Tendulkar Prakash, Pandey Pragya, Panda Prasan K, Bhadoria Ajeet S, Kulshreshtha Poorvi, Mishra Mayank, Saxena Gaurika
Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.
Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.
Cureus. 2023 Apr 12;15(4):e37472. doi: 10.7759/cureus.37472. eCollection 2023 Apr.
Introduction The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is continuously evolving, and many mutant variants of the virus are circulating in the world. Recurrent waves of COVID-19 have caused enormous mortality all across the globe. Considering the novelty of the virus, it becomes crucial for healthcare experts and policymakers to understand the demographic and clinical attributes of inpatient deaths in the first and second waves of COVID-19. Methods This hospital record-based comparative study was conducted at a tertiary care hospital in Uttarakhand, India. The study included all COVID-19 RT PCR-positive patients admitted to the hospital during the first wave, from 1 April 2020 to 31 January 2021, and the second wave from 1 March 2021 to 30 June 2021. Comparisons were made with respect to demographic, clinical, laboratory parameters, and course of hospital stay. Results The study exhibited 11.34% more casualties in the second wave, with the number of deaths being 424 and 475 for the first and second waves, respectively. A male preponderance of mortality was evident in both waves with significant differences (p=0.004). There was no significant difference in age between the two waves (p=0.809). The significantly different comorbidities were hypertension (p=0.003) and coronary artery disease (p=0.014). The clinical manifestations demonstrating a significant difference were cough (p=0.000), sore throat (p=0.002), altered mental status (p=0.002), headache (p=0.025), loss of taste and smell (p=0.001), and tachypnea (p=0.000). The lab parameters with a significant difference across both waves were lymphopenia (p=0.000), elevated aspartate aminotransferase (p=0.004), leukocytosis (p=0.008), and thrombocytopenia (p=0.004). During the hospital course of the second wave, in terms of intensive care unit stay, the need for non-invasive ventilation and inotrope support was higher. The complications manifesting in the form of acute respiratory distress syndrome and sepsis were observed more in the second wave. A significant difference was discerned in the median duration of hospital stay in both waves (p=0.000). Conclusion Despite being of shorter duration, the second wave of COVID-19 culminated in more deaths. The study demonstrated that most of the baseline demographic and clinical characteristics attributed to mortality were more common during the second wave of COVID-19, including lab parameters, complications, and duration of hospital stays. The unpredictable nature of COVID-19 waves calls for instituting a well-planned surveillance mechanism in place to identify the surge in cases at the earliest possible time and prompt response, along with developing infrastructure and capacity to manage complications.
引言 严重急性呼吸综合征冠状病毒2（SARS-CoV-2）在持续演变，该病毒的许多突变变体在全球传播。新冠疫情的反复浪潮已在全球造成了巨大的死亡人数。鉴于该病毒的新颖性，医疗保健专家和政策制定者了解新冠疫情第一波和第二波住院死亡病例的人口统计学和临床特征变得至关重要。方法 这项基于医院记录的对比研究在印度北阿坎德邦的一家三级护理医院进行。该研究纳入了2020年4月1日至2021年1月31日第一波期间以及2021年3月1日至2021年6月30日第二波期间收治入院的所有新冠病毒逆转录聚合酶链反应（RT PCR）检测呈阳性的患者。对人口统计学、临床、实验室参数以及住院病程进行了比较。结果 该研究显示第二波的死亡人数多11.34%，第一波和第二波的死亡人数分别为424人和475人。两波疫情中男性死亡占比均明显更高，差异有统计学意义（p = 0.004）。两波疫情患者的年龄无显著差异（p = 0.809）。有显著差异的合并症是高血压（p = 0.003）和冠状动脉疾病（p = 0.014）。表现出显著差异的临床表现有咳嗽（p = 0.000）、咽痛（p = 0.002）、精神状态改变（p = 0.002）、头痛（p = 0.025）、味觉和嗅觉丧失（p = 0.001）以及呼吸急促（p = 0.000）。两波疫情间有显著差异的实验室参数是淋巴细胞减少（p = 0.000）、天门冬氨酸氨基转移酶升高（p = 0.004）、白细胞增多（p = 0.008）和血小板减少（p = 0.004）。在第二波疫情的住院病程中，就重症监护病房住院时间而言，无创通气和血管活性药物支持的需求更高。以急性呼吸窘迫综合征和脓毒症形式出现的并发症在第二波中观察到的更多。两波疫情的住院中位时长存在显著差异（p = 0.000）。结论 尽管新冠疫情第二波持续时间较短，但死亡人数更多。该研究表明，第二波新冠疫情期间，大多数与死亡相关的基线人口统计学和临床特征更为常见，包括实验室参数、并发症和住院时长。新冠疫情浪潮的不可预测性要求建立一个精心规划的监测机制，以便尽早识别病例激增情况并迅速做出反应，同时发展管理并发症的基础设施和能力。
