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Original article

Vol. 151 No. 3132 (2021)

Comparison of characteristics, predictors and outcomes between the first and second COVID-19 waves in a tertiary care centre in Switzerland: an observational analysis

DOI
https://doi.org/10.4414/smw.2021.20569
Cite this as:
Swiss Med Wkly. 2021;151:w20569
Published
10.08.2021

Summary

AIM OF THE STUDY

To compare admission characteristics, predictors and outcomes of patients with confirmed coronavirus disease 2019 (COVID-19) hospitalised in a tertiary care hospital in Switzerland during the first and second waves of the pandemic.

METHODS

This retrospective observational analysis included adult patients with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection confirmed by a real-time reverse transcriptase polymerase chain reaction (RT-PCR) or rapid antigen test and hospitalised at the Cantonal Hospital Aarau from 26 February to 30 April 2020 (first wave) and from 1 October to 31 December 2020 (second wave). The primary endpoint was all-cause in-hospital mortality. The secondary endpoints were transfer to the intensive care unit (ICU) and length of hospital stay (LOS).

RESULTS

Overall, 486 patients (mean age 65.9 years ± 14.7 SD, 65% male) were included. Ninety-two patients (19%) died during the hospital stay and 92 patients (19%) were transferred to the ICU. Admission characteristics, including comorbidities and frailty, were similar for patients of the first (n = 100) and second wave (n = 386). However, during the second wave the median time from symptom onset to presentation to the emergency department (ED) was shorter (7 days, interquartile range [IQR] 4–9 vs 8 days, IQR 4–11; p = 0.02). In the second wave, most patients received high-dose glucocorticoid treatment (0% vs 76%, p <0.01). In-hospital mortality was similar among COVID-19 patients in the first (19/100, 19%) and second wave (73/386, 19%); this finding persisted after full adjustment in multiple regression models (adjusted odds ratio [aOR] 1.18, 95% confidence interval [CI] 0.49–2.80; p = 0.71). Risk for ICU admission was also similar (24% vs 18%; aOR 0.98, 95% CI 0.46–2.06; p = 0.95). More patients were transferred to rehabilitation facilities in the second wave (18% vs 31%; aOR 2.06, 95% CI 1.04–4.07; p = 0.04) and LOS was 2.5 days shorter (9.0 vs 6.5 days; adjusted difference −2.53 days, 95%-CI −4.51 to −0.54; p = 0.01). Main predictors for in-hospital death were patient age (aOR 1.07, 95% CI 1.02–1.11; p <0.01), male sex (aOR 2.41, 95% CI 1.05–5.55; p = 0.04) and the age-adjusted Charlson comorbidity index (aOR 1.27, 95% CI 1.09–1.48 p <0.01).

CONCLUSION

Despite differing treatment regimens, mortality and ICU admission remained largely unchanged for COVID-19 patients admitted during the second wave of the pandemic in our tertiary care hospital. However, discharge processes were optimised with patients leaving the hospital earlier and going to rehabilitation facilities more often.

