Caracterização clínica e sociodemográfica de casos de síndrome respiratória aguda grave nos municípios da 28ª Região de Saúde do Rio Grande do Sul.

Abstract

Introduction: In February 2020, the World Health Organization (WHO) named the disease from the new coronavirus of Covid-19. Understanding how it is possible to control and delay the spread of infectious diseases is a priority in the prevention of infectious diseases. Objective: To characterize clinical and sociodemographic variables and georeferencing reported SARS cases in the 28th Health Region. Manuscript I: Objective: To compare the clinical and sociodemographic aspects of patients with SARS reported in a region of Rio Grande do Sul between 2020 and 2021. Methods: Cross-sectional population-based study, carried out from March 2020 to October 2021. Clinical and sociodemographic variables of patients diagnosed with SARS were analyzed, where the groups were compared according to the year of notification. Descriptive and univariate analyzes were performed. Results: A total of 4,710 patients were reported with SARS in the study region, with 53.4% SARS due to Covid-19 in 2020 and 87.5% in 2021 (p<0.001). In the two analyzed periods, men were the majority (52.5% vs 53.8%), the most frequent age group was 50-89 years (69.1 vs 64.6), with elementary education (33.8 % vs 33.2%) and residents of urban areas (71.7% vs 73.6%). Regarding preexisting health conditions, in 2020 and 2021, most had cardiovascular disease (37.2% vs 25.0%). Regarding signs and symptoms, in 2020 O2 saturation <95% (80.2%) was the most reported, while dyspnea (83.5%) was the most frequent in 2021. Regarding hospitalization, most were admitted to hospital units (99.3% vs 98.2%), 27.4% were admitted to the ICU in 2020 and 23.6% in 2021 and required non-invasive ventilatory support (52.9% vs 69.6%), where 18.7% died in 2020 and 22.3% in 2021. Conclusion: In the studied period, it was observed that this study corroborates what has been described in the literature about older age, male sex and the presence of preexisting health conditions being factors associated with a worse prognosis of SARS by Covid-19. Manuscript II: Objective: To describe the epidemiological profile, identify the lethality and carry out a spatial analysis of cases hospitalized in hospitals and deaths from Covid-19 in the municipalities belonging to the 28th Health Region. Methods: Cross-sectional population-based study, using data from the SIVEP-Gripe, obtained from the local Epidemiological Surveillance from March 2020 to October 2021. Spatial analysis was performed using maps, using geoprocessing techniques. To estimate the odds of death, the odds ratio (OR) and its 95% confidence intervals were used. Results: 3,602 confirmed hospitalized cases and deaths of Covid-19 were included. As for preexisting health conditions, the presence of cardiovascular disease (OR=1.39 – 95%CI 1.17-1.66), diabetes mellitus (OR=1.49 - 95%CI 1.24-1.79) and obesity (OR=0.98 – 95%CI 0.80-1.21) were significantly associated with higher mortality. Regarding the most frequent signs and symptoms, most had a significant association with an increased chance of evolving death from Covid-19, having O2 saturation <95% (OR=5.25 - 95%CI 3.90-7.09), dyspnea (OR=2.49 - 95%CI 1.90-3.26) and respiratory distress (OR=3.28 - 95%CI 2.58-4.18). Regarding hospitalization characteristics, the use of ICU is related to greater chances of death (OR=5.92 – 95%CI 4.99-7.01) and the use of invasive ventilatory support was associated with 33.9 more chances of death. progress to death (95%CI 23.34-49.31). The Covid-19 incidence coefficient in the health macro-region was 1,015.0/100 thousand inhab, the mortality coefficient was 242.6/100 thousand inhab and the lethality was 23.9% until October 31 of 2021. Conclusions: The main factors associated with death were being male, being of advanced age, being white, having elementary education, being a resident of the urban area, presence of preexisting health conditions such as cardiovascular disease, having O2 saturation <95%, need for ICU admission need for invasive ventilatory support. The highest incidence rate was observed in the municipality of Santa Cruz do Sul. General conclusions: The sample consisted of 4,710 patients with SARS notification. Of these, 3,672 had SARS due to Covid-19, of which the outcome cure vs. death due to Covid-19 (3,602) were evaluated. The main factors associated with death were being male, being of advanced age, being white, having complete or incomplete elementary school, being a resident of the urban area. Among the most frequent pre-existing health conditions, cardiovascular disease, diabetes mellitus, pulmonary disease and obesity were observed, as well as having O2 saturation <95%, dyspnea and respiratory distress. The need for ICU admission and the need for invasive ventilatory support were more associated with death. The highest incidence rate was observed in the municipality of Santa Cruz do Sul, Rio Pardo had the highest mortality rate and Pantano Grande had the highest fatality rate.