Comparison of Clinical, Laboratory, and Radiological Symptoms of Patients Hospitalized in the COVID-19 Wards of Imam Reza Hospital in Mashhad During the First, Second, and Third Peaks of COVID-19

Background: Considering that few studies have investigated the differences in clinical, laboratory, and imaging symptoms of patients with coronavirus disease 2019 (COVID-19) during different peaks of the disease in Iran, the present study compares the patients who were admitted to the COVID-19 departments of Imam Reza Hospital during the first, second, and third peaks of the disease. Methods: In this cross-sectional study, data were collected by reviewing the files of patients with a definite diagnosis of COVID-19 based on the RT-PCR test in Imam Reza Hospital in Mashhad. The patients were divided into three groups based on the time of admission: The first peak from March 2020 to June 2020, the second peak from July to September 2020, and the third peak from October to December 2020. The variables evaluated in this study included demographic information, clinical signs and symptoms, and laboratory and radiological findings. Descriptive qualitative data were reported using frequency tables, while quantitative descriptive data were reported using measures of central tendency and dispersion. A comparison of qualitative data among the three peaks was conducted using the chi-square test, while for quantitative data, the ANOVA test was used followed by appropriate post-hoc tests. Results: A total of 561 patients with an average age of 58.90 ± 16.80 years were included in the study, of which 336 (59.9%) were male. Regarding underlying diseases, significant differences were found in age (P < 0.001), smoking (P < 0.001), diabetes (P = 0.003), high blood pressure (P < 0.001), asthma (P = 0.025), and ischemic heart disease (P < 0.001). For vital signs, significant differences were observed in heart rate (P < 0.001), respiration rate (P < 0.001), diastolic blood pressure (P = 0.010), and SPO2 (P < 0.001). In clinical characteristics, significant differences were found in fever (P < 0.001), nausea (P = 0.011), vomiting (P = 0.031), headache (P < 0.001), weakness (P < 0.001), and sore throat (P < 0.001). In laboratory characteristics, significant differences were observed in white blood cell (WBC) count (P = 0.024), neutrophil percentage (P < 0.001), lymphocyte percentage (P < 0.001), and C-reactive protein (CRP) (P = 0.001). The CT score values of the patients were significantly different between the three peaks. Patient mortality was significantly different across the three peaks. Less than 15% of hospitalized patients died in the first peak, while over 24% died in the second peak and nearly 40% of inpatients died in the third peak. In our study, the first and third surges and the second and third surges had different mortalities. Conclusions: The third and first peaks had the highest and lowest mortality rates, respectively. Underlying diseases and unstable vital signs were more common in the second and third peaks. Patients in the second peak had significantly higher CT scores compared to the other peaks.