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Thakur I, Chatterjee A, Ghosh AK, Chatterjee SS, Saha S, Panja T, Dan U. A comparative study between first three waves of COVID-19 pandemic with respect to risk factors, initial clinic-demographic profile, severity and outcome. J Family Med Prim Care 2024; 13:2455-2461. [PMID: 39027859 PMCID: PMC11254042 DOI: 10.4103/jfmpc.jfmpc_1884_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/30/2023] [Accepted: 02/04/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction During the 2 years and 9 months from March 2020 to December 2022, the SARS-CoV-2 virus raged across the country. Cases occurred in three particular time clusters recognised by World Health Organisation as coronavirus disease 2019 (COVID-19) waves. In this study, we compare the clinical parameters of adult non-obstetric COVID-19 patients admitted to our rural tertiary care hospital during the three distinct waves of the pandemic. Materials and Methods Retrospective chart analysis of 272, 853 and 97 patients admitted with SARS-CoV-2 infection to the only rural medical tertiary care centre in the Sunderbans of West Bengal in the first, second and third waves, respectively, was done after obtaining ethical and scientific clearance. Clinical [vital parameters, oxygen requirement, mental status, risk factor assessment, duration of hospital stay, modified-emergency warning score (m-EWS), quick Sequential Organ Failure Assessment (qSOFA), confusion, uraemia, respiratory rate, blood pressure, age ≥ 65 years (CURB65)], epidemiological variables (age, gender, and vaccination status), laboratory parameters and in-hospital outcome were recorded and analysed statistically. Results Statistically significant (P < 0.05) m-EWS and qSOFA scores were recorded during the second wave of the pandemic. The second wave also recorded the highest mortality (14.89%) compared to the first (12.87%) and third (11.96%) waves, though this was not statistically significant. The highest duration of hospital stay was recorded in the first wave of the pandemic (mean = 9.99 days, P < 0.01). The difference in mortality rates between patients with and without co-morbidity (P < 0.05) was observed during Wave-1, across any pandemic wave, and overall but not in Wave-2 and Wave-3. Conclusion The second wave of the COVID-19 pandemic was the most severe in comparison with the other two waves, while the outcome was poorer in those with co-morbidities, especially in the first wave.
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Affiliation(s)
- Indranil Thakur
- General Medicine, DHGMCH, Diamond Harbour, West Bengal, India
| | - Arabinda Chatterjee
- Department of Forensic Medicine and Toxicology, JGMCH, Jhargram, West Bengal, India (Formerly Department of Forensic Medicine and Toxicology, DHGMCH, Diamond Harbour, West Bengal, India)
| | - Ashis Kumar Ghosh
- Department of Otorhinolaryngology, DHGMCH, Diamond Harbour, West Bengal, India
| | - Shiv Sekhar Chatterjee
- Department of Microbiology, AIIMS, Kalyani, West Bengal, India (Formerly Department of Microbiology, DHGMCH, Diamond Harbour, West Bengal, India)
| | - Santanu Saha
- General Medicine, DHGMCH, Diamond Harbour, West Bengal, India
| | | | - Utpal Dan
- Principal and Anatomy, DHGMCH, Diamond Harbour, West Bengal, India
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Palazzuoli A, Beltrami M, McCullough PA. Acute COVID-19 Management in Heart Failure Patients: A Specific Setting Requiring Detailed Inpatient and Outpatient Hospital Care. Biomedicines 2023; 11:biomedicines11030790. [PMID: 36979769 PMCID: PMC10045184 DOI: 10.3390/biomedicines11030790] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
The relationship existing between heart failure (HF) and COVID-19 remains questioned and poorly elucidated. Many reports suggest that HF events are reduced during pandemics, although other studies have demonstrated higher mortality and sudden death in patients affected by HF. Several vascular, thrombotic, and respiratory features may deteriorate stable HF patients; therefore, the infection may directly cause direct myocardial damage, leading to cardiac function deterioration. Another concern is related to the possibility that antiviral, anti-inflammatory, and corticosteroid agents commonly employed during acute COVID-19 infection may have potentially deleterious effects on the cardiovascular (CV) system. For these reasons, HF patients deserve specific management with a tailored approach in order to avoid arrhythmic complications and fluid retention events. In this review, we describe the complex interplay between COVID-19 and HF, the evolving trend of infection with related CV events, and the specific management strategy to adopt in this setting.
