Comparison of the clinical presentation across two waves of COVID-19: a retrospective cohort study

Abstract

Background Only a few studies have performed comprehensive comparisons between hospitalized patients from different waves of COVID-19. Thus, we aimed to compare the clinical characteristics and laboratory data of patients admitted to the western part of Denmark during the first and second waves of COVID-19 in 2020. Furthermore, we aimed to identify risk factors for critical COVID-19 disease and to describe the available information on the sources of infection. Methods We performed a retrospective study of medical records from 311 consecutive hospitalized patients, 157 patients from wave 1 and 154 patients from wave 2. The period from March 7 to June 30, 2020, was considered wave 1, and the period from July 1st to December 31, 2020, was considered wave 2. Data are presented as the total study population, as a comparison between waves 1 and 2, and as a comparison between patients with and without critical COVID-19 disease (nonsurvivors and patients admitted to the intensive care unit (ICU)). Results Patients admitted during the first COVID-19 wave experienced a more severe course of disease than patients admitted during wave 2. Admissions to the ICU and fatal disease were significantly higher among patients admitted during wave 1 compared to wave 2. The percentage of patients infected at hospital decreased in wave 2 compared to wave 1, whereas more patients were infected at home during wave 2. We found no significant differences in sociodemographics, lifestyle information, or laboratory data in the comparison of patients from waves 1 and 2. However, age, sex, smoking status, comorbidities, fever, and dyspnea were identified as risk factors for critical COVID-19 disease. Furthermore, we observed significantly increased levels of C-reactive protein and creatinine, and lower hemoglobin levels among patients with critical disease. Conclusions At admission, patients were more severely ill during wave 1 than during wave 2, and the outcomes were worse during wave 1. We confirmed previously identified risk factors for critical COVID-19 disease. In addition, we found that most COVID-19 infections were acquired at home.

COVID-19 in Iran: clinical presentations and outcomes in three different surges of COVID-19 infection

“…In contrast, patients admitted during the first surge presented with lower oxygen saturation and higher temperature compared to surge 2 on admission according to Buttenshon et al study. However, similar to our reports they presented with lower SBP during surge one [ 17 ]. The SARS-CoV-2 virus can infect various organs using angiotensin-converting enzyme (ACE2) receptors to enter cells [ 20 ].…”

“…Underlying diseases are associated with a higher risk of severe COVID-19 and its complications [ 15 , 16 ]. In a study comparing two surges of COVID-19 pandemic showed that more than 80% of patients had at least one comorbidity with hypertension being the most common comorbidity similar to our results [ 17 ]. Vahidy et al reported that the number of COVID-19 hospitalized patients with hypertension was significantly higher during surge 1 of the COVID-19 pandemic in Houston, which is in alignment with our results [ 18 ].…”

“…Our patients differed significantly in neutrophil to lymphocyte ratio, Urea, CRP, and ESR with higher levels of these laboratory markers in surge 2. In contrast, several studies found higher CRP and creatinine levels in patients admitted during surge 1 compared to surge two which were associated with more critical diseases [ 17 , 23 ].…”

The effect of prescribing vitamin D analogues and serum vitamin D status on both contracting COVID‐19 and clinical outcomes in kidney dialysis patients'

“… 23 , 24 , 25 However, reviewing our data patients with more severe disease requiring hospital admission, these patients were older, with greater underlying comorbidity and frailty, and higher concentrations of markers of disease activity; CRP, ferritin, and NT‐proBNP, in keeping with other studies in nondialysis and dialysis patients. 26 , 27 , 28 , 29 We found that patients requiring acute hospital admission had marginally lower, but not significantly lower 25ViD levels, but had received similar dosages of alfacalcidol, but alfacalcidol dosages were lower in those who died with COVID‐19. However, on multivariate testing only comorbidity, and markers of inflammation; CRP and NT‐proBNP remained significantly associated with disease severity requiring hospital admission, similar to observational reports from nondialysis patients.…”

“…However, on multivariate testing only comorbidity, and markers of inflammation; CRP and NT‐proBNP remained significantly associated with disease severity requiring hospital admission, similar to observational reports from nondialysis patients. 26 , 27 , 28 …”