Surfing the Waves: Differences in Hospitalised COVID-19 Patients across 4 Variant Waves in a Belgian University Hospital
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Sources and Ethical Clearance
2.2. Study Design, Setting, and Duration
2.3. Inclusion Periods
- Period 1 (50 weeks long): pre-Variant Of Concern (‘pre-VOC’): from 03/02/2020 until the end of week 2 (17/01/2021);
- Period 2 (9 weeks long): ‘Alpha’ variant, from the start of week 11 (15/03/2021) until the end of week 20 (23/05/2021);
- Period 3 (23 weeks long): ‘Delta’ variant, from the start of week 27 (05/07/2021) until the end of week 50 (19/12/2021);
- Period 4 (6 weeks long): ‘Omicron’ variant (BA1), from the start of week 1 (03/01/2022) until the end of week 6 (13/02/2022).
2.4. Patient Selection
2.5. Measurements
2.5.1. Vaccination Status
2.5.2. Severity Scores
2.6. Statistical Analyses
3. Results
3.1. Demographic Data and Co-Morbidities, per Variant Wave
3.2. Vaccination Status and Treatment during Admission, per Variant Wave
3.3. Patients’ Outcomes and Severity Scores per Variant Wave
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- ECDC COVID-19 Situation Updates. Available online: https://www.ecdc.europa.eu/en/covid-19/situation-updates (accessed on 1 October 2022).
- Huang, C.; Wang, Y.; Li, X.; Ren, L.; Zhao, J.; Hu, Y.; Zhang, L.; Fan, G.; Xu, J.; Gu, X.; et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020, 395, 497–506. [Google Scholar] [CrossRef] [Green Version]
- Hu, B.; Guo, H.; Zhou, P.; Shi, Z.-L. Characteristics of SARS-CoV-2 and COVID-19. Nat. Rev. Microbiol. 2021, 19, 141–154. [Google Scholar] [CrossRef]
- Brandi, N.; Ciccarese, F.; Rimondi, M.R.; Balacchi, C.; Modolon, C.; Sportoletti, C.; Renzulli, M.; Coppola, F.; Golfieri, R. An Imaging Overview of COVID-19 ARDS in ICU Patients and Its Complications: A Pictorial Review. Diagnostics 2022, 12, 846. [Google Scholar] [CrossRef]
- WHO. Tracking SARS-CoV-2 variants. Available online: https://www.who.int/activities/tracking-SARS-CoV-2-variants (accessed on 1 October 2022).
- Butt, A.A.; Dargham, S.R.; Chemaitelly, H.; Al Khal, A.; Tang, P.; Hasan, M.R.; Coyle, P.V.; Thomas, A.G.; Borham, A.M.; Concepcion, E.G.; et al. Severity of Illness in Persons Infected With the SARS-CoV-2 Delta Variant vs Beta Variant in Qatar. JAMA Intern. Med. 2022, 182, 197. [Google Scholar] [CrossRef]
- Ajmera, P.; Kharat, A.; Dhirawani, S.; Khaladkar, S.M.; Kulkarni, V.; Duddalwar, V.; Lamghare, P.; Rathi, S. Evaluating the Association Between Comorbidities and COVID-19 Severity Scoring on Chest CT Examinations Between the Two Waves of COVID-19: An Imaging Study Using Artificial Intelligence. Cureus 2022, 14. [Google Scholar] [CrossRef] [PubMed]
- Balacchi, C.; Brandi, N.; Ciccarese, F.; Coppola, F.; Lucidi, V.; Bartalena, L.; Parmeggiani, A.; Paccapelo, A.; Golfieri, R. Comparing the first and the second waves of COVID-19 in Italy: Differences in epidemiological features and CT findings using a semi-quantitative score. Emerg. Radiol. 2021, 28, 1055–1061. [Google Scholar] [CrossRef] [PubMed]
- Flisiak, R.; Rzymski, P.; Zarębska-Michaluk, D.; Ciechanowski, P.; Dobrowolska, K.; Rogalska, M.; Jaroszewicz, J.; Szymanek-Pasternak, A.; Rorat, M.; Kozielewicz, D.; et al. Variability in the Clinical Course of COVID-19 in a Retrospective Analysis of a Large Real-World Database. Viruses 2023, 15, 149. [Google Scholar] [CrossRef]
- Harris, P.A.; Taylor, R.; Thielke, R.; Payne, J.; Gonzalez, N.; Conde, J.G. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J. Biomed. Inform. 2009, 42, 377–381. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Meurisse, M.; Van Oyen, H.; Blot, K.; Catteau, L.; Serrien, B.; Klamer, S.; Cauët, E.; Robert, A.; Van Goethem, N. Evaluating Methodological Approaches to Assess the Severity of Infection with SARS-CoV-2 Variants: Scoping Review and Applications on Belgian COVID-19 Data. BMC Infect. Dis. 2022, 22, 1–18. [Google Scholar] [CrossRef]
- Belgium COVID-19 Dashboard—Sciensano › Vaccination. Available online: https://datastudio.google.com/embed/u/0/reporting/c14a5cfc-cab7-4812-848c-0369173148ab/page/p_j1f02pfnpc (accessed on 23 January 2023).
