Changes in admissions to Internal Medicine for acute respiratory infections during 2015-2020 and burden of the SARS-CoV-2 pandemic

ABSTRACT

Background and Aim: Respiratory infections are a leading cause of admission to Internal Medicine (IM) wards, and the 2020 SARSCoV- 2 pandemic dramatically increased this burden. Aim of our study was to assess the changes in admissions to IM for respiratory infections over the past 5 years and the impact on patient outcomes. Methods: All admissions to IM for acute pneumonia (AP) during 2015-2020 were included in a prospective database. Demographic and clinical data, length of stay (LOS) and outcome were analysed. Testing for SARS-CoV-2 began for all febrile patients in March 2020. Results: 745 admissions for AP were included in the analysis (males, 50.8%, mean age 76.5±15.4 years, median LOS 9 days, range 0-57). Admissions to IM for AP rose from 14.7% in 2015 to 20.1% in 2019 (18% overall), vs 27.2% in 2020 (p<0.001). In 2015-2019, 32% of admissions occurred in the first quarter vs 24.1% in 2020 (p=0.001). During 2020, 56 AP were SARS-CoV- 2-positive (38.6%, 95% in the fourth quarter). SARS-CoV-2 patients were younger and had a higher rate of intensive care therapy. Mean LOS in 2020 was 12.7±10.0 vs 10.9±7.6 days in 2015- 2019 (p=0.01). In-hospital mortality was not significantly different, although negative outcomes in the fourth quarter were significantly higher in 2020 (28.1% vs 15.1%, p=0.02). Conclusions: Admissions to IM for AP have been increasing even before the onset of the SARS-CoV-2 pandemic. In 2020 urgent admissions for AP were significantly higher than in previous years, requiring greater LOS, although SARS-CoV-2 infections were concentrated in the fourth quarter.