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Affiliation(s)
- Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Medical Sciences, Le Scotte Hospital University of Siena Italy, 53100 Siena, Italy
| | - Matteo Beltrami
- Cardiology Unit, San Giovanni di Dio Hospital, Azienda USL Toscana Centro, 50134 Florence, Italy
- Correspondence: ; Tel.: +39-339-5418158
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Chandel A, Leazer S, Alcover KC, Farley J, Berk J, Jayne C, Mcnutt R, Olsen M, Allard R, Yang J, Johnson C, Tripathi A, Rechtin M, Leon M, Williams M, Sheth P, Messer K, Chung KK, Collen J. Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis. Crit Care Explor 2023; 5:e0876. [PMID: 36890875 PMCID: PMC9988289 DOI: 10.1097/cce.0000000000000876] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
To perform a systematic review and meta-analysis to generate estimates of mortality in patients with COVID-19 that required hospitalization, ICU admission, and organ support. DATA SOURCES A systematic search of PubMed, Embase, and the Cochrane databases was conducted up to December 31, 2021. STUDY SELECTION Previously peer-reviewed observational studies that reported ICU, mechanical ventilation (MV), renal replacement therapy (RRT) or extracorporeal membrane oxygenation (ECMO)-related mortality among greater than or equal to 100 individual patients. DATA EXTRACTION Random-effects meta-analysis was used to generate pooled estimates of case fatality rates (CFRs) for in-hospital, ICU, MV, RRT, and ECMO-related mortality. ICU-related mortality was additionally analyzed by the study country of origin. Sensitivity analyses of CFR were assessed based on completeness of follow-up data, by year, and when only studies judged to be of high quality were included. DATA SYNTHESIS One hundred fifty-seven studies evaluating 948,309 patients were included. The CFR for in-hospital mortality, ICU mortality, MV, RRT, and ECMO were 25.9% (95% CI: 24.0-27.8%), 37.3% (95% CI: 34.6-40.1%), 51.6% (95% CI: 46.1-57.0%), 66.1% (95% CI: 59.7-72.2%), and 58.0% (95% CI: 46.9-68.9%), respectively. MV (52.7%, 95% CI: 47.5-58.0% vs 31.3%, 95% CI: 16.1-48.9%; p = 0.023) and RRT-related mortality (66.7%, 95% CI: 60.1-73.0% vs 50.3%, 95% CI: 42.4-58.2%; p = 0.003) decreased from 2020 to 2021. CONCLUSIONS We present updated estimates of CFR for patients hospitalized and requiring intensive care for the management of COVID-19. Although mortality remain high and varies considerably worldwide, we found the CFR in patients supported with MV significantly improved since 2020.