- National Institutes of Health (NIH). COVID-19 Treatment Guidelines, Clinical Spectrum of SARS-CoV-2 Infection. 2021. Available online: https://www.covid19treatmentguidelines.nih.gov/overview/clinical-spectrum/ (accessed on 2 March 2022).
- Cascella, M.; Rajnik, M.; Cuomo, A.; Dulebohn, S.C.; Di Napoli, R. Features, Evaluation, and Treatment of Coronavirus (COVID-19); StatPearls: Tampa, FL, USA, 2022. [Google Scholar]
- Lauring, A.S.; Tenforde, M.W.; Chappell, J.D.; Gaglani, M.; Ginde, A.A.; McNeal, T.; Ghamande, S.; Douin, D.J.; Talbot, H.K.; Casey, J.D.; et al. Clinical severity of, and effectiveness of mRNA vaccines against, covid-19 from omicron, delta, and alpha SARS-CoV-2 variants in the United States: Prospective observational study. BMJ 2022, 376, e069761. [Google Scholar] [CrossRef]
- Maslo, C.; Friedland, R.; Toubkin, M.; Laubscher, A.; Akaloo, T.; Kama, B. Characteristics and Outcomes of Hospitalized Patients in South Africa During the COVID-19 Omicron Wave Compared with Previous Waves. JAMA 2022, 327, 583. [Google Scholar] [CrossRef]
- Feikin, D.R.; Higdon, M.M.; Abu-Raddad, L.J.; Andrews, N.; Araos, R.; Goldberg, Y.; Groome, M.J.; Huppert, A.; O’Brien, K.L.; Smith, P.G.; et al. Duration of effectiveness of vaccines against SARS-CoV-2 infection and COVID-19 disease: Results of a systematic review and meta-regression. Lancet 2022, 399, 924–944. [Google Scholar] [CrossRef] [PubMed]
- Nyberg, T.; Ferguson, N.M.; Nash, S.G.; Webster, H.H.; Flaxman, S.; Andrews, N.; Hinsley, W.; Bernal, J.L.; Kall, M.; Bhatt, S.; et al. Comparative analysis of the risks of hospitalisation and death associated with SARS-CoV-2 omicron (B.1.1.529) and delta (B.1.617.2) variants in England: A cohort study. Lancet 2022, 399, 1303–1312. [Google Scholar] [CrossRef] [PubMed]
- Lin, L.; Liu, Y.; Tang, X.; He, D. The Disease Severity and Clinical Outcomes of the SARS-CoV-2 Variants of Concern. Front. Public Health 2021, 9, 1929. [Google Scholar] [CrossRef] [PubMed]
- Mendiola-Pastrana, I.R.; López-Ortiz, E.; de la Loza-Zamora, J.G.R.; González, J.; Gómez-García, A.; López-Ortiz, G. SARS-CoV-2 Variants and Clinical Outcomes: A Systematic Review. Life 2022, 12, 170. [Google Scholar] [CrossRef] [PubMed]
- Bager, P.; Wohlfahrt, J.; Fonager, J.; Rasmussen, M.; Albertsen, M.; Michaelsen, T.Y.; Møller, C.H.; Ethelberg, S.; Legarth, R.; Button, M.S.F.; et al. Risk of hospitalisation associated with infection with SARS-CoV-2 lineage B.1.1.7 in Denmark: An observational cohort study. Lancet Infect. Dis. 2021, 21, 1507–1517. [Google Scholar] [CrossRef]
