Institute for Global Health, University College London, London, UK
Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK.
BMJ Open Respir Res. 2021 Sep;8(1). doi: 10.1136/bmjresp-2021-001029.
SARS-CoV-2 lineage B.1.1.7 has been associated with an increased rate of transmission and disease severity among subjects testing positive in the community. Its impact on hospitalised patients is less well documented.
We collected viral sequences and clinical data of patients admitted with SARS-CoV-2 and hospital-onset COVID-19 infections (HOCIs), sampled 16 November 2020 to 10 January 2021, from eight hospitals participating in the COG-UK-HOCI study. Associations between the variant and the outcomes of all-cause mortality and intensive therapy unit (ITU) admission were evaluated using mixed effects Cox models adjusted by age, sex, comorbidities, care home residence, pregnancy and ethnicity.
Sequences were obtained from 2341 inpatients (HOCI cases=786) and analysis of clinical outcomes was carried out in 2147 inpatients with all data available. The HR for mortality of B.1.1.7 compared with other lineages was 1.01 (95% CI 0.79 to 1.28, p=0.94) and for ITU admission was 1.01 (95% CI 0.75 to 1.37, p=0.96). Analysis of sex-specific effects of B.1.1.7 identified increased risk of mortality (HR 1.30, 95% CI 0.95 to 1.78, p=0.096) and ITU admission (HR 1.82, 95% CI 1.15 to 2.90, p=0.011) in females infected with the variant but not males (mortality HR 0.82, 95% CI 0.61 to 1.10, p=0.177; ITU HR 0.74, 95% CI 0.52 to 1.04, p=0.086).
In common with smaller studies of patients hospitalised with SARS-CoV-2, we did not find an overall increase in mortality or ITU admission associated with B.1.1.7 compared with other lineages. However, women with B.1.1.7 may be at an increased risk of admission to intensive care and at modestly increased risk of mortality.
在社区检测呈阳性的人群中，SARS-CoV-2 谱系 B.1.1.7 与传播率和疾病严重程度的增加有关。其对住院患者的影响记录较少。
我们收集了 2020 年 11 月 16 日至 2021 年 1 月 10 日期间，参加 COG-UK-HOCI 研究的 8 家医院的 SARS-CoV-2 和医院获得性 COVID-19 感染（HOCI）住院患者的病毒序列和临床数据。使用混合效应 Cox 模型，根据年龄、性别、合并症、养老院居住情况、妊娠和种族调整变异与全因死亡率和重症监护病房（ITU）入院的相关性。
从 2341 名住院患者（HOCI 病例=786 例）中获得了序列，并对所有数据均可用的 2147 名住院患者进行了临床结局分析。与其他谱系相比，B.1.1.7 的死亡率 HR 为 1.01（95%CI 0.79 至 1.28，p=0.94），重症监护病房入院率 HR 为 1.01（95%CI 0.75 至 1.37，p=0.96）。对 B.1.1.7 性别特异性影响的分析表明，感染该变体的女性死亡风险（HR 1.30，95%CI 0.95 至 1.78，p=0.096）和重症监护病房入院率（HR 1.82，95%CI 1.15 至 2.90，p=0.011）风险增加，但男性则不然（死亡率 HR 0.82，95%CI 0.61 至 1.10，p=0.177；重症监护病房 HR 0.74，95%CI 0.52 至 1.04，p=0.086）。
与对 SARS-CoV-2 住院患者的较小研究一致，与其他谱系相比，我们未发现 B.1.1.7 与死亡率或重症监护病房入院率总体增加相关。然而，感染 B.1.1.7 的女性可能有更高的入住重症监护病房的风险，死亡率也有适度增加的风险。
