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Lookup NU author(s): Melvin JoyORCiD
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).
© Objectives To compare the clinical severity and outcome of hospitalised patients during the two waves of the COVID-19 pandemic in India. Setting A tertiary care referral hospital in South India. Participants Symptomatic SARS CoV-2 reverse transcriptase PCR positive patients presenting to the emergency department during the two waves were recruited. The first wave spanned between April and December 2020 and the second wave between April and May 2021. Primary and secondary outcome measures The primary outcome of interest was mortality. Secondary outcomes included illness severity at presentation, need for oxygen therapy, non-invasive ventilation (NIV) and hospital or intensive care unit admission. Results The mean (SD) age of the 4971 hospitalised patients in the first wave was similar to the 2293 patients in the second wave (52.5±15.4 vs 52.1±15.1 years, p=0.37). When compared with the first wave, during the second wave, a higher proportion of patients presented with critical illness (11% vs 1.1%, p<0.001) and needed supplemental oxygen therapy (n=2092: 42.1% vs n=1459: 63.6%; p<0.001), NIV (n=643; 12.9% vs n=709; 30.9%; p<0.001) or inotropes/vasoactive drugs (n=108; 2.2% vs n=77: 3.4%; p=0.004). Mortality was higher during the second wave (19.2% vs 9.3%; p<0.001). On multivariable regression analysis, age >60 years (risk ratio, RR 2.80; 95% CI 2.12 to 3.70), D-dimer >1000 ng/mL (RR 1.34; 95% CI 1.15 to 1.55), treatment with supplemental oxygen (RR 14.6; 95% CI 8.98 to 23.6) and presentation during the second wave (RR 1.40; 95% CI 1.21 to 1.62) were independently associated with mortality. Conclusion The second wave of the COVID-19 pandemic in India appeared to be associated with more severe presentation and higher mortality when compared with the first wave. Increasing age, elevated D-dimer levels and treatment with supplemental oxygen were independent predictors of mortality.
Author(s): Kundavaram APP, Selvan S, Raja V, Mathiyalagan P, Kanagarajan R, Reddy NP, Rajendiran N, Hazra D, Gunasekaran K, Moorthy M, Lenin A, Mathew D, Iyyadurai R, Varghese GM, Dj C, Joy M, Peter JV
Publication type: Article
Publication status: Published
Journal: BMJ Open
Year: 2022
Volume: 12
Issue: 11
Online publication date: 21/11/2022
Acceptance date: 26/10/2022
Date deposited: 28/07/2023
ISSN (print): 2044-6055
ISSN (electronic): 2044-6055
Publisher: BMJ Publishing Group
URL: https://doi.org/10.1136/bmjopen-2022-062724
DOI: 10.1136/bmjopen-2022-062724
PubMed id: 36410807
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