Comparison of first and second waves of COVID-19 through severity markers in ICU patients of a developing country

Analysis of six consecutive waves of ICU-admitted COVID-19 patients: key findings and insights from a Portuguese population

Identifying high-risk patients, particularly in intensive care units (ICUs), enhances treatment and reduces severe outcomes. Since the pandemic, numerous studies have examined COVID-19 patient profiles and factors linked to increased mortality. Despite six pandemic waves, to the best of our knowledge, there is no extensive comparative analysis of patients' characteristics across these waves in Portugal. Thus, we aimed to analyze the demographic and clinical features of 1041 COVID-19 patients admitted to an ICU and their relationship with the different SARS-Cov-2 variants in Portugal. Additionally, we conducted an in-depth examination of factors contributing to early and late mortality by analyzing clinical data and laboratory results from the first 72 h of ICU admission. Our findings revealed a notable decline in ICU admissions due to COVID-19, with the highest mortality rates observed during the second and third waves. Furthermore, immunization could have significantly contributed to the reduction in the median age of ICU-admitted patients and the severity of their conditions. The factors contributing to early and late mortality differed. Age, wave number, D-dimers, and procalcitonin were independently associated with the risk of early death. As a measure of discriminative power for the derived multivariable model, an AUC of 0.825 (p < 0.001; 95% CI, 0.719-0.931) was obtained. For late mortality, a model incorporating age, wave number, hematologic cancer, C-reactive protein, lactate dehydrogenase, and platelet counts resulted in an AUC of 0.795 (p < 0.001; 95% CI, 0.759-0.831). These findings underscore the importance of conducting comprehensive analyses across pandemic waves to better understand the dynamics of COVID-19.

Quantitative Chest CT Analysis: Three Different Approaches to Quantify the Burden of Viral Interstitial Pneumonia Using COVID-19 as a Paradigm

Objectives: To investigate the relationship between COVID-19 pneumonia outcomes and three chest CT analysis approaches. Methods: Patients with COVID-19 pneumonia who underwent chest CT were included and divided into survivors/non-survivors and intubated/not-intubated. Chest CTs were analyzed through a (1) Total Severity Score visually quantified by an emergency (TSS1) and a thoracic radiologist (TSS2); (2) density mask technique quantifying normal parenchyma (DM_Norm 1) and ground glass opacities (DM_GGO1) repeated after the manual delineation of consolidations (DM_Norm2, DM_GGO2, DM_Consolidation); (3) texture analysis quantifying normal parenchyma (TA_Norm) and interstitial lung disease (TA_ILD). Association with outcomes was assessed through Chi-square and the Mann-Whitney test. The TSS inter-reader variability was assessed through intraclass correlation coefficient (ICC) and Bland-Altman analysis. The relationship between quantitative variables and outcomes was investigated through multivariate logistic regression analysis. Variables correlation was investigated using Spearman analysis. Results: Overall, 192 patients (mean age, 66.8 ± 15.4 years) were included. TSS was significantly higher in intubated patients but only TSS1 in survivors. TSS presented an ICC of 0.83 (0.76; 0.88) and a bias (LOA) of 1.55 (-4.69, 7.78). DM_Consolidation showed the greatest median difference between survivors/not survivors (p = 0.002). The strongest independent predictor for mortality was DM_Consolidation (AUC 0.688), while the strongest independent predictor for the intensity of care was TSS2 (0.7498). DM_Norm 2 was the singular feature independently associated with both the outcomes. DM_GGO1 strongly correlated with TA_ILD (ρ = 0.977). Conclusions: The DM technique and TA achieved consistent measurements and a better correlation with patient outcomes.

Impact of Vitamin D Therapy on C-Reactive Protein, Ferritin, and IL-6 Levels in Hospitalised Covid-19 Patients

Vitamin D insufficiency is associated with poor prognosis in COVID-19 patients. Vitamin D supplementation is related to improved clinical outcomes in terms of intensive care unit admission and death, particularly in individuals with moderate-to-severe forms of COVID-19. The placebo-controlled five-day study was performed on 99 hospitalised COVID-19 patients with vitamin D insufficiency randomised into two groups. Vitamin D in the form of a sublingual sprayable microemulsion was given three times daily (daily dose 12,000 IU) to 51 patients with blood 25(OH)D levels below 30 ng/ml. Forty-eight patients in the control group received a placebo spray in the same daily regimen. Intention-to-treat (ITT) analysis and pre-protocol analysis were used to verify the impact of 25(OH)D level elevation on inflammatory markers. There was a statistically significant increase by 8.7 ± 7.6 ng/ml in 25(OH)D level from the baseline level of 15.6 ± 6.5 ng/ml in the case group. Individuals with moderately severe disease showed negative correlation between changes in 25(OH)D and C-reactive protein (CRP) levels in both ITT and pre-protocol analysis (p < 0.05). Mild and severe cases showed no statistical significance in CRP levels. There were no statistically significant changes in ferritin and IL-6 levels in ITT and pre-protocol analysis. In conclusion, high-dose vitamin D therapy was accompanied by significant decrease in CRP levels in COVID-19 patients with a moderate to severe illness.

