Journal of Mazandaran University of Medical Sciences (Aug 2024)
Analysis of Clinical and Paraclinical Findings and Outcomes of COVID-19 Patients Admitted to Intensive Care Units in a Referral Hospital during the First to Fifth Waves
Abstract
Background and purpose: In late December 2019, pneumonia originating from nCOV-2019 spread rapidly around the world, and in March 2020, the World Health Organization officially declared it a pandemic and chose the name "COVID-19" for the resulting disease. A significant proportion of COVID-19 patients experience severe pulmonary complications and life-threatening conditions that necessitate respiratory support and admission to the intensive care unit (ICU). Since the detection of the first case of COVID-19 in Iran, the country has experienced several waves, with different strains of the coronavirus prevailing in each wave. According to the studies conducted in this field, in the first wave, the alpha strain (B.1.1) 7), the second wave of the beta strain (B.1.351), the third wave of the gamma strain (P.1), the fourth wave of the delta strain (B.1.617.2) and in the fifth wave the Amicron strain (B.1.1.529) of the strain were dominant in patients. This study aims to evaluate the clinical and paraclinical findings, as well as the outcomes, of COVID-19 patients admitted to the intensive care units at a referral teaching hospital in northern Iran during the first through fifth waves of the pandemic. Materials and methods: This research is a descriptive-analytical retrospective study that was conducted on all patients with COVID-19 who were hospitalized in the ICU of Razi Qaemshahr Hospital (Infectious Diseases Referral Center of Mazandaran Province) in first to fifth waves. Personal information, underlying diseases, time from the onset of symptoms to a hospital visit, laboratory tests, and length of stay of the patient in the intensive care unit was collected through dossier reading and spss25 software was used for statistical analysis. Results: Out of the 304 patients admitted to the ICU during the first through fifth waves of the COVID-19 outbreak, 50.3% were male. The age range of the patients was from 22 years to 98 years with an average of 65.14±15.08. 244 patients had at least one underlying disease. So 41% of the patients had diabetes and 50% had blood HTN. Among 244 patients with underlying disease, only 28 patients recovered and 216 patients died, which difference was significant (P=0.01). The second wave had the highest number of patients (25.7%), while the third wave had the lowest (16.4%). The average hemoglobin level differed significantly between the second and fourth waves, being 1.37 units lower in the fourth wave. The mortality rates varied significantly across the different waves (P<0.001), with a rate of 100% in wave 1, 85.9% in wave 2, 82% in wave 3, 64.3% in wave 4, and 93% in wave 5. Regarding underlying health conditions, no significant differences were observed among patients across waves 1 to 5. Notably, among the 244 patients with underlying diseases, only 28 recovered, while 216 passed away (P= 0.01). Conclusion: Male Gender and underlying conditions, particularly diabetes and heart failure, are influential factors in determining the prognosis and severity of the disease. The mortality in the fourth wave has decreased significantly and the maximum rate of recovery of patients was in this wave.
