Clinical course and outcomes of critically ill COVID-19 patients in two successive pandemic waves

  1. Athanasios Chalkias
  2. Ioannis Pantazopoulos
  3. Nikolaos Papagiannakis
  4. Anargyros Skoulakis
  5. Eleni Laou
  6. Konstantina Kolonia
  7. Nicoletta Ntalarizou
  8. Dimitrios Ragias
  9. Christos Kampolis
  10. Luis García de Guadiana Romualdo
  11. Konstantinos Tourlakopoulos
  12. Athanasios Pagonis
  13. Salim S Hayek
  14. Jesper Eugen-Olsen
  15. Konstantinos Gourgoulianis
  16. Eleni Arnaoutoglou

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Abstract

Rationale

The progress of COVID-19 from moderate to severe may be precipitous, while the heterogenous characteristics of the disease pose challenges to the management of these patients.

Objectives

To characterize the clinical course and outcomes of critically ill patients with COVID-19 during two successive waves.

Methods

We leveraged the multi-center SuPAR in Adult Patients With COVID-19 (SPARCOL) study and collected data from consecutive patients requiring admission to the intensive care unit from April 1 st to December 31 st , 2020.

Measurements and Main Results

Of 252 patients, 81 (32%) required intubation and mechanical ventilation. Of them, 17 (20.9%) were intubated during the first wave, while 64 (79%) during the second wave. The most prominent difference between the two waves was the overall survival (first wave 58.9% vs. second wave 15.6%, adjusted p-value=0.006). This difference is reflected in the prolonged hospitalization during the first wave. The mean ICU length of stay (19.1 vs. 11.7 days, p=0.022), hospital length of stay (28.5 vs. 17.1 days, p=0.012), and days on ventilator (16.7 vs. 11.5, p=0.13) were higher during the first wave. A significant difference between the two waves was the development of bradycardia. In the first wave, 2 (11.7%) patients developed sinus bradycardia only after admission to the intensive care unit, while in the second wave, 63 (98.4%) patients developed sinus bradycardia during hospitalization.

Conclusions

Survival of critically ill patients with COVID-19 was significantly lower during the second wave. The majority of these patients developed sinus bradycardia during hospitalization.

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  1. Version published to 10.1101/2021.02.26.21251848v3 on medRxiv
  2. ScreenIT

    SciScore for 10.1101/2021.02.26.21251848: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Ethical approval was provided by the Ethical Committee of the University Hospital of Larisa (IRB no. 17543)
    Consent: Written informed consent was obtained from the patients.
    Randomizationnot detected.
    BlindingThe authors and laboratory technicians were blinded to clinical data and measurements until the end of the study and all data were analyzed.
    Power Analysisnot detected.
    Sex as a biological variablenot 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:
    The major limitations of the present study are the relatively small sample and its observational nature. Despite the careful analysis, it is not possible to fully account for all potential confounders and therefore, the study cannot be trusted per se as a basis of clinical decision. However, our findings have significant implications for a better understanding of the epidemiology of COVID-19 and for better planning and organization in the future. The present study adds to the growing body of research that indicates differences in the severity of COVID-19 and in overall survival between successive outbreak waves. Moreover, it provides additional evidence with respect to the involvement of cardiac conduction system with SARS-CoV-2. These findings may help in the classification of novel phenotypes for informing treatment strategy and for identifying populations that may benefit from early admission to ICU.

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04590794Active, not recruitingSuPAR in Adult Patients With Covid-19

    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.

    About SciScore

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  3. Version published to 10.1101/2021.02.26.21251848v2 on medRxiv
  4. Version published to 10.1101/2021.02.26.21251848v1 on medRxiv
  5. Version published to 10.1016/j.toxrep.2021.07.004