Outcomes of COVID-19 patients with acute kidney injury and longitudinal analysis of laboratory markers during the hospital stay: A multi-center retrospective cohort experience from Pakistan

The frequency of acute kidney injury (AKI) in COVID-19 patients can be varied and related to worse outcomes in the disease population. AKI is common among hospitalized patients with COVID-19, particularly the ones needing critical care. This study was conducted in order to determine the outcomes of hospitalized patients with prolonged hospital stays who suffered from COVID-19 associated AKI. It was conducted as a multi-centered, retrospective, cohort study, and including all patients who were diagnosed on COVID-19 PCR. End-stage renal disease patients on hemodialysis were excluded. The cohort included 1069 patients, with 68% males, mean age of 56.21 years, and majority within 50 to 75 years age group (60%). Mean disease onset was 14.43 ± 7.44 days and hospital stay was 7.01 ± 5.78 days. About 62% of patients stayed in intensive care and 18% of them were on invasive ventilation. The mortality rate was 27%. Frequency of AKI was 42%, around 14% of them were resolving during hospital stay and other 28% worsened. The mortality rate was significantly higher with AKI (OR: 4.7, P < .001). Alongside AKI, concomitant liver dysfunction was also significantly contributing to mortality (OR: 2.5), apart from ICU stay (OR: 2.9), invasive ventilation (OR: 9.2), and renal replacement therapy (OR: 2.4). Certain laboratory markers were associated with AKI throughout in-hospital stay.

Retrospective study of comparison of clinical severity and outcome of hospitalised COVID-19 patients during the first and second waves of the pandemic in India

OBJECTIVES

To compare the clinical severity and outcome of hospitalised patients during the two waves of the COVID-19 pandemic in India.

SETTING

A tertiary care referral hospital in South India.

PARTICIPANTS

Symptomatic SARS CoV-2 reverse transcriptase PCR positive patients presenting to the emergency department during the two waves were recruited. The first wave spanned between April and December 2020 and the second wave between April and May 2021.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome of interest was mortality. Secondary outcomes included illness severity at presentation, need for oxygen therapy, non-invasive ventilation (NIV) and hospital or intensive care unit admission.

RESULTS

The mean (SD) age of the 4971 hospitalised patients in the first wave was similar to the 2293 patients in the second wave (52.5±15.4 vs 52.1±15.1 years, p=0.37). When compared with the first wave, during the second wave, a higher proportion of patients presented with critical illness (11% vs 1.1%, p<0.001) and needed supplemental oxygen therapy (n=2092: 42.1% vs n=1459: 63.6%; p<0.001), NIV (n=643; 12.9% vs n=709; 30.9%; p<0.001) or inotropes/vasoactive drugs (n=108; 2.2% vs n=77: 3.4%; p=0.004). Mortality was higher during the second wave (19.2% vs 9.3%; p<0.001). On multivariable regression analysis, age >60 years (risk ratio, RR 2.80; 95% CI 2.12 to 3.70), D-dimer >1000 ng/mL (RR 1.34; 95% CI 1.15 to 1.55), treatment with supplemental oxygen (RR 14.6; 95% CI 8.98 to 23.6) and presentation during the second wave (RR 1.40; 95% CI 1.21 to 1.62) were independently associated with mortality.

CONCLUSION

The second wave of the COVID-19 pandemic in India appeared to be associated with more severe presentation and higher mortality when compared with the first wave. Increasing age, elevated D-dimer levels and treatment with supplemental oxygen were independent predictors of mortality.

Clinical Presentation and Outcome of Hospitalized Patients With COVID-19 in the First and Second Waves in Saudi Arabia

Introduction

The world had witnessed the occurrence of multiple waves of the SARS-CoV-2. Data comparing the clinical characteristics and outcomes of hospitalized patients in Saudi Arabia during the first and second waves are lacking. This study compares the characteristics and the outcomes of patients in these 2 waves.

Methods

This is a retrospective case series of hospitalized patients with confirmed SARS-CoV-2. We compared epidemiological, demographic, laboratory, and clinical data.

Results

The study included hospitalized patients admitted up to February 28, 2021 as the first wave and those admitted from March 1, 2021 as the second wave. There were 378 patients in the first wave and 241 patients in the second wave. Patients in the first wave were significantly younger (mean age and SD of 47.5 ± 20 vs 55.3 ± 18.2 years; p <0.001). In relation to symptoms, shortness of breath, wheezes, myalgia, tachypnea, and respiratory distress were significantly more common in the second wave than the first wave. On the other hand, sore throat was more common in the first wave than the second wave. Patients in the second wave had higher mean values of lymphocytes count, platelet counts, and ALT than those in the first wave. Patients in the first wave were more likely to receive antibiotics and antiviral therapy and had higher death rate (16.2% vs 8.4%; p = 0.001).

Conclusion

The study showed that patients in the second wave were younger and had a lower rate of death than the first wave.