Increased risk of death in COVID-19 hospital admissions during the second wave as compared to the first epidemic wave: a prospective, single-centre cohort study in London, UK
This article has been Reviewed by the following groups
Listed in
- Evaluated articles (ScreenIT)
Abstract
Background
The second coronavirus disease (COVID-19) epidemic wave in the UK progressed aggressively and was characterised by the emergence and circulation of variant of concern alpha (VOC 202012/01). The impact of this variant on in-hospital COVID-19-specific mortality has not been widely studied. We aimed to compare mortality, clinical characteristics, and management of COVID-19 patients across epidemic waves to better understand the progression of the epidemic at a hospital level and support resource planning.
Methods
We conducted an analytical, dynamic cohort study in a large hospital in South London. We included all adults (≥ 18 years) with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who required hospital admission to COVID-19-specific wards between January 2020 and March 2021 ( n = 2701). Outcome was COVID-19-specific in-hospital mortality ascertained through Medical Certificate Cause of Death.
Results
In the second wave, the number of COVID-19 admissions doubled, and the crude mortality rate dropped 25% (1.66 versus 2.23 per 100 person-days in second and first wave, respectively). After accounting for age, sex, dexamethasone, oxygen requirements, symptoms at admission and Charlson Comorbidity Index, mortality hazard ratio associated with COVID-19 admissions was 1.62 (95% CI 1.26, 2.08) times higher in the second wave.
Conclusions
Although crude mortality rates dropped during the second wave, the multivariable analysis suggests a higher underlying risk of death for COVID-19 admissions in the second wave. These findings are ecologically correlated with an increased circulation of SARS-CoV-2 variant of concern 202012/1 (alpha). Availability of improved management, particularly dexamethasone, was important in reducing risk of death.
Article activity feed
-
-
SciScore for 10.1101/2021.06.09.21258537: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and limitations: This was a large analytical cohort study comparing groups of patients at different points in time. The overall goal was to investigate if different standards of care and possible changes in the natural history of the disease …
SciScore for 10.1101/2021.06.09.21258537: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and limitations: This was a large analytical cohort study comparing groups of patients at different points in time. The overall goal was to investigate if different standards of care and possible changes in the natural history of the disease (attributed to changes in SARS-CoV-2 variants), had an impact on in-hospital mortality. We included all patients admitted to covid-19 wards for treatment. All variables used in this study were extracted prospectively from electronic medical records ensuring data collected were the same across waves. The majority of the data were collected by experienced respiratory and ICU clinicians, and although some data inconsistencies were rectified early during data management, misclassification of covariates due transcription errors cannot be ruled out. Laboratory variables such as oxygenation parameters were obtained through the informatic department, but due to the limited quality of the electronic records, data were inconsistent and, in many cases, missing. We dichotomised this variable (FiO2) in an effort to reduce measurement error, but the coarse categorisation of oxygenation parameters into a dichotomous variable is likely to have introduced residual confounding. Outcome and date of outcome were collected separately and ascertained from MCCD (available for 752 deaths, 94.1%). The number of deaths we observed during the first wave is consistent with numbers previously reported for the same catchment area and period [23]. However, it...
Results from TrialIdentifier: We found the following clinical trial numbers in your paper:
Identifier Status Title NCT04416347 Recruiting COVID19 Clinical Predictors and Outcome Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
-