References

  1. Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. J Med Virol. 2020;92(4):401–2. doi:.https://doi.org/10.1002/jmv.25678
  2. Hui DS, I Azhar E, Madani TA, Ntoumi F, Kock R, Dar O, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health - The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. 2020;91:264–6. doi:.https://doi.org/10.1016/j.ijid.2020.01.009
  3. Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020;20(5):533–4. doi:.https://doi.org/10.1016/S1473-3099(20)30120-1
  4. World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard. [cited 2021 July 7]; Available from: https://covid19.who.int/.
  5. De Natale G, De Natale L, Troise C, Marchitelli V, Coviello A, Holmberg KG, et al. The Evolution of Covid-19 in Italy after the Spring of 2020: An Unpredicted Summer Respite Followed by a Second Wave. Int J Environ Res Public Health. 2020;17(23):8708. doi:.https://doi.org/10.3390/ijerph17238708
  6. Bundesamt für Gesundheit BAG. Covid-19 Schweiz: Informationen zur aktuellen Lage, Stand 24. Dezember 2020. 2020 [cited 2021 July 7]; Available from: https://www.covid19.admin.ch/de/overview.
  7. Pan H, Peto R, Henao-Restrepo AM, Preziosi MP, Sathiyamoorthy V, Abdool Karim Q, et al., WHO Solidarity Trial Consortium. Repurposed Antiviral Drugs for Covid-19 - Interim WHO Solidarity Trial Results. N Engl J Med. 2021;384(6):497–511. doi:.https://doi.org/10.1056/NEJMoa2023184
  8. World Health Organization. Clinical management of COVID-19: interim guidance, 27 May 2020. 2020 [cited 2021 July 7]; Available from: https://apps.who.int/iris/handle/10665/332196.
  9. World Health Organization. Corticosteroids for COVID-19, Living Guidance 2 September 2020. 2020 [cited 2021 July 7]; Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-Corticosteroids-2020.1.
  10. Schweizerische Gesellschaft für Infektionskrankheiten. SARS-CoV-2/COVID-19: Antiviral and immunomodulatory treatment considerations (continually updated). 2020 [cited 2021 July 7]; Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-Corticosteroids-2020.1.
  11. Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, et al., RECOVERY Collaborative Group. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021;384(8):693–704. doi:.https://doi.org/10.1056/NEJMoa2021436
  12. Tomazini BM, Maia IS, Cavalcanti AB, Berwanger O, Rosa RG, Veiga VC, et al.; COALITION COVID-19 Brazil III Investigators. Effect of Dexamethasone on Days Alive and Ventilator-Free in Patients With Moderate or Severe Acute Respiratory Distress Syndrome and COVID-19: The CoDEX Randomized Clinical Trial. JAMA. 2020;324(13):1307–16. doi:.https://doi.org/10.1001/jama.2020.17021
  13. National Institutes of Health. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. 2020 [cited 2021 July 7]; Available from: https://www.covid19treatmentguidelines.nih.gov/.
  14. Gregoriano C, Koch D, Haubitz S, Conen A, Fux CA, Mueller B, et al. Characteristics, predictors and outcomes among 99 patients hospitalised with COVID-19 in a tertiary care centre in Switzerland: an observational analysis. Swiss Med Wkly. 2020;150:w20316.
  15. Looi MK. Covid-19: Is a second wave hitting Europe? BMJ. 2020;371:m4113. doi:.https://doi.org/10.1136/bmj.m4113
  16. Griffin S. Covid-19: Second wave death rate is doubling fortnightly but is lower and slower than in March. BMJ. 2020;371:m4092. doi:.https://doi.org/10.1136/bmj.m4092
  17. Suter P, Pargger H. Strong second COVID-19 wave calls for a second look at ICU triage guidelines. Swiss Med Wkly. 2020;150:w20407. doi:.https://doi.org/10.4414/smw.2020.20407
  18. Lampl BMJ, Salzberger B. Changing epidemiology of COVID-19. GMS Hyg Infect Control. 2020;15:Doc27.
  19. Thiabaud A, Iten A, Balmelli C, Senn L, Troillet N, Widmer A, et al. Cohort profile: SARS-CoV-2/COVID-19 hospitalised patients in Switzerland. Swiss Med Wkly. 2021;151:w20475.
  20. Salyer SJ, Maeda J, Sembuche S, Kebede Y, Tshangela A, Moussif M, et al. The first and second waves of the COVID-19 pandemic in Africa: a cross-sectional study. Lancet. 2021;397(10281):1265–75. doi:.https://doi.org/10.1016/S0140-6736(21)00632-2
  21. World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected: interim guidance, 25 January 2020. 2020 [cited 2021 July 7]; Available from: https://apps.who.int/iris/handle/10665/330854.
  22. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245–51. doi:.https://doi.org/10.1016/0895-4356(94)90129-5
  23. Juma S, Taabazuing MM, Montero-Odasso M. Clinical Frailty Scale in an Acute Medicine Unit: a Simple Tool That Predicts Length of Stay. Can Geriatr J. 2016;19(2):34–9. doi:.https://doi.org/10.5770/cgj.19.196
  24. Saito S, Asai Y, Matsunaga N, Hayakawa K, Terada M, Ohtsu H, et al. First and second COVID-19 waves in Japan: A comparison of disease severity and characteristics. J Infect. 2021;82(4):84–123. doi:.https://doi.org/10.1016/j.jinf.2020.10.033
  25. Di Fusco M, Shea KM, Lin J, Nguyen JL, Angulo FJ, Benigno M, et al. Health outcomes and economic burden of hospitalized COVID-19 patients in the United States. J Med Econ. 2021;24(1):308–17. doi:.https://doi.org/10.1080/13696998.2021.1886109
  26. Mallow PJ, Belk KW, Topmiller M, Hooker EA. Outcomes of Hospitalized COVID-19 Patients by Risk Factors: Results from a United States Hospital Claims Database. J Health Econ Outcomes Res. 2020;7(2):165–74. doi:.https://doi.org/10.36469/jheor.2020.17331
  27. Rodríguez-Núñez N, Gude F, Lama A, Rábade C, Varela A, Abelleira R, et al. Health Indicators in Hospitalized Patients With SARS-CoV-2 Pneumonia: A Comparison Between the First and Second Wave. Arch Bronconeumol (Engl Ed). 2021;S0300-2896(21)00110-1.
  28. Contou D, Fraissé M, Pajot O, Tirolien JA, Mentec H, Plantefève G. Comparison between first and second wave among critically ill COVID-19 patients admitted to a French ICU: no prognostic improvement during the second wave? Crit Care. 2021;25(1):3. doi:.https://doi.org/10.1186/s13054-020-03449-6
  29. Stocker R, Berner M, Binet I, Bürgi U, Fischer J, Gardaz V, et al.; Swiss Academy Of Medical Sciences. Medical ethical guidelines: Intensive-care interventions. Swiss Med Wkly. 2015;145:w14109. doi:.https://doi.org/10.4414/smw.2015.14109
  30. Blum CA, Nigro N, Briel M, Schuetz P, Ullmer E, Suter-Widmer I, et al. Adjunct prednisone therapy for patients with community-acquired pneumonia: a multicentre, double-blind, randomised, placebo-controlled trial. Lancet. 2015;385(9977):1511–8. doi:.https://doi.org/10.1016/S0140-6736(14)62447-8
  31. Allameh SF, Nemati S, Ghalehtaki R, Mohammadnejad E, Aghili SM, Khajavirad N, et al. Clinical Characteristics and Outcomes of 905 COVID-19 Patients Admitted to Imam Khomeini Hospital Complex in the Capital City of Tehran, Iran. Arch Iran Med. 2020;23(11):766–75. doi:.https://doi.org/10.34172/aim.2020.102
  32. Ludwig M, Jacob J, Basedow F, Andersohn F, Walker J. Clinical outcomes and characteristics of patients hospitalized for Influenza or COVID-19 in Germany. Int J Infect Dis. 2021;103:316–22. doi:.https://doi.org/10.1016/j.ijid.2020.11.204

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