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. 2023 Nov 2;18(1):933.
doi: 10.4081/mrm.2023.933. eCollection 2023 Jan 17.

Outcomes comparison between the first and the subsequent SARS-CoV-2 waves - a systematic review and meta-analysis

Tulio Caldonazo  1 , Ricardo E Treml  2 , Felipe S L Vianna  3   4 , Panagiotis Tasoudis  5 , Hristo Kirov  1 , Murat Mukharyamov  1 , Torsten Doenst  1 , João M Silva  3   4
Affiliations

Outcomes comparison between the first and the subsequent SARS-CoV-2 waves - a systematic review and meta-analysis

Tulio Caldonazo et al. Multidiscip Respir Med. .

Abstract

Background: In the beginning of the SARS-CoV-2 pandemic, health care professionals dealing with COVID-19 had to rely exclusively on general supportive measures since specific treatments were unknown. The subsequent waves could be faced with new diagnostic and therapeutic tools (e.g., anti-viral medications and vaccines). We performed a meta-analysis and systematic review to compare clinical endpoints between the first and subsequent waves.

Methods: Three databases were assessed. The primary outcome was in-hospital mortality. The secondary outcomes were intensive care unit (ICU) mortality, ICU length of stay (LOS), acute renal failure, extracorporeal membrane oxygenation (ECMO) implantation, mechanical ventilation time, hospital LOS, systemic thromboembolism, myocarditis and ventilator associated pneumonia.

Results: A total of 25 studies with 126,153 patients were included. There was no significant difference for the primary endpoint (OR=0.94, 95% CI 0.83-1.07, p=0.35). The first wave group presented higher rates of ICU LOS (SMD= 0.23, 95% CI 0.11-0.35, p<0.01), acute renal failure (OR=1.71, 95% CI 1.36-2.15, p<0.01) and ECMO implantation (OR=1.64, 95% CI 1.06-2.52, p=0.03). The other endpoints did not show significant differences.

Conclusions: The analysis suggests that the first wave group, when compared with the subsequent waves group, presented higher rates of ICU LOS, acute renal failure and ECMO implantation, without significant difference in in-hospital or ICU mortality, mechanical ventilation time, hospital LOS, systemic thromboembolism, myocarditis or ventilator- associated pneumonia.

Keywords: COVID-19; SARS-CoV-2; critical care; extracorporeal membrane oxygenation.

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Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.
Figure 2.
Figure 2.
Graphical abstract showing the main findings of the analysis.
Figure 3.
Figure 3.
Forest plot for in-hospital mortality. CI, confidence interval; OR, odds ratio.
Figure 4.
Figure 4.
Forest plot for ICU mortality. CI, confidence interval; OR, odds ratio.
Figure 5.
Figure 5.
Forest plot for ICU length of stay. CI, confidence interval; SMD, standard mean difference.
Figure 6.
Figure 6.
Forest plot for acute renal failure. CI, confidence interval; OR, odds ratio.
Figure 7.
Figure 7.
Forest plot for ECMO implantation. CI, confidence interval; OR, odds ratio.
See this image and copyright information in PMC

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