Changes in severity, mortality, and virus genome among a Spanish cohort of patients hospitalized with SARS-CoV-2

Abstract

Comparing pandemic waves could aid in understanding the evolution of COVID-19. The objective of the present study was to compare the characteristics and outcomes of patients hospitalized for COVID-19 in different pandemic waves in terms of severity and mortality. We performed an observational retrospective cohort study of 5,220 patients hospitalized with SARS-CoV-2 infection from February to September 2020 in Aragon, Spain. We compared ICU admissions and 30-day mortality, clinical characteristics, and risk factors of the first and second waves of COVID-19. The SARS-CoV-2 genome was also analyzed in 236 samples. Patients in the first wave (n = 2,547) were older (median age 74 years [IQR 60–86] vs. 70 years [53–85]; p < 0.001) and had worse clinical and analytical parameters related to severe COVID-19 than patients in the second wave (n = 2,673). The probability of ICU admission at 30 days was 16% and 10% (p < 0.001) and the cumulative 30-day mortality rates 38% and 32% in the first and second wave, respectively (p = 0.007). Survival differences were observed among patients aged 60 to 80 years. We also found some variability among death risk factors and the viral genome between waves. Therefore, the two analyzed COVID-19 pandemic waves were different in terms of disease severity and mortality.

Temporal trends in hospitalizations and 30-day mortality in older patients during the COVID pandemic from March 2020 to July 2021

“…12 A Spanish study reported that COVID-19 patients in the first wave were older, with more comorbidities and higher mortality than in the second wave. 13 However, information is missing on mortality trends later in the pandemic, trends in older population and in geriatric patients with diagnoses other than COVID-19.…”

How intensive care has adapted to the changing face of COVID ‐19 in Australia

“…In contrast, overseas reports on ICU care and outcomes have been retrospective analyses and chiefly focused on the first two waves or combined waves. 6 , 7 Their report suggests that the most recent recommendations by the National COVID‐19 Clinical Evidence Taskforce 8 have been widely implemented. The authors derived ICU demand patterns from another collaborative large data project, CHRIS (Critical Health Resource Information System), a real‐time national ICU capacity database that, like the SPRINT‐SARI database, relies on daily updates by local ICU staff.…”

“…The finding by Begum and her co‐authors 3 that risk‐adjusted in‐hospital mortality was highest during the third wave is concerning; it had generally been lower during the second than the first wave. 2 , 6 The impact of adopting beneficial treatments identified by clinical trials needs to be examined in more detail, to determine, for example, the appropriate use of prone ventilation or the optimal steroid dose. A recent multinational randomised controlled trial found that 12 mg dexamethasone may be more beneficial than the typically employed 6 mg dose.…”

“…SARS‐CoV‐2 will not rest in its evolution, and nor should we. The finding by Begum and her co‐authors 3 that risk‐adjusted in‐hospital mortality was highest during the third wave is concerning; it had generally been lower during the second than the first wave 2,6 . The impact of adopting beneficial treatments identified by clinical trials needs to be examined in more detail, to determine, for example, the appropriate use of prone ventilation or the optimal steroid dose.…”

“…The study by Begum and colleagues 3 was strengthened by its prospective collection of data from ICUs across Australia and the separate analyses of the three waves. In contrast, overseas reports on ICU care and outcomes have been retrospective analyses and chiefly focused on the first two waves or combined waves 6,7 . Their report suggests that the most recent recommendations by the National COVID‐19 Clinical Evidence Taskforce 8 have been widely implemented.…”