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

Abstract

Background: Many countries are experiencing outbreaks of the second wave of COVID-19 infection. With these outbreaks, the severity of the disease is still ambiguously projected. Certain inflammatory markers are known to be associated with the severity of the disease and regular monitoring of these biomarkers in intensive care unit admissions is paramount to improve clinical outcomes. Objectives: This study was aimed to compare the severity markers of the patients infected during the first wave versus the second wave in an intensive care unit. Methods: We conducted a retrospective study obtaining patient's data from hospital records, admitted during the first wave in March-May 2020, and compared the data with those COVID-19 patients admitted during the second wave from October-November 2020. A descriptive comparison was done among the patients admitted to intensive care unit (ICU) during both waves of the pandemic. Results: 92 patients from first wave and 68 patients from second wave were included in the analysis, all admitted to ICU with equal gender distribution. Increased age and length of ICU stay was observed during the first wave. BMI, in-hospital mortality and invasive ventilation were statistically indifferent between both the waves. There was significantly higher APACHE-II during first wave (p = 0.007), but SOFA at day 1 (p = 0.213) and day 7 of ICU stay remain indifferent (p = 0.119). Inflammatory markers were less severe during second wave while only neutrophils and lymphocytes were found to peak higher. Conclusion: Most of the severity markers were less intense during the early analysis of second wave.

Comparison of Hematological and Inflammatory Markers to Predict Outcome in Covid-19 in 1st and 4th Wave

“…While most of these hematological markers predicting severity in the first wave were less remarkable in the 4 th wave. Similar findings have been reported by Asghar MS et al 13 comparing the first and second waves. Another study in Spain reported the predictive accuracy of severity and mortality for 6 hematological markers ( NLR, CRP, LDH and ferritin, d-dimer and interleukin 6) in the first wave was 84% with an Area under the curve of 0.84. when the signature was validated for the 2 nd and third waves, the accuracy was 83%, with an AUC of 0.78.…”

“…12 A study from Karachi reported ICU admission due to Covid-19 with increased age and hospital stay st nd during the first wave. 13 Regarding the hematological markers, a statistically significant difference exists between the groups (1 vs 4 th wave) regarding; higher neutrophil to lymphocyte ratio (NLR) (p=0.02), Absolute Neutrophilic count (ANC) (p=0.01) and platelet count (p=0.001) were noted in the first wave. While most of these hematological markers predicting severity in the first wave were less remarkable in the 4 th wave.…”

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

“…In contrast, an ICU-based study from Pakistan showed that patients admitted during the second wave were older (65±18.5 years) when compared with the first wave (56±19 years). 14 A secondary analysis of more than 0.5 million RT-PCR tests conducted in a laboratory in North India in Uttar Pradesh reported an overall lower mean age, but again with an older mean age in the second wave (46.1±16.8 years) compared with the first (35.1±15.9 years). 15 In South Africa, where the peaks of the first two waves preceded the waves in India by 2 months, a similar pattern of a higher age was noted among hospitalised patients during the second wave.…”

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

“…[ 37 ] While, we reported previously in our comparison of waves that similar rises in serum urea levels were observed during both waves, while peak levels were attained early in the second wave, despite creatinine was deranged equally in both waves. [ 38 ] Coming to laboratory derangements, Ghosn and his colleagues did not find an association between inflammatory (interleukin-6, C-reactive protein, and ferritin) or thrombotic (D-dimer and fibrinogen) markers with severe AKI after adjustment for potential confounders. [ 39 ] In another analysis, there was a significant relationship between the KDIGO AKI classification stage and serum levels of ferritin, interleukin-6, and procalcitonin.…”