Yegorov Sergey, Goremykina Maiya, Ivanova Raifa, Good Sara V, Babenko Dmitriy, Shevtsov Alexandr, MacDonald Kelly S, Zhunussov Yersin
School of Sciences and Humanities, Nazarbayev University, 53 Kabanbay Batyr Ave, Nur-Sultan 010000, Kazakhstan.
Michael G. DeGroote Institute for Infectious Disease Research, Faculty of Health Sciences, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada.
Lancet Reg Health Eur. 2021 May;4:100096. doi: 10.1016/j.lanepe.2021.100096. Epub 2021 Apr 16.
The earliest coronavirus disease-2019 (COVID-19) cases in Central Asia were announced in March 2020 by Kazakhstan. Despite the implementation of aggressive measures to curb infection spread, gaps remain in the understanding of the clinical and epidemiologic features of the regional pandemic.
We did a retrospective, observational cohort study of patients with laboratory-confirmed COVID-19 hospitalized in Kazakhstan between February and April 2020. We compared demographic, clinical, laboratory and radiological data of patients with different COVID-19 severities on admission. Logistic regression was used to assess factors associated with disease severity and in-hospital death. Whole-genome SARS-CoV-2 analysis was performed in 53 patients.
Of the 1072 patients with laboratory-confirmed COVID-19 in March-April 2020, the median age was 36 years (IQR 24-50) and 484 (45%) were male. On admission, 683 (64%) participants had asymptomatic/mild, 341 (32%) moderate, and 47 (4%) severe-to-critical COVID-19 manifestation; 20 in-hospital deaths (1•87%) were reported by 5 May 2020. Multivariable regression indicated increasing odds of severe disease associated with older age (odds ratio 1•05, 95% CI 1•03-1•07, per year increase; p<0•001), the presence of comorbidities (2•34, 95% CI 1•18-4•85; p=0•017) and elevated white blood cell count (WBC, 1•13, 95% CI 1•00-1•27; p=0•044) on admission, while older age (1•09, 95% CI 1•06-1•13, per year increase; p<0•001) and male sex (5•63, 95% CI 2•06-17•57; p=0•001) were associated with increased odds of in-hospital death. The SARS-CoV-2 isolates grouped into seven phylogenetic lineages, O/B.4.1, S/A.2, S/B.1.1, G/B.1, GH/B.1.255, GH/B.1.3 and GR/B.1.1.10; 87% of the isolates were O and S sub-types descending from early Asian lineages, while the G, GH and GR isolates were related to lineages from Europe and the Americas.
Older age, comorbidities, increased WBC count, and male sex were risk factors for COVID-19 disease severity and mortality in Kazakhstan. The broad SARS-CoV-2 diversity suggests multiple importations and community-level amplification predating travel restriction.
Ministry of Education and Science of the Republic of Kazakhstan.
2020年3月，哈萨克斯坦宣布了中亚地区最早的新型冠状病毒肺炎（COVID-19）病例。尽管采取了积极措施来遏制感染传播，但在了解该地区疫情的临床和流行病学特征方面仍存在差距。
我们对2020年2月至4月在哈萨克斯坦住院的实验室确诊COVID-19患者进行了一项回顾性观察队列研究。我们比较了入院时不同COVID-19严重程度患者的人口统计学、临床、实验室和放射学数据。采用逻辑回归评估与疾病严重程度和住院死亡相关的因素。对53例患者进行了严重急性呼吸综合征冠状病毒2（SARS-CoV-2）全基因组分析。
在2020年3月至4月的1072例实验室确诊COVID-19患者中，中位年龄为36岁（四分位间距24-50岁），484例（45%）为男性。入院时，683例（64%）参与者表现为无症状/轻症，341例（32%）为中症，47例（4%）为重症至危重症COVID-19；截至2020年5月5日，报告了20例住院死亡（1.87%）。多变量回归表明，年龄较大（比值比1.05，95%置信区间1.03-1.07，每年增加；p<0.001）、存在合并症（2.34，95%置信区间1.18-4.85；p=0.017）和入院时白细胞计数升高（WBC，1.13，95%置信区间1.00-1.27；p=0.044）与严重疾病的几率增加相关，而年龄较大（1.09，95%置信区间1.06-1.13，每年增加；p<0.001）和男性（5.63，95%置信区间2.06-17.57；p=0.001）与住院死亡几率增加相关。SARS-CoV-2分离株分为七个系统发育谱系，即O/B.4.1、S/A.2、S/B.1.1、G/B.1、GH/B.1.255、GH/B.1.3和GR/B.1.1.10；87%的分离株是源自早期亚洲谱系的O和S亚型，而G、GH和GR分离株与来自欧洲和美洲的谱系有关。
在哈萨克斯坦，年龄较大、合并症、白细胞计数增加和男性是COVID-19疾病严重程度和死亡率的危险因素。SARS-CoV-2的广泛多样性表明在旅行限制之前存在多次输入和社区层面的传播。
哈萨克斯坦共和国教育和科学部。
