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. 2024 Mar 7;19(3):e0299607.
doi: 10.1371/journal.pone.0299607. eCollection 2024.

Temporal trends of severity and outcomes of critically ill patients with COVID-19 after the emergence of variants of concern: A comparison of two waves

Daniela Helena Machado Freitas  1 , Eduardo Leite Vieira Costa  1 , Natalia Alcantara Zimmermann  1 , Larissa Santos Oliveira Gois  1 , Mirella Vittig Alves Anjos  1 , Felipe Gallego Lima  2 , Pâmela Santos Andrade  3 , Daniel Joelsons  4 , Yeh-Li Ho  4 , Flávia Cristina Silva Sales  4   5 , Ester Cerdeira Sabino  4   5 , Carlos Roberto Ribeiro Carvalho  1 , Juliana Carvalho Ferreira  1
Affiliations

Temporal trends of severity and outcomes of critically ill patients with COVID-19 after the emergence of variants of concern: A comparison of two waves

Daniela Helena Machado Freitas et al. PLoS One. .

Abstract

Background: The emergence of SARS-CoV-2 variants led to subsequent waves of COVID-19 worldwide. In many countries, the second wave of COVID-19 was marked by record deaths, raising the concern that variants associated with that wave might be more deadly. Our aim was to compare outcomes of critically-ill patients of the first two waves of COVID-19.

Methods: This retrospective cohort included critically-ill patients admitted between March-June 2020 and April-July 2021 in the largest academic hospital in Brazil, which has free-access universal health care system. We compared admission characteristics and hospital outcomes. The main outcome was 60-day survival and we built multivariable Cox model based on a conceptual causal diagram in the format of directed acyclic graph (DAG).

Results: We included 1583 patients (1315 in the first and 268 in the second wave). Patients in the second wave were younger, had lower severity scores, used prone and non-invasive ventilatory support more often, and fewer patients required mechanical ventilation (70% vs 80%, p<0.001), vasopressors (60 vs 74%, p<0.001), and dialysis (22% vs 37%, p<0.001). Survival was higher in the second wave (HR 0.61, 95%CI 0.50-0.76). In the multivariable model, admission during the second wave, adjusted for age, SAPS3 and vaccination, was not associated with survival (aHR 0.85, 95%CI 0.65-1.12).

Conclusions: In this cohort study, patients with COVID-19 admitted to the ICU in the second wave were younger and had better prognostic scores. Adjusted survival was similar in the two waves, contrasting with record number of hospitalizations, daily deaths and health system collapse seen across the country in the second wave. Our findings suggest that the combination of the burden of severe cases and factors such as resource allocation and health disparities may have had an impact in the excess mortality found in many countries in the second wave.

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Conflict of interest statement

Dr. Ferreira reports personal fees from Medtronic, outside the submitted work; Dr. Costa reports personal fees from Timpel, personal fees from Magnamed, outside the submitted work; Dr. Ho reports personal fees from Pan‐American Health Organization, outside the submitted work. This does not alter our adherence to PLOS ONE policies on sharing data and materials. The other authors have no conflict of interest to disclose.

Figures

Fig 1
Fig 1. Study participant flow chart.
Flow of potentially eligible participants in the study, and final numbers included and analyzed. ICU: Intensive Care Unit; COVID-19: Coronavirus Disease 2019.
Fig 2
Fig 2. Hospital 60-day survival according to year of admission.
Solid red line represents survival of patients who were admitted in 2020 (first wave) and solid blue line represents survival of patients who were admitted in 2021 (second wave). (A) Unadjusted survival, logrank p<0.001 and HR 0.61, 95%CI 0.50–0.76. (B) Survival adjusted by age, SAPS 3 and vacination (aHR 0.85, 95%CI 0.65–1.12). The p values were obtained with Cox proportional hazards models.
See this image and copyright information in PMC

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