Seasonal COVID-19 surge related hospital volumes and case fatality rates

BMC Infectious Diseases

Bernice Coleman¹  Margo B. Minissian¹  Roy Lan²  Susan Cheng³  Joseph E. Ebinger³  Richard Riggs⁴  Pamela Roberts⁵  Tod Davis⁶  Eunice Park⁶  Patrick Botting⁷  Nancy Sun⁷  Matthew Driver⁷ 

[1] Brawerman Nursing Institute and Nursing Research Department, Cedars-Sinai Medical Center, Los Angeles, CA, USA;College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA;Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA;Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA;Department of Medical Affairs, Cedars-Sinai Medical Center, Los Angeles, CA, USA;Department of Medical Affairs, Cedars-Sinai Medical Center, Los Angeles, CA, USA;Department of Biomedical Sciences, Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA;Enterprise Data Intelligence, Cedars-Sinai Medical Center, Los Angeles, California, USA;Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA;

关键词: COVID-19;    Surge;    Case fatality;   

DOI  :  10.1186/s12879-022-07139-2

来源: Springer

【 摘 要 】

BackgroundSeasonal and regional surges in COVID-19 have imposed substantial strain on healthcare systems. Whereas sharp inclines in hospital volume were accompanied by overt increases in case fatality rates during the very early phases of the pandemic, the relative impact during later phases of the pandemic are less clear. We sought to characterize how the 2020 winter surge in COVID-19 volumes impacted case fatality in an adequately-resourced health system.MethodsWe performed a retrospective cohort study of all adult diagnosed with COVID-19 in a large academic healthcare system between August 25, 2020 to May 8, 2021, using multivariable logistic regression to examine case fatality rates across 3 sequential time periods around the 2020 winter surge: pre-surge, surge, and post-surge. Subgroup analyses of patients admitted to the hospital and those receiving ICU-level care were also performed. Additionally, we used multivariable logistic regression to examine risk factors for mortality during the surge period.ResultsWe studied 7388 patients (aged 52.8 ± 19.6 years, 48% male) who received outpatient or inpatient care for COVID-19 during the study period. Patients treated during surge (N = 6372) compared to the pre-surge (N = 536) period had 2.64 greater odds (95% CI 1.46–5.27) of mortality after adjusting for sociodemographic and clinical factors. Adjusted mortality risk returned to pre-surge levels during the post-surge period. Notably, first-encounter patient-level measures of illness severity appeared higher during surge compared to non-surge periods.ConclusionsWe observed excess mortality risk during a recent winter COVID-19 surge that was not explained by conventional risk factors or easily measurable variables, although recovered rapidly in the setting of targeted facility resources. These findings point to how complex interrelations of population- and patient-level pandemic factors can profoundly augment health system strain and drive dynamic, if short-lived, changes in outcomes.

【 授权许可】

CC BY