Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2022 Jan:146:105031.
doi: 10.1016/j.jcv.2021.105031. Epub 2021 Nov 23.

Wave comparisons of clinical characteristics and outcomes of COVID-19 admissions - Exploring the impact of treatment and strain dynamics

Anna Freeman  1 , Alastair Watson  2 , Paul O'Regan  3 , Oskar Wysocki  4 , Hannah Burke  2 , Andre Freitas  5 , Robert Livingstone  2 , Ahilanadan Dushianthan  6 , Michael Celinski  2 , James Batchelor  7 , Hang Phan  8 , Florina Borca  9 , Paul Fitzpatrick  3 , Donal Landers  3 , Tom Ma Wilkinson  2
Affiliations
Observational Study

Wave comparisons of clinical characteristics and outcomes of COVID-19 admissions - Exploring the impact of treatment and strain dynamics

Anna Freeman et al. J Clin Virol. 2022 Jan.

Abstract

Objectives: Dexamethasone has now been incorporated into the standard of care for COVID-19 hospital patients. However, larger intensive care unit studies have failed to show discernible improvements in mortality in the recent wave. We aimed to investigate the impacts of these factors on disease outcomes in a UK hospital study.

Methods: This retrospective observational study reports patient characteristics, interventions and outcomes in COVID-19 patients from a UK teaching hospital; cohort 1, pre 16th June-2020 (pre-dexamethasone); cohort 2, 17th June to 30th November-2020 (post-dexamethasone, pre-VOC 202,012/01 as dominant strain); cohort 3, 1st December-2020 to 3rd March-2021 (during establishment of VOC202012/01 as the dominant strain).

Results: Dexamethasone treatment was more common in cohorts 2 and 3 (42.7% and 51.6%) compared with cohort 1 (2.5%). After adjusting for risk, odds of death within 28 days were 2-fold lower in cohort 2 vs 1 (OR:0.47,[0.27,0.79],p = 0.006). Mortality was higher cohort 3 vs 2 (20% vs 14%); but not significantly different to cohort 1 (OR: 0.86,[0.64, 1.15],p = 0.308).

Conclusions: The real world finding of lower mortality following dexamethasone supports the published trial evidence and highlights ongoing need for research with introduction of new treatments and ongoing concern over new COVID-19 variants.

Keywords: COVID-19 variants; COVID-19 waves; Dexamethasone.

PubMed Disclaimer

Figures

Fig. 1:
Fig. 1
Changes in prevalence of new COVID-19 variant, SE England. Estimates from the ONS (11) suggest that the prevalence of the novel COVID-19 variant (VOC202012/01) within the community in South East England started to become dominant from December 2020 onward.
Fig. 2:
Fig. 2
(A) 28-day mortality according to first risk score and cohort. Curves represent predicted probability of death within 28 days of first positive test according to cohort based on a binomial logistic regression model fitted to observed data. Shaded areas indicate 95% confidence interval. (B) Risk-adjusted mortality according to cohort. Odds of death within 28 days of first positive test based on a logistic regression model including first risk score and cohort.
See this image and copyright information in PMC

References

    1. Guan W.J., Liang W.H., Zhao Y., Liang H.R., Chen Z.S., Li Y.M., et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur. Respir. J. 2020;55(5) - PMC - PubMed
    1. Guan W-j, Ni Z-y, Hu Y., Liang W-h, Ou C-q, He J-x, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. New Eng. J. Med. 2020;382(18):1708–1720. - PMC - PubMed
    1. Wilkinson T., Dixon R., Page C., Carroll M., Griffiths G., Ho Ll-P, et al. ACCORD: a multicentre, seamless, phase 2 adaptive randomisation platform study to assess the efficacy and safety of multiple candidate agents for the treatment of COVID-19 in hospitalised patients: a structured summary of a study protocol for a randomised controlled trial. Trials. 2020;21(1):691. - PMC - PubMed
    1. Horby P., Lim W.S., Emberson J.R., Mafham M., Bell J.L., Linsell L., et al. Dexamethasone in hospitalized patients with Covid-19. New Eng. J. Med. 2020;384(8):693–704. - PMC - PubMed
    1. Monk P.D., Marsden R.J., Tear V.J., Brookes J., Batten T.N., Mankowski M., et al. Safety and efficacy of inhaled nebulised interferon beta-1a (SNG001) for treatment of SARS-CoV-2 infection: a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet Respir. Med. 2021;9(2):196–206. - PMC - PubMed

Publication types

Supplementary concepts