Trends of In-Hospital and Icu Mortality in Covid-19 Patients Over the Fourth and Fifth Covid-19 Surges in Iran: A Retrospective Cohort Study From Iran Publisher Pubmed



Abdi S¹ ; Nemati S¹ ; Nederi Darbaghshahi N² ; Mohammadi M² ; Saeedi E³ ; Naji P¹ ; Taheri N¹ ; Qandian A⁴ ; Joshang N⁴ ; Fattahi P^{1, 5} ; Namdar P⁶ ; Vand Rajabpour M¹
Source: International Journal for Quality in Health Care Published:2022

Abstract

Objective: The current study aimed to investigate the temporal trend of in-hospital and intensive care unit (ICU) mortality of coronavirus disease 2019 (COVID-19) patients over 6 months in the spring and summer of 2021 in Iran. Design: We performed an observational retrospective cohort study. Setting: Qazvin Province- Iran during 6 month from April to September 2021. Participants: All 14355 patients who were hospitalized with confirmed COVID-19 in hospitals of Qazvin Province. Intervention: No intervention. Main outcome measures: The trends of overall in-hospital mortality and ICU mortality were the main outcome of interest. We obtained crude and adjusted in-hospital and ICU mortality rates for each month of admission and over surge and lull periods of the disease. Results: The overall in-hospital mortality, early mortality and ICU mortality were 8.8%, 3.2% and 67.6%, respectively. The trend for overall mortality was almost plateau ranging from 6.5% in July to 10.7% in April. The lowest ICU mortality was 60.0% observed in April, whereas it reached a peak in August (ICU mortality = 75.7%). Admission on surge days of COVID-19 was associated with an increased risk of overall mortality (Odds ratio = 1.3, 95% confidence interval = 1.1, 1.5). The comparison of surge and lull status showed that the odds of ICU mortality in the surge of COVID-19 was 1.7 higher than in the lull period (P-value < 0.001). Conclusions: We found that the risk of both overall in-hospital and ICU mortality increased over the surge period and fourth and fifth waves of severe acute respiratory syndrome coronavirus 2 infection in Iran. The lack of hospital resources and particularly ICU capacities to respond to the crisis during the surge period is assumed to be the main culprit. © 2022 The Author(s). Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved.