Inpatient COVID-19 mortality has reduced over time: Results from an observational cohort

Autor: Katie Bechman, Mark Yates, Kirsty Mann, Deepak Nagra, Laura-Jane Smith, Andy I. Rutherford, Amit Patel, Jimstan Periselneris, David Walder, Richard J. B. Dobson, Zeljko Kraljevic, James H. T. Teo, William Bernal, Richard Barker, James B. Galloway, Sam Norton
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Male
Viral Diseases
Epidemiology
Neutrophils
Nosocomial Infections
Comorbidity
Dexamethasone
Cohort Studies
White Blood Cells
Medical Conditions
Endocrinology
Animal Cells
London
Medicine and Health Sciences
Hospital Mortality
Multidisciplinary
Alanine
Middle Aged
Hospitals
Patient Discharge
Hospitalization
Chemistry
Infectious Diseases
Physical Sciences
Medicine
Female
Cellular Types
Research Article
Chemical Elements
Death Rates
Endocrine Disorders
Science
Immune Cells
Immunology
Population Metrics
Diabetes Mellitus
Humans
Pandemics
Aged
Proportional Hazards Models
Inpatients
Blood Cells
Population Biology
Biology and Life Sciences
COVID-19
Covid 19
Cell Biology
Adenosine Monophosphate
COVID-19 Drug Treatment
Oxygen
Health Care
Health Care Facilities
Medical Risk Factors
Metabolic Disorders
Zdroj: PLoS ONE
PLoS ONE, Vol 17, Iss 1, p e0261142 (2022)
ISSN: 1932-6203
Popis: Background The Covid-19 pandemic in the United Kingdom has seen two waves; the first starting in March 2020 and the second in late October 2020. It is not known whether outcomes for those admitted with severe Covid were different in the first and second waves. Methods The study population comprised all patients admitted to a 1,500-bed London Hospital Trust between March 2020 and March 2021, who tested positive for Covid-19 by PCR within 3-days of admissions. Primary outcome was death within 28-days of admission. Socio-demographics (age, sex, ethnicity), hypertension, diabetes, obesity, baseline physiological observations, CRP, neutrophil, chest x-ray abnormality, remdesivir and dexamethasone were incorporated as co-variates. Proportional subhazards models compared mortality risk between wave 1 and wave 2. Cox-proportional hazard model with propensity score adjustment were used to compare mortality in patients prescribed remdesivir and dexamethasone. Results There were 3,949 COVID-19 admissions, 3,195 hospital discharges and 733 deaths. There were notable differences in age, ethnicity, comorbidities, and admission disease severity between wave 1 and wave 2. Twenty-eight-day mortality was higher during wave 1 (26.1% versus 13.1%). Mortality risk adjusted for co-variates was significantly lower in wave 2 compared to wave 1 [adjSHR 0.49 (0.37, 0.65) p Conclusion There has been substantial improvements in COVID-19 mortality in the second wave, even accounting for demographics, comorbidity, and disease severity. Neither dexamethasone nor remdesivir appeared to be key explanatory factors, although there may be unmeasured confounding present.
Databáze: OpenAIRE
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