- Patone, M.; Thomas, K.; Hatch, R.; Tan, P.S.; Coupland, C.; Liao, W.; Mouncey, P.; Harrison, D.; Rowan, K.; Horby, P.; et al. Mortality and critical care unit admission associated with the SARS-CoV-2 lineage B.1.1.7 in England: An observational cohort study. Lancet Infect. Dis. 2021, 21, 1518–1528. [Google Scholar] [CrossRef]
- Pastick, K.A.; Okafor, E.C.; Wang, F.; Lofgren, S.M.; Skipper, C.P.; Nicol, M.R.; Pullen, M.F.; Rajasingham, R.; McDonald, E.G.; Lee, T.C.; et al. Review: Hydroxychloroquine and Chloroquine for Treatment of SARS-CoV-2 (COVID-19). Open Forum Infect. Dis. 2020, 7, ofaa130. [Google Scholar] [CrossRef] [Green Version]
- Zhou, D.; Dai, S.-M.; Tong, Q. COVID-19: A recommendation to examine the effect of hydroxychloroquine in preventing infection and progression. J. Antimicrob. Chemother. 2020, 75, 1667–1670. [Google Scholar] [CrossRef]
- Abdullah, F.; Myers, J.; Basu, D.; Tintinger, G.; Ueckermann, V.; Mathebula, M.; Ramlall, R.; Spoor, S.; de Villiers, T.; Van der Walt, Z.; et al. Decreased severity of disease during the first global omicron variant covid-19 outbreak in a large hospital in tshwane, south africa. Int. J. Infect. Dis. 2021, 116, 38–42. [Google Scholar] [CrossRef]
- Shuai, H.; Chan, J.F.-W.; Hu, B.; Chai, Y.; Yuen, T.T.-T.; Yin, F.; Huang, X.; Yoon, C.; Hu, J.-C.; Liu, H.; et al. Attenuated replication and pathogenicity of SARS-CoV-2 B.1.1.529 Omicron. Nature 2022, 603, 693–699. [Google Scholar] [CrossRef]
- Wijtvliet, V.; Ledeganck, K.; Peeters, B.; Hellemans, R.; Abramowicz, D. SARS-CoV-2 breakthrough infections in vaccinated kidney transplant recipients: An issue of concern. Clin. Kidney J. 2021, 14, 2261–2262. [Google Scholar] [CrossRef] [PubMed]
- Van Goethem, N.; Chung, P.Y.J.; Meurisse, M.; Vandromme, M.; De Mot, L.; Brondeel, R.; Stouten, V.; Klamer, S.; Cuypers, L.; Braeye, T.; et al. Clinical Severity of SARS-CoV-2 Omicron Variant Compared with Delta among Hospitalized COVID-19 Pa-tients in Belgium during Autumn and Winter Season 2021–2022. Viruses 2022, 14, 1297. [Google Scholar] [CrossRef] [PubMed]
- Demuyser, T.; Seyler, L.; Buttiens, R.; Soetens, O.; Van Nedervelde, E.; Caljon, B.; Praet, J.; Seyler, T.; Boeckmans, J.; Meert, J.; et al. Healthcare-Associated COVID-19 across Five Pandemic Waves: Prediction Models and Genomic Analyses. Viruses 2022, 14, 2292. [Google Scholar] [CrossRef] [PubMed]
Period of Admission | Pre-VOC | Alpha | Delta | Omicron | p-Value |
---|---|---|---|---|---|
Number of patients (% within wave) | 814 | 174 | 265 | 73 | - |
Women | 341 (41.9%) | 72 (41.4%) | 121 (45.7%) | 36 (49.3%) | 0.467 |
Ethnicity § | <0.001 | ||||
Age | 65.3 ± 17.3 | 62.1 ± 16.4 | 58.6 ± 18.1 | 69.6 ± 19.1 | <0.001 * |