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Affiliation(s)
- Abhimanyu Chandel
- Department of Pulmonary and Critical Care Medicine, Walter Reed National Medical Center, Bethesda, MD
| | - Sahar Leazer
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
- The Metis Foundation, San Antonio, TX
| | - Karl C Alcover
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Josiah Farley
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Joshua Berk
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Christopher Jayne
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Ryan Mcnutt
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Meredith Olsen
- Department of Pulmonary and Critical Care Medicine, Walter Reed National Medical Center, Bethesda, MD
| | - Rhonda Allard
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Jiahong Yang
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Caitlyn Johnson
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Ananya Tripathi
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Maria Rechtin
- Department of Pulmonary and Critical Care Medicine, Walter Reed National Medical Center, Bethesda, MD
| | - Mathew Leon
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Mathias Williams
- Department of Pulmonary and Critical Care Medicine, Walter Reed National Medical Center, Bethesda, MD
| | - Phorum Sheth
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Kyle Messer
- Department of Pulmonary and Critical Care Medicine, Walter Reed National Medical Center, Bethesda, MD
| | - Kevin K Chung
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Jacob Collen
- Department of Pulmonary and Critical Care Medicine, Walter Reed National Medical Center, Bethesda, MD
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
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Improvements throughout the Three Waves of COVID-19 Pandemic: Results from 4 Million Inhabitants of North-West Italy. J Clin Med 2022; 11:jcm11154304. [PMID: 35893395 PMCID: PMC9332615 DOI: 10.3390/jcm11154304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/13/2022] [Accepted: 07/19/2022] [Indexed: 02/05/2023] Open
Abstract
At the very beginning of the European spread of SARS-CoV-2, Piedmont was one of the most affected regions in Italy, with a strong impact on healthcare organizations. In this study, we evaluated the characteristics and outcomes of the COVID-19 patients in an entire region during the first three pandemic waves, identifying similarities and differences in the SARS-CoV-2 epidemic’s timeline. We collected the health-administrative data of all the Piedmont COVID-19 patients infected during the first three pandemic waves (1 March 2020–15 April 2020; 15 October 2020–15 December 2020; 1 March 2021–15 April 2021, respectively). We compared differences among the waves in subjects positive for SARS-CoV-2 and in patients admitted to ICU. Overall, 18.621 subjects tested positive during the first wave (405 patients/day), 144.350 (2366.4 patients/day) in the second, and 81.823 (1778.8 patients/day) in the third. In the second and third waves, we observed a reduction in median age, comorbidity burden, mortality in outpatients, inpatients, and patients admitted to ICU, in intubation, invasive ventilation and tracheostomy, and a parallel increase in the use of CPAP. Our study confirmed a trend towards younger and healthier patients over time but also showed an independent effect of the period on mortality and ICU admission. The appearance of new viral variants, the starting of vaccination, and organizational improvements in tracking, outpatients and inpatients management could have influenced these trends.
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Haase N, Plovsing R, Christensen S, Poulsen LM, Brøchner AC, Rasmussen BS, Helleberg M, Jensen JUS, Andersen LPK, Siegel H, Ibsen M, Jørgensen VL, Winding R, Iversen S, Pedersen HP, Madsen J, Sølling C, Garcia RS, Michelsen J, Mohr T, Michagin G, Espelund US, Bundgaard H, Kirkegaard L, Smitt M, Buck DL, Ribergaard NE, Pedersen HS, Christensen BV, Nielsen LP, Clapp E, Jonassen TB, Weihe S, la Cour K, Nielsen FM, Madsen EK, Haberlandt TN, Meier N, Perner A. Changes over time in characteristics, resource use and outcomes among ICU patients with COVID-19 - a nationwide, observational study in Denmark. Acta Anaesthesiol Scand 2022; 66:987-995. [PMID: 35781689 PMCID: PMC9544552 DOI: 10.1111/aas.14113] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/01/2022] [Accepted: 06/22/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Characteristics and care of ICU patients with COVID-19 may have changed during the pandemic, but longitudinal data assessing this are limited. We compared patients with COVID-19 admitted to Danish ICUs in the first wave with those admitted later. METHODS Among all Danish ICU patients with COVID-19, we compared demographics, chronic comorbidities, use of organ support, length of stay and vital status of those admitted 10th March to 19th May 2020 (first wave) versus 20th May 2020 to 30th June 2021. We analysed risk factors for death by adjusted logistic regression analysis. RESULTS Among all hospitalised patients with COVID-19, a lower proportion was admitted to ICU after the first wave (13 vs 8%). Among all 1374 ICU patients with COVID-19, 326 were admitted during the first wave. There were no major differences in patient's characteristics or mortality between the two periods, but use of invasive mechanical ventilation (81% vs 58% of patients), renal replacement therapy (26% vs. 13%) and ECMO (8% vs 3%) and median length of stay in ICU (13 vs 10 days) and in hospital (20 vs 17 days) were all significantly lower after the first wave. Risk factors for death were higher age, larger burden of co-morbidity (hearth failure, pulmonary disease, and kidney disease), and active cancer, but not admission during or after the first wave. CONCLUSIONS After the first wave of COVID-19 in Denmark, a lower proportion of hospitalised patients with COVID-19 was admitted to ICU. Among ICU patients, use of organ support was lower and length of stay was reduced, but mortality rates remained at a relatively high level. EDITORIAL COMMENT This study assessed the temporal changes in the care of patients with COVID-19 requiring ICU care in Denmark. The findings showed that while a lower ratio of patients with documented infections required ICU and they required less organ support, ICU mortality remained unchanged. This might reflect the effects of vaccines on disease severity and improvement in floor management of hypoxic patients, but also underscores that COVID-19 remains a serious threat to the health of many patients, in particularly elderly patients with a high degree of comorbidity.
