Abstract
Data from the general population suggest that fatality rates declined during the course of the pandemic. This analysis, using data extracted from the Brazilian Kidney Transplant COVID-19 Registry, seeks to determine fatality rates over time since the index case on March 3rd, 2020. Data from hospitalized patients with RT-PCR positive SARS-CoV-2 infection from March to August 2020 (35 sites, 878 patients) were compared using trend tests according to quartiles (Q1: <72 days; Q2: 72–104 days; Q3: 105–140 days; Q4: >140 days after the index case). The 28-day fatality decreased from 29.5% (Q1) to 18.8% (Q4) (p for-trend = 0.004). In multivariable analysis, patients diagnosed in Q4 showed a 35% reduced risk of death. The trend of reducing fatality was associated with a lower number of comorbidities (20.7–10.6%, p for-trend = 0.002), younger age (55–53 years, p for-trend = 0.062), and better baseline renal function (43.6–47.7 ml/min/1.73 m2, p for-trend = 0.060), and were confirmed by multivariable analysis. The proportion of patients presenting dyspnea (p for-trend = 0.001) and hypoxemia (p for-trend < 0.001) at diagnosis, and requiring intensive care was also found reduced (p for-trend = 0.038). Despite possible confounding variables and time-dependent sampling differences, we conclude that COVID-19-associated fatality decreased over time. Differences in demographics, clinical presentation, and treatment options might be involved.
Highlights
Over the past year, the coronavirus disease 2019 (COVID-19) global pandemic has been responsible for more than 126 million cases of severe acute respiratory syndrome worldwide and over 2.76 million deaths
We extracted data of patients with COVID-19-related signs and symptoms and SARS-CoV-2 detected by reversetranscription polymerase chain reaction (RT-PCR) of a respiratory sample, between 3rd March and 31st August 2020, who required hospitalization, totalizing 878 patients from 35 transplant centers of four Brazilian Regions (615 from the Southeast, 124 Northeast, 111 South, and 28 from the Midwest)
We considered as the index case the first kidney transplant (KT) patient diagnosed with COVID-19 and included in the Brazilian Kidney Transplant COVID-19 Registry (March 3rd, 2020)
Summary
The coronavirus disease 2019 (COVID-19) global pandemic has been responsible for more than 126 million cases of severe acute respiratory syndrome worldwide and over 2.76 million deaths. To date there is still no specific treatment for COVID19, several pharmacological and non-pharmacological strategies have been explored to improve the clinical outcomes Among these strategies, the following are noteworthy: 1) the use of prehospital pulse oximetry to early detect silent hypoxemia (4); 2) the important role of non-invasive mechanical ventilation often avoiding unnecessary early intubation (5); 3) prone position to improve oxygenation in intubated and non-intubated patients with COVID-19-related acute respiratory distress syndrome (6, 7); 4) anticoagulant treatment in patients with coagulopathy (8); and 5) corticosteroids in patients with severe disease (9). Multicenter national studies have reported COVID-19-related fatality rates varying from 20.5 to 32% among hospitalized kidney transplant (KT) patients (14–18), but no study evaluated the impact of the timing on deaths in this population
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