Director & Head, Department of Medicine and Department of Critical Care.
Chair, Department of Medicine; Corresponding Author.
J Assoc Physicians India. 2023 Jul;71(7):11-12. doi: 10.59556/japi.71.0293.
To compare clinical and laboratory features, and outcomes in the second COVID-19 phase (delta variant) with the first and third phases in India we performed a registry-based study.
Patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were recruited over the study period from March 2020 to July 2022. In the first phase (wild type, March-December 2020) of the 7,476 suspected, 1,395 (18.7%) were positive and 863 (61.8%) were hospitalized, in the second phase (delta, January-July 2021) out of 8,680 suspected, 1,641 (19.4%) tested positive and 388 (23.6%) were hospitalized, and in the third phase (omicron, January-July 2022) out of 5,188 suspected patients, 886 (17.1%) tested positive and 94 (10.6%) were hospitalized. We compared details of admission clinical and laboratory features and in-hospital management and outcomes in the three phases.
A total of 2,352 patients were recruited. The majority of the patients were men, aged <45 years were 20% and about 20% of patients had hypertension, diabetes, and cardiovascular diseases. Patients in the second phase had significantly more cough, fever, shortness of breath, and lower oxygen saturation (SpO2) at admission and also had more lymphopenia, C-reactive proteins (CRPs), interleukin-6, ferritin, lactic dehydrogenase, and transaminases than patients in the other two phases. In the second vs the first and third phases, the requirement of supplementary oxygen (47.9 vs 33.1 and 23.4%), proning (89.2 vs 37.1 and 5.3%), high flow nasal oxygen (15.7 vs 8.71 and 5.3%), noninvasive ventilation (14.4 vs 9.1 and 11.7%), invasive ventilation (16.2 vs 9.1 and 9.6%), steroids (94.1 vs 83.4 and 37.2%), remdesivir (91.2 vs 73.8 and 39.4%), and anticoagulants (94.3 vs 83.0 and 61.7%) was significantly more (p < 0.001). The median length of stay in days [interquartile range (IQR)] was longer in the second phase [8 (6-10)] vs the first [7 (5-10)] and the third phase [4 (3-6) days]. The intensive care unit (ICU) stay in the second phase [9 (5-13) days] was also significantly more than the first [6 (2-10)] and third [0 (0-3)] phases (p <0.001). Overall, in-hospital deaths occurred in 176 patients (12.8%). Deaths were significantly higher in the second phase (19.3%), compared to the first (11.0%) and the third (3.3%) phases (p <0.01). We also observed that greater disease severity at presentation was associated with higher mortality in all the phases.
This study shows that COVID-19 patients that were hospitalized in the second (delta) phase of the epidemic had more severe disease compared to the first and third phases. In the second phase of patients, there was a significantly higher duration of hospitalization, ICU hospitalization, greater oxygen requirement, noninvasive and invasive ventilatory support, and more deaths.
我们开展了一项基于注册的研究，比较了印度第二波（德尔塔变异株）和第一波、第三波 COVID-19 期间的临床和实验室特征及结局。
在研究期间，从 2020 年 3 月至 2022 年 7 月，我们招募了确诊为严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染的患者。在第一波（野生型，2020 年 3 月至 12 月），7476 例疑似患者中，有 1395 例（18.7%）检测结果为阳性，863 例（61.8%）住院治疗；在第二波（德尔塔变异株，2021 年 1 月至 7 月），8680 例疑似患者中，有 1641 例（19.4%）检测结果为阳性，388 例（23.6%）住院治疗；在第三波（奥密克戎变异株，2022 年 1 月至 7 月），5188 例疑似患者中，有 886 例（17.1%）检测结果为阳性，94 例（10.6%）住院治疗。我们比较了三个阶段的入院临床和实验室特征、住院管理和结局的详细信息。
共纳入 2352 例患者。大多数患者为男性，年龄<45 岁的患者占 20%，约 20%的患者患有高血压、糖尿病和心血管疾病。第二波患者入院时咳嗽、发热、呼吸急促和血氧饱和度（SpO2）较低的情况明显更多，淋巴细胞减少症、C 反应蛋白（CRP）、白细胞介素-6、铁蛋白、乳酸脱氢酶和转氨酶也明显更高。与第一波和第三波相比，第二波患者需要补充氧气（47.9%比 33.1%和 23.4%）、俯卧位通气（89.2%比 37.1%和 5.3%）、高流量鼻氧（15.7%比 8.71%和 5.3%）、无创通气（14.4%比 9.1%和 11.7%）、有创通气（16.2%比 9.1%和 9.6%）、皮质类固醇（94.1%比 83.4%和 37.2%）、瑞德西韦（91.2%比 73.8%和 39.4%）和抗凝剂（94.3%比 83.0%和 61.7%）的比例明显更高（p <0.001）。第二波的中位住院时间[四分位数间距（IQR）]也更长[8（6-10）天]，与第一波[7（5-10）天]和第三波[4（3-6）天]相比。第二波的 ICU 住院时间[9（5-13）天]也明显长于第一波[6（2-10）天]和第三波[0（0-3）天]（p <0.001）。总体而言，住院期间共有 176 例（12.8%）患者死亡。第二波的死亡率（19.3%）明显高于第一波（11.0%）和第三波（3.3%）（p <0.01）。我们还观察到，在所有阶段，入院时的疾病严重程度越高，死亡率越高。
本研究表明，与第一波和第三波相比，COVID-19 患者在第二波（德尔塔变异株）疫情中住院时病情更严重。在第二波患者中，住院时间、ICU 住院时间、氧气需求、无创和有创通气支持的持续时间以及死亡人数均明显更长。