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Affiliation(s)
- Nicolai Haase
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
| | - Ronni Plovsing
- Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, Copenhagen, Denmark
| | - Steffen Christensen
- Department of Anaesthesiology and Intensive Care, Århus University Hospital, Århus, Denmark
| | | | | | - Bodil Steen Rasmussen
- Department of Anaesthesiology and Intensive Care, Ålborg University Hospital, Ålborg, Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Hanna Siegel
- Department of Anaesthesiology and Intensive Care, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - Michael Ibsen
- Department of Anaesthesiology and Intensive Care, North Zealand Hospital, Hillerød, Denmark
| | | | - Robert Winding
- Department of Anaesthesiology and Intensive Care, Herning Hospital, Herning, Denmark
| | - Susanne Iversen
- Department of Anaesthesiology and Intensive Care, Slagelse Hospital, Slagelse, Denmark
| | - Henrik Planck Pedersen
- Department of Anaesthesiology and Intensive Care, Zealand University Hospital, Roskilde, Denmark
| | - Jacob Madsen
- Department of Anaesthesiology and Intensive Care, Ålborg University Hospital, Ålborg, Denmark
| | - Christoffer Sølling
- Department of Anaesthesiology and Intensive Care, Viborg Hospital, Viborg, Denmark
| | | | - Jens Michelsen
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Thomas Mohr
- Department of Anaesthesiology and Intensive Care, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - George Michagin
- Department of Anaesthesiology and Intensive Care, Svendborg Hospital, Svendborg, Denmark
| | | | - Helle Bundgaard
- Department of Anaesthesiology and Intensive Care, Randers Hospital, Randers, Denmark
| | - Lynge Kirkegaard
- Department of Anaesthesiology and Intensive Care, Åbenrå Hospital, Åbenrå, Denmark
| | - Margit Smitt
- Department of Neuroanaesthesiology, Rigshospitalet, Copenhagen, Denmark
| | - David Levarett Buck
- Department of Anaesthesiology and Intensive Care, Holbaek Hospital, Holbaek, Denmark
| | - Niels-Erik Ribergaard
- Department of Anaesthesiology and Intensive Care, Hjørring Hospital, Hjørring, Denmark
| | - Helle Scharling Pedersen
- Department of Anaesthesiology and Intensive Care, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | | | - Lone Pia Nielsen
- Department of Anaesthesiology and Intensive Care, Bornholms Hospital, Rønne, Denmark
| | - Esben Clapp
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
| | - Trine Bak Jonassen
- Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, Copenhagen, Denmark
| | - Sarah Weihe
- Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | - Kirstine la Cour
- Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | | | - Emilie Kabel Madsen
- Department of Anaesthesiology and Intensive Care, Århus University Hospital, Århus, Denmark
| | | | - Nick Meier
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
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