Comparison of Patient Clinical characteristics and Outcomes Between Different COVID-19 Peak Periods: A Single Center Retrospective Propensity Matched Analysis

Abstract

IntroductionWhile Coronavirus disease 2019 (COVID-19) specific treatments have been instituted, overall mortality rates among hospitalized patients remain significant. Our study aimed to evaluate patient clinical characteristics and outcomes comparing the different COVID-19 infection peak periods. MethodsThis is a retrospective study of all adult patients hospitalized with a confirmed diagnosis of COVID-19 between March 1 to April 24, 2020 and November 1 to December 31, 2020, which corresponded to the first and second waves of COVID-19 infection in our institution, respectively. Demographic and clinical characteristics of the patients were compared and used for propensity matching. Clinical outcomes, such as need for intubation, renal replacement therapy and inpatient mortality were subsequently compared between the two groups. ResultsPatients in the second COVID-19 wave had a significantly higher body mass index (32.58 vs 29.83, p <0.001), as well as prevalence of asthma (14% vs 8%, p=0.019) and chronic kidney disease (42% vs 18%, p <0.001). Almost all patients in the second COVID-19 wave received corticosteroid treatment (99% vs 30%, p <0.001), and significantly more patients received remdesivir (43% vs 2%, p <0.001). Meanwhile, none of the patients in the second COVID-19 wave were treated with tocilizumab or hydroxychloroquine. Differences in clinical outcomes, such as need for renal replacement therapy or intubation, and median length of stay were not statistically significant. Inpatient mortality remained largely unchanged between the two COVID-19 peak periods. Discussion/ ConclusionIn our institution, after propensity matched analysis, clinical outcomes such as need for renal replacement therapy, intubation and inpatient mortality remained unchanged between the two COVID-19 peak periods.

Mortality comparison between the first and second/third waves among 3,795 critical COVID-19 patients with pneumonia admitted to the ICU: A multicentre retrospective cohort study

“…Most of these studies include case-mixes from the ward and critical care units, where the range of fatality rates is considerably different and thereby potential selection bias could be present. Contrary, other authors did not find differences in inpatient mortality after propensity score matching, remaining as high in the first as in the second wave [19] .…”

Comparison of demographic, clinical and laboratory characteristics between first and second COVID-19 waves in a secondary care hospital in Qatar: a retrospective study

“…When comparing comorbidities in both the waves, previous research have yielded conflicting outcomes. Iftimie et al 22 showed no significant differences in comorbidity between the two waves; however, Jarrett et al 24 and Sargin et al 25 identified a higher frequency of chronic kidney illness in the second wave than in the first wave.…”

“…Obesity was found in 30% of the whole study population in both waves, according to a study from Switzerland. 21 Another study from the USA 24 found that the second wave had a higher BMI than the first wave (32.58 vs 29.83).…”

A Practical Strategy for Exploring the Pharmacological Mechanism of Luteolin Against COVID-19/Asthma Comorbidity: Findings of System Pharmacology and Bioinformatics Analysis

“…Asthma patients with the persistence of impaired innate immune responses are more susceptible to releasing lower levels of INF during viral respiratory infections (8)(9)(10). Moreover, a cohort study finds that children with COVID-19/asthma comorbidity show more serious disease progression and a single-center retrospective propensity-matched analysis proves that patients infected with COVID-19 have a higher prevalence of asthma (11,12). In addition, a study recruiting 493,000 patients from the UK Biobank confirms that adults with asthma have a higher risk of suffering from COVID-19 and a nationwide cohort study performed by Koreans proves that asthma contributes to increased susceptibility to SARS-CoV-2 infection and poor prognosis of COVID-19 (13,14).…”

“…Jordan et al conduct a study incorporating 818,490 asthma patients that estimates the relationship between the fatality risk of COVID-19 and ICS treatment and find that ICS intervention may cause damage and suboptimal outcome to asthma/mild COVID-19 comorbidity patients (18). A recovery trial corrected that systemic glucocorticoid treatment for patients with mild COVID-19 increases the risk of death, and another study finds that treatment with glucocorticoid shows no clinical benefit for COVID-19-caused mild to moderate acute respiratory distress syndrome (11,19,20). The above results indicate that glucocorticoid for COVID-19/asthma comorbidity patients requires cautious interpretation, and thus, safer and more effective interventions or adjunctive interventions are likely to be afforded for such patients.…”