Patients Hospitalized for COVID-19 in the Periods of Delta and Omicron Variant Dominance in Greece: Determinants of Severity and Mortality
Authors: Karageorgou Vagia , Papaioannou Andriana I. , Kallieri Maria , Blizou Myrto , Lampadakis Stefanos , Sfika Maria , Krouskos Antonios , Papavasileiou Vasileios , Strakosha Franceska , Vandorou Kalliopi Theoni , Siozos Pavlos , Moustaka Christodoulou Marina , Kontonasiou Georgia , Apollonatou Vasiliki , Antonogiannaki Elvira Markella , Kyriakopoulos Christos , Aggelopoulou Christina , Chronis Christos , Kostikas Konstantinos , Koukaki Evangelia , Sotiropoulou Zoi , Athanasopoulou Athanasia , Bakakos Petros , Schoini Pinelopi , Alevrakis Emmanouil , Poupos Sotirios , Chondrou Evangelia , Tsoukalas Dionisios , Chronaiou Alexia , Tsoukalas George , Koukidou Sofia , Hillas Georgios , Dimakou Katerina , Roukas Konstantinos , Nakou Ifigeneia , Chloros Diamantis , Fouka Evangelia , Papiris Spyros A. , Loukides Stelios 
Published: September 2023

Background: Coronavirus disease 2019 (COVID-19) has been a pandemic since 2020, and depending on the SARS-CoV-2 mutation, different pandemic waves have been observed. The aim of this study was to compare the baseline characteristics of patients in two phases of the pandemic and evaluate possible predictors of mortality. Methods: This is a retrospective multicenter observational study that included patients with COVID-19 in 4 different centers in Greece. Patients were divided into two groups depending on the period during which they were infected during the Delta and Omicron variant predominance. Results: A total of 979 patients (433 Delta, 546 Omicron) were included in the study (median age 67 years (54, 81); 452 [46.2%] female). Compared to the Omicron period, the patients during the Delta period were younger (median age [IQR] 65 [51, 77] vs. 70 [55, 83] years, p < 0.001) and required a longer duration of hospitalization (8 [6, 13] vs. 7 [5, 12] days, p = 0.001), had higher procalcitonin levels (ng/mL): 0.08 [0.05, 0.17] vs. 0.06 [0.02, 0.16], p = 0.005, ferritin levels (ng/mL): 301 [159, 644] vs. 239 [128, 473], p = 0.002, C- reactive protein levels (mg/L): 40.4 [16.7, 98.5] vs. 31.8 [11.9, 81.7], p = 0.003, and lactate dehydrogenase levels (U/L): 277 [221, 375] vs. 255 [205, 329], p < 0.001. The Charlson Comorbidity Index was lower (3 [0, 5] vs. 4 [1, 6], p < 0.001), and the extent of disease on computed tomography (CT) was greater during the Delta wave (p < 0.001). No evidence of a difference in risk of death or admission to the intensive care unit was found between the two groups. Age, cardiovascular events, acute kidney injury during hospitalization, extent of disease on chest CT, D-dimer, and neutrophil/lymphocyte ratio values were identified as independent predictors of mortality for patients in the Delta period. Cardiovascular events and acute liver injury during hospitalization and the PaO2/FiO2 ratio on admission were identified as independent predictors of mortality for patients in the Omicron period. Conclusions: In the Omicron wave, patients were older with a higher number of comorbidities, but patients with the Delta variant had more severe disease and a longer duration of hospitalization.