Inpatient COVID-19 mortality has reduced over time: Results from an observational cohort

• DOI: 10.1371/journal.pone.0261142
• Publication Date: 2022-01-13T18:37:17Z
• Authors: Katie Bechman; Mark Yates; Kirsty Mann; Deepak Nagra; Laura-Jane Smith; Andy I. Rutherford; Amit Patel; Jimstan Periselneris; David Walder; Richard J. B. Dobson; Zeljko Kraljevic; James H. T. Teo; William Bernal; Richard Barker; James B. Galloway; Sam Norton
• Keywords: Pandemic

Background The Covid-19 pandemic in the United Kingdom has seen two waves; first starting March 2020 and second late October 2020. It is not known whether outcomes for those admitted with severe Covid were different waves. Methods study population comprised all patients to a 1,500-bed London Hospital Trust between 2021, who tested positive by PCR within 3-days of admissions. Primary outcome was death 28-days admission. Socio-demographics (age, sex, ethnicity), hypertension, diabetes, obesity, baseline physiological observations, CRP, neutrophil, chest x-ray abnormality, remdesivir dexamethasone incorporated as co-variates. Proportional subhazards models compared mortality risk wave 1 2. Cox-proportional hazard model propensity score adjustment used compare prescribed dexamethasone. Results There 3,949 COVID-19 admissions, 3,195 hospital discharges 733 deaths. notable differences age, ethnicity, comorbidities, admission disease severity Twenty-eight-day higher during (26.1% versus 13.1%). Mortality adjusted co-variates significantly lower 2 [adjSHR 0.49 (0.37, 0.65) p<0.001]. Analysis treatment impact did show statistically effects [HR 0.84 (95%CI 0.65, 1.08), p = 0.17] or 0.97 0.70, 1.35) 0.87]. Conclusion been substantial improvements wave, even accounting demographics, comorbidity, severity. Neither nor appeared be key explanatory factors, although there may unmeasured confounding present.