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Observational Study
. 2022 Jan 13;17(1):e0261142.
doi: 10.1371/journal.pone.0261142. eCollection 2022.

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

Katie Bechman  1 , Mark Yates  1 , Kirsty Mann  1 , Deepak Nagra  1 , Laura-Jane Smith  2 , Andy I Rutherford  2 , Amit Patel  2 , Jimstan Periselneris  2 , David Walder  2 , Richard J B Dobson  3   4   5 , Zeljko Kraljevic  3 , James H T Teo  2   3 , William Bernal  2   6 , Richard Barker  1 , James B Galloway  1 , Sam Norton  1   7
Affiliations
Observational Study

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

Katie Bechman et al. PLoS One. .

Abstract

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<0.001]. Analysis of treatment impact did not show statistically different effects of remdesivir [HR 0.84 (95%CI 0.65, 1.08), p = 0.17] or dexamethasone [HR 0.97 (95%CI 0.70, 1.35) p = 0.87].

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Daily Covid-19 admissions and deaths.
Number of daily COVID-19 admissions in blue and 28-day COVID-19 mortality purple by day of admission. Lilac lines represent the end of wave 1 and the beginning of wave 2.
Fig 2
Fig 2. Cumulative incidence of COVID-19 death.
See this image and copyright information in PMC

References

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