes de Abreu, Rufino de Freitas Silva, Saionara Cristina Francisco, Silvana Mangeon Mereilles Guimarães, Silvia Ferreira Araújo, Talita Fischer Oliveira, Tatiana Kurtz, Tatiani Oliveira Fereguetti, Thainara Conceição de Oliveira, Yara Cristina Neves Marques Barbosa Ribeiro, Yuri Carlotto Ramires, Carísi Anne Polanczyk, and Milena Soriano Marcolino.
• Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, sala 246, Belo Horizonte, Minas Gerais, Brazil. mairavsouza@gmail.com.
• Intern Emerg Med. 2022 Nov 1; 17 (8): 229923132299-2313.

AbstractThe COVID-19 pandemic caused unprecedented pressure over health care systems worldwide. Hospital-level data that may influence the prognosis in COVID-19 patients still needs to be better investigated. Therefore, this study analyzed regional socioeconomic, hospital, and intensive care units (ICU) characteristics associated with in-hospital mortality in COVID-19 patients admitted to Brazilian institutions. This multicenter retrospective cohort study is part of the Brazilian COVID-19 Registry. We enrolled patients ≥ 18 years old with laboratory-confirmed COVID-19 admitted to the participating hospitals from March to September 2020. Patients' data were obtained through hospital records. Hospitals' data were collected through forms filled in loco and through open national databases. Generalized linear mixed models with logit link function were used for pooling mortality and to assess the association between hospital characteristics and mortality estimates. We built two models, one tested general hospital characteristics while the other tested ICU characteristics. All analyses were adjusted for the proportion of high-risk patients at admission. Thirty-one hospitals were included. The mean number of beds was 320.4 ± 186.6. These hospitals had eligible 6556 COVID-19 admissions during the study period. Estimated in-hospital mortality ranged from 9.0 to 48.0%. The first model included all 31 hospitals and showed that a private source of funding (β = - 0.37; 95% CI - 0.71 to - 0.04; p = 0.029) and location in areas with a high gross domestic product (GDP) per capita (β = - 0.40; 95% CI - 0.72 to - 0.08; p = 0.014) were independently associated with a lower mortality. The second model included 23 hospitals and showed that hospitals with an ICU work shift composed of more than 50% of intensivists (β = - 0.59; 95% CI - 0.98 to - 0.20; p = 0.003) had lower mortality while hospitals with a higher proportion of less experienced medical professionals had higher mortality (β = 0.40; 95% CI 0.11-0.68; p = 0.006). The impact of those association increased according to the proportion of high-risk patients at admission. In-hospital mortality varied significantly among Brazilian hospitals. Private-funded hospitals and those located in municipalities with a high GDP had a lower mortality. When analyzing ICU-specific characteristics, hospitals with more experienced ICU teams had a reduced mortality.© 2022. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).

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