Smoking status: | 0.010 | ||||
Never | 289 (61.1%) | 112 (73.7%) | 150 (71.8%) | 32 (65.1%) | |
Former | 149 (31.5%) | 32 (21.1%) | 46 (22.0%) | 23 (37.7%) | |
Current | 35 (7.4%) | 11 (5.3%) | 13 (6.2%) | 6 (9.8%) | |
BMI § | 28.2 ± 5.7 | 28.9 ± 5.5 | 28.5 ± 6.1 | 27.7 ± 6.2 | 0.084 |
Lung disease | 143 (17.7%) | 38 (22.2%) | 58 (26.2%) | 26 (36.1%) | <0.001 * |
Cancer | 44 (5.5%) | 15 (8.7%) | 15 (6.8%) | 14 (19.4%) | <0.001 * |
Hypertension | 352 (43.7%) | 86 (50.0%) | 92 (45.3%) | 39 (54.2%) | 0.198 |
Dementia | 50 (6.2%) | 4 (2.4%) | 11 (6.3%) | 3 (4.4%) | 0.239 |
Diabetes | 237 (29.3%) | 49 (28.5%) | 48 (23.4%) | 18 (26.5%) | 0.407 |
Heart disease | 199 (24.7%) | 42 (24.4%) | 39 (19.7%) | 24 (33.8%) | 0.121 |
Neuromuscular disorder | 26 (3.2%) | 6 (3.6%) | 5 (2.8%) | 4 (5.8%) | 0.675 |
Renal disease | 125 (15.5%) | 31 (18.0%) | 26 (11.7%) | 13 (18.3%) | 0.286 |
Rheumatological disease | 46 (6.1%) | 5 (2.9%) | 15 (6.8%) | 4 (5.8%) | 0.380 |
Stroke | 28 (3.7%) | 4 (2.4%) | 6 (3.4%) | 4 (6.1%) | 0.590 |
Clinical Frailty Scale | 3.6 ± 1.6 | 3.3 ± 1.7 | 4.6 ± 3.4 | 5.3 ± 2.9 | <0.001 * |
Period of Admission | Pre-VOC | Alpha | Delta | Omicron | p-Value |
---|---|---|---|---|---|
Number of patients (% within wave) | 814 | 174 | 265 | 73 | - |
COVID-19 vaccination status | <0.001 * | ||||
Not vaccinated | 812 (99.8%) | 150 (86.2%) | 173 (65.3%) | 26 (35.6%) | * |
Partially vaccinated | 2 (0.2%) | 20 (11.5%) | 4 (1.5%) | 0 (0.0%) | * |
Fully vaccinated | (0.0%) | 3 (1.7%) | 77 (29.1%) | 13 (17.8%) | * |
Booster | (0.0%) | (0.0%) | 10 (3.8%) | 32 (43.8%) | * |
Unknown vaccination status | 0 (0.0%) | 1 (0.6%) | 1 (0.4%) | 2 (2.7%) | |
Specific COVID-19 treatments | |||||
Nasal oxygen | 738 (90.7%) | 159 (91.4%) | 249 (94.0%) | 70 (95.9%) | 0.200 |
Prone position | 49 (6.0%) | 36 (20.7%) | 33 (12.5%) | 7 (9.6%) | <0.001 * |
Antiviral | 36 (4.7%) | 4 (2.3%) | 0 (0.0%) | 0 (0.0%) | <0.001 |
Hydroxychloroquine | 303 (39.5%) | 0 (0.0%) | 1 (0.4%) | 1 (1.4%) | <0.001 |
Corticosteroid | 326 (42.5%) | 152 (87.9%) | 233 (88.3%) | 54 (76.1%) | <0.001 |
Il6-blockade | 0 (0.0%) | 1 (0.6%) | 14 (5.3%) | 6 (8.5%) | <0.001 |
Antibiotics | 345 (45.0%) | 63 (36.4%) | 99 (37.5%) | 38 (53.5%) | 0.013 |
LMWH | 331 (43.2%) | 156 (90.2%) | 231 (87.5%) | 58 (81.7%) | <0.001 |
Period of Admission | Pre-VOC | Alpha | Delta | Omicron | p-Value |
---|---|---|---|---|---|
Number of patients (% within wave) | 814 | 174 | 265 | 73 | - |
Outcome | |||||
Died | 146 (17.9%) | 27 (15.5%) | 30 (11.3%) | 10 (13.7%) | 0.076 |
Discharged | 668 (82.1%) | 147 (84.5%) | 235 (88.7%) | 63 (86.3%) | |
