First and second waves among hospitalised patients with COVID-19 with severe pneumonia: a comparison of 28-day mortality over the 1-year pandemic in a tertiary university hospital in Italy. Issue 1 (3rd January 2022)

• Record Type: Journal Article
• Authors: Meschiari, Marianna; Cozzi-Lepri, Alessandro; Tonelli, Roberto; Bacca, Erica; Menozzi, Marianna; Franceschini, Erica; Cuomo, Gianluca; Bedini, Andrea; Volpi, Sara; Milic, Jovana; Brugioni, Lucio; Romagnoli, Elisa; Pietrangelo, Antonello; Corradini, Elena; Coloretti, Irene; Biagioni, Emanuela; Busani, Stefano; Girardis, Massimo; Cossarizza, Andrea; Clini, Enrico; Guaraldi, Giovanni; Mussini, Cristina
• Other Names: author non-byline.; Bedini Andrea author non-byline.; Borghi Vanni author non-byline.; Burastero Giulia author non-byline.; Carli Federica author non-byline.; Ciusa Giacomo author non-byline.; Corradi Luca author non-byline.; Gaetano Margherita Di author non-byline.; Faltoni Matteo author non-byline.; Franceschi Giacomo author non-byline.; Orlando Gabriella author non-byline.; Puzzolante Cinzia author non-byline.; Santoro Antonella author non-byline.; Tutone Marco author non-byline.; Yaacoub Dina author non-byline.; Andreotti Alberto author non-byline.; Biagioni Emanuela author non-byline.; Bondi Filippo author non-byline.; Busani Stefano author non-byline.; Chierego Giovanni author non-byline.; Scotti Marzia author non-byline.; Serio Lucia author non-byline.; Bellinazzi Caterina author non-byline.; Borella Rebecca author non-byline.; Biasi Sara De author non-byline.; Gaetano Anna De author non-byline.; Fidanza Lucia author non-byline.; Gibellini Lara author non-byline.; Iannone Anna author non-byline.; Tartaro Domenico Lo author non-byline.; Mattioli Marco author non-byline.; Paolini Annamaria author non-byline.; Fantini Riccardo author non-byline.; Castaniere Ivana author non-byline.; Tabbì Luca author non-byline.; Bruzzi Giulia author non-byline.; Nani Chiara author non-byline.; Pellegrino Maria Rosaria author non-byline.; Manicardi Linda author non-byline.; Moretti Antonio author non-byline.; Vermi Morgana author non-byline.; Cerbone Caterina author non-byline.; Fogliani Rossella author non-byline.; Righini Grazia author non-byline.; Lugli Mario author non-byline.;
• Is Part Of: BMJ open. Volume 12:Issue 1(2022)
• Publication Date: 2022-01-03
• Subjects: COVID-19 -- epidemiology -- respiratory infections; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2021-054069
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objective: The first COVID-19–19 epidemic wave was over the period of February–May 2020. Since 1 October 2020, Italy, as many other European countries, faced a second wave. The aim of this analysis was to compare the 28-day mortality between the two waves among COVID-19 hospitalised patients. Design: Observational cohort study. Standard survival analysis was performed to compare all-cause mortality within 28 days after hospital admission in the two waves. Kaplan-Meier curves as well as Cox regression model analysis were used. The effect of wave on risk of death was shown by means of HRs with 95% CIs. A sensitivity analysis around the impact of the circulating variant as a potential unmeasured confounder was performed. Setting: University Hospital of Modena, Italy. Patients admitted to the hospital for severe COVID-19 pneumonia during the first (22 February–31 May 2020) and second (1 October–31 December 2020) waves were included. Results: During the two study periods, a total of 1472 patients with severe COVID-19 pneumonia were admitted to our hospital, 449 during the first wave and 1023 during the second. Median age was 70 years (IQR 56–80), 37% women, 49% with PaO2 /FiO2 <250 mm Hg, 82% with ≥1 comorbidity, median duration of symptoms was 6 days. 28-day mortality rate was 20.0% (95% CI 16.3 to 23.7) during the first wave vs 14.2% (95% CI 12.0 to 16.3) in the second (log-rank test p value=0.03). After including key predictors of death in the multivariable Cox regression model, the data still strongly suggested a lower 28-day mortality rate in the second wave (aHR=0.64, 95% CI 0.45 to 0.90, p value=0.01). Conclusions: In our hospitalised patients with COVID-19 with severe pneumonia, the 28-day mortality appeared to be reduced by 36% during the second as compared with the first wave. Further studies are needed to identify factors that may have contributed to this improved survival.