Comorbidities and in-hospital death of viral pneumonia adults admitted to SUS (2002–2015)

ABSTRACT OBJECTIVE To identify demographic and clinical characteristics of adult patients hospitalized in the Brazilian Unified Health System (SUS) due to viral pneumonia and investigate the association between some comorbidities and death during hospitalization. METHODS This retrospective cohort study was conducted with secondary data of adults admitted to SUS due to viral pneumonia between 2002 and 2015. Patient profile was characterized based on demographic and clinical variables. The association between the ten Elixhauser comorbidities and in-hospital death was investigated using Poisson regression models with robust standard errors. Results were quantified as incidence rate ratio (IRR) with 95% confidence intervals (CI), and we built five models using successive inclusion of variables blocks. RESULTS Hospital admissions for viral pneumonias decreased throughout the study period, and it was observed that 5.8% of hospitalized patients had an in-hospital death. We observed significant differences in demographic and clinical characteristics by comparing individuals who died during hospitalization with those who did not, with the occurrence of one or more comorbidities being more expressive among patients who died. Although not considered risk factors for in-hospital death, chronic pulmonary disease and congestive heart failure were the most common comorbidities. Conversely, IRR for in-hospital death increased with other neurological disorders, diabetes, cancer, obesity, and especially with HIV/AIDS. CONCLUSIONS Individuals presenting with pulmonary and cardiovascular diseases require proper attention during hospitalization, as well as those with other neurological diseases, diabetes, cancer, obesity, and especially HIV/AIDS. Understanding the influence of chronic diseases on viral infections may support the healthcare system in achieving better outcomes.

摘要
研究目的：本研究旨在明确因病毒性肺炎入住巴西统一健康系统（SUS）的成年患者的人口学与临床特征，并探讨部分合并症与住院期间死亡的关联。
研究方法：本研究为回顾性队列研究，采用2002至2015年间因病毒性肺炎入住SUS的成年患者的二手数据开展分析。基于人口学与临床变量对患者特征进行描述。采用带有稳健标准误的泊松回归模型，探讨10种埃莱克豪瑟合并症（Elixhauser comorbidities）与住院死亡的关联。研究结果以发病率比（IRR）及95%置信区间（CI）进行量化，并通过逐步纳入变量模块构建了5个回归模型。
研究结果：研究期间，病毒性肺炎的住院收治量呈下降趋势，且观察到5.8%的住院患者发生住院死亡。对比住院期间死亡患者与存活患者的人口学及临床特征，可见二者存在显著差异，死亡患者中合并1种及以上基础疾病的比例更高。尽管慢性肺部疾病与充血性心力衰竭未被视为住院死亡的危险因素，但却是最常见的合并症。与之相反，合并其他神经系统疾病、糖尿病、癌症、肥胖，尤其是人类免疫缺陷病毒/获得性免疫缺陷综合征（HIV/AIDS）时，住院死亡的发病率比（IRR）会升高。
研究结论：合并肺部与心血管疾病的患者，以及合并其他神经系统疾病、糖尿病、癌症、肥胖，尤其是HIV/AIDS的患者，在住院期间需得到充分关注。明确慢性疾病对病毒感染的影响，可为医疗系统优化诊疗结局提供支持。