Cause of death | |||||
COVID-19 | 143 (97.9%) | 25 (96.2%) | 14 (66.7%) | 4 (100.0%) | <0.001 |
COVID-19 + other | 1 (0.7%) | 0 (0.0%) | 6 (28.6%) | 0 (0.0%) | |
Other | 2 (1.4%) | 1 (3.8%) | 1 (4.8%) | 0 (0.0%) | |
LOS (in days) | 12.8 ± 21.7 | 18.7 ± 29.5 | 11.6 ± 14.7 | 12.9 ± 15.2 | 0.028 * |
ICU admission | 192 (23.6%) | 62 (35.6%) | 74 (27.9%) | 10 (13.7%) | <0.001 * |
ICU LOS (in days) | 14.8 ± 20.1 | 22.4 ± 25.6 | 16.9 ± 19.2 | 19.3 ± 15.2 | 0.007 * |
NIH Severity score | 0.022 * | ||||
Mild | 10 (1.2%) | 2 (1.1%) | 3 (1.1%) | 1 (1.4%) | |
Moderate | 81 (10.0%) | 14 (8.0%) | 30 (11.3%) | 11 (15.1%) | |
Severe | 434 (53.3%) | 75 (43.1%) | 147 (55.5%) | 45 (61.6%) | |
Critical | 289 (35.5%) | 83 (47.7%) | 85 (32.1%) | 16 (21.9%) | |
Complications | |||||
None | 378 (49.3%) | 64 (37.0%) | 159 (60.2%) | 32 (45.1%) | <0.001 |
ARDS | 41 (5.0%) | 22 (12.6%) | 12 (4.5%) | 1 (1.4%) | <0.001 |
Pneumonia (sec. bacterial) | 82 (10.1%) | 31 (17.8%) | 24 (9.1%) | 8 (11.0%) | 0.018 |
Sepsis | 35 (4.3%) | 11 (6.3%) | 3 (1.1%) | 0 (0.0%) | 0.008 |
Heart failure | 41 (5.3%) | 24 (13.9%) | 6 (2.3%) | 2 (2.8%) | <0.001 |
Multiorgan failure | 7 (0.9%) | 8 (4.6%) | 1 (0.4%) | 0 (0.0%) | <0.001 |
Acute renal injury | 119 (14.6%) | 17 (9.8%) | 6 (2.3%) | 1 (1.4%) | <0.001 |
Thrombotic event (DVT or PE) | 21 (2.6%) | 7 (4.0%) | 6 (2.3%) | 3 (4.1%) | 0.605 |
Respiratory failure | 97 (12.6%) | 45 (26.0%) | 28 (10.6%) | 8 (11.3%) | <0.001 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Seyler, L.; Van Nedervelde, E.; De Cock, D.; Mann, C.; Pien, K.; Allard, S.D.; Demuyser, T. Surfing the Waves: Differences in Hospitalised COVID-19 Patients across 4 Variant Waves in a Belgian University Hospital. Viruses 2023, 15, 618. https://doi.org/10.3390/v15030618
Seyler L, Van Nedervelde E, De Cock D, Mann C, Pien K, Allard SD, Demuyser T. Surfing the Waves: Differences in Hospitalised COVID-19 Patients across 4 Variant Waves in a Belgian University Hospital. Viruses. 2023; 15(3):618. https://doi.org/10.3390/v15030618
Chicago/Turabian StyleSeyler, Lucie, Els Van Nedervelde, Diederik De Cock, Claudia Mann, Karen Pien, Sabine D. Allard, and Thomas Demuyser. 2023. "Surfing the Waves: Differences in Hospitalised COVID-19 Patients across 4 Variant Waves in a Belgian University Hospital" Viruses 15, no. 3: 618. https://doi.org/10.3390/v15030618
APA StyleSeyler, L., Van Nedervelde, E., De Cock, D., Mann, C., Pien, K., Allard, S. D., & Demuyser, T. (2023). Surfing the Waves: Differences in Hospitalised COVID-19 Patients across 4 Variant Waves in a Belgian University Hospital. Viruses, 15(3), 618. https://doi.org/10.3390/v15030618