Analysing COVID treatment outcomes in dedicated wards at a large university hospital in northern Poland. A result-based observational study
Authors: Palus Damian Krystian , Gołębiewska Martyna Ewa , Piątek Olga , Majeranowski Alan , Owczuk Radosław , Kuziemski Krzysztof , Stefaniak Tomasz 
Published: July 2022

Introduction

Presenting outcomes of patients hospitalised for coronavirus disease (COVID-19) should be put in context and comparison with other facilities. Number of statistical parameters can be used to compare effectiveness of treatment, however varied methodology applied in studies can impede or hinder a reliable comparison. The aim of this study is to present outcomes of COVID-19 treatment in our facility using simplest parameters allowing for intercenter comparison - case fatality ratio (CFR), length of stay (LOS) and transparent patients’ characteristics, and to discuss factors affecting mortality in COVID-19.

Methods

The data were collected from patients hospitalized in COVID-19 general and ICU isolation wards in the University Clinical Centre (UCC) in Gdansk, Poland, from November 2020 to June 2021, using a computer-based patient record system. The group consisted of 642 patients – 144 (39,1 %) were women and 391 (60,9 %) were men, with a median age of 69 (IQR 59-78) years. Values of LOS and CFR were calculated and analysed.

Results

Overall CFR for the analysed period was 24,8 %, varying from 19,9 % in January to May 2021 to 33,8 % in November to December 2020. CFR was 18,9 % in general ward and 70,7 % in ICU. All ICU patients required intubation and mechanical ventilation, and forty-four (75,9 %) of them developed acute respiratory distress syndrome (ARDS). Average length of stay was 13,1 (± 7,1) days.

Conclusion

CFR in the general ward in UCC was analogous to published outcomes, but higher in our ICU ward. It resulted from more rigorous ICU admittance criteria in UCC compared to other facilities, which corresponds with patients’ severe clinical condition and unfavourable prognosis. Heterogeneity of methods assessing initial clinical condition in different facilities makes a meaningful intercenter comparison challenging. In this study, we propose simple and transparent statistical and clinical parameters applicable in an intercenter analysis.

What is already known on this topic - the outbreak of global pandemic caused by novel coronavirus SARS-CoV-2 has strained healthcare systems all over the world. Healthcare workers faced new challenges, as organisational, structural, and personal flaws were unearthed in the process. In subsequent waves the number of hospitalisations increased together with the death number in the ICUs. As we come to terms with a new disease, numerous studies reports, analyse and assess COVID-19 treatment outcomes

What this study adds - COVID-19 treatment outcomes in ICU in our facility contrast with most of the published reports. We analyse the influence of some commonly omitted under-examined factors and propose simple and applicable parameters to compare results, such as CFR and LOS, enabling a meaningful intercenter comparison.

How this study might affect research, practice, or policy - inclusion of CFR and LOS in studies on COVID-19 would remove significant bias and enable more robust evaluation of therapeutic interventions and outcomes. In this study we also discuss heterogeneity of admission criteria and show how their influence on treatment outcomes.