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. 2023 Mar 1;8(3):153.
doi: 10.3390/tropicalmed8030153.

Comparison of COVID-19 Severity and Mortality Rates in the First Four Epidemic Waves in Hungary in a Single-Center Study with Special Regard to Critically Ill Patients in an Intensive Care Unit

Éva Nagy  1   2 , Péter Golopencza  2 , István Barcs  1 , Endre Ludwig  2   3   4
Affiliations

Comparison of COVID-19 Severity and Mortality Rates in the First Four Epidemic Waves in Hungary in a Single-Center Study with Special Regard to Critically Ill Patients in an Intensive Care Unit

Éva Nagy et al. Trop Med Infect Dis. .

Abstract

Different variants of coronavirus 2 (SARS-CoV-2), a virus responsible for severe acute respiratory syndrome, caused several epidemic surges in Hungary. The severity of these surges varied due to the different virulences of the variants. In a single-center, retrospective, observational study, we aimed to assess and compare morbidities and mortality rates across the epidemic waves I to IV with special regard to hospitalized, critically ill patients. A significant difference was found between the surges with regard to morbidity (p < 0.001) and ICU mortality (p = 0.002), while in-hospital mortality rates (p = 0.503) did not differ significantly. Patients under invasive ventilation had a higher incidence of bloodstream infection (aOR: 8.91 [4.43-17.95] p < 0.001), which significantly increased mortality (OR: 3.32 [2.01-5.48]; p < 0.001). Our results suggest that Waves III and IV, caused by the alpha (B.1.1.7) and delta (B.1.617.2) variants, respectively, were more severe in terms of morbidity. The incidence of bloodstream infection was high in critically ill patients. Our results suggest that clinicians should be aware of the risk of bloodstream infection in critically ill ICU patients, especially when invasive ventilation is used.

Keywords: COVID-19 critically ill patients; COVID-19 epidemiology; COVID-19 waves; ICU; SARS-CoV-2 variants; bloodstream infections.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Epidemic dynamics.
Figure 2
Figure 2
Hospital loads during the epidemic waves I–IV.
Figure 3
Figure 3
(a) Number of and mortality among ICU patients between 2018 and 2021. (b) Number and proportion of ICU patients with COVID-19 in Waves I–IV.
Figure 4
Figure 4
Distribution of ICU patients treated by ventilation method in the epidemic waves. NRB—non-rebreather mask; HFNO—high-flow nasal oxygen; NIV—non-invasive ventilation; IMV—invasive mechanical ventilation; APRV—airway pressure release ventilation; ECMO—extracorporeal membrane oxygenation.
See this image and copyright information in PMC

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