Trends of in-hospital and ICU mortality in COVID-19 patients over the fourth and fifth COVID-19 surges in Iran: a retrospective cohort study from Iran

Abstract

Background The current study aimed to investigate the temporal trend of in-hospital and ICU mortality of COVID-19 patients over 6 months in the spring and summer of 2021 in Iran. Methods We performed an observational retrospective cohort study on 14,355 patients who were hospitalized with confirmed COVID-19 for six months from April to September 2021 in Qazvin province, Iran. The trend of overall in-hospital mortality and ICU mortality were the main outcome of interest. We obtained crude and adjusted in-hospital and ICU mortality rates for each month of admission and over surge and lull periods of the disease. Results The overall in-hospital mortality, early mortality, and ICU mortality were 8.8%, 3.2%, and 67.6%, respectively. The trend for overall mortality was almost plateau ranging from 6.5% in July to 10.7% in April. The lowest ICU mortality was 60.0% observed in April, whereas it reached a peak in August (ICU-mortality= 75.7%). Admission on surge days of COVID-19 was associated with an increased risk of overall mortality (OR=1.3, 95% CI= 1.1, 1.5). The comparison of surge and lull status showed that the odds of ICU mortality in the surge of COVID-19 was 1.7 higher than in the lull period (P-value<0.001). Conclusion We found that the risk of both overall in-hospital and ICU mortality increased over the surge period and fourth and fifth waves of SARS-CoV-2 infection in Iran. Lack of hospital resources and particularly ICU capacities to respond to the crisis during the surge period is assumed to be the main culprit.

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