Department of Medicine, Veterans' Affairs (VA) Boston Healthcare System, Boston, Massachusetts.
Dana Farber Cancer Institute, Boston, Massachusetts.
Infect Control Hosp Epidemiol. 2022 Dec;43(12):1767-1772. doi: 10.1017/ice.2022.13. Epub 2022 Jan 11.
Coronavirus disease 2019 (COVID-19) hospitalization definitions do not include a disease severity assessment. Thus, we sought to identify a simple and objective mechanism for identifying hospitalized severe cases and to measure the impact of vaccination on trends.
All admissions to a Veterans' Affairs (VA) hospital, where routine inpatient screening is recommended, between March 1, 2020, and November 22, 2021, with laboratory-confirmed severe acute respiratory coronavirus virus 2 (SARS-CoV-2) were included. Moderate-to-severe COVID-19 was defined as any oxygen supplementation or any oxygen saturation (SpO) <94% between 1 day before and 2 weeks after the positive SARS-CoV-2 test. Admissions with moderate-to-severe disease were divided by the total number of admissions, and the proportion of admissions with moderate-to-severe COVID-19 was modelled using a penalized spline in a Poisson regression and stratified by vaccination status. Dexamethasone receipt and its correlation with moderate-to-severe cases was also assessed.
Among 67,025 admissions with SARS-CoV-2, the proportion with hypoxemia or supplemental oxygen fell from 64% prior to vaccine availability to 56% by November 2021, driven in part by lower rates in vaccinated patients (vaccinated, 52% versus unvaccinated, 58%). The proportion of cases of moderate-to-severe disease identified using SpO levels and oxygen supplementation was highly correlated with dexamethasone receipt (correlation coefficient, 0.95), and increased after July 1, 2021, concurrent with δ (delta) variant predominance.
A simple and objective definition of COVID-19 hospitalizations using SpO levels and oxygen supplementation can be used to track pandemic severity. This metric could be used to identify risk factors for severe breakthrough infections, to guide clinical treatment algorithms, and to detect trends in changes in vaccine effectiveness over time and against new variants.
2019 年冠状病毒病（COVID-19）住院定义不包括疾病严重程度评估。因此，我们试图寻找一种简单而客观的机制来识别住院重症病例，并衡量疫苗接种对趋势的影响。
所有在退伍军人事务部（VA）医院住院的患者，该医院推荐常规进行住院筛查，时间为 2020 年 3 月 1 日至 2021 年 11 月 22 日，实验室确诊为严重急性呼吸冠状病毒 2（SARS-CoV-2）。中度至重度 COVID-19 定义为 SARS-CoV-2 检测阳性前 1 天至 2 周内任何氧疗或任何血氧饱和度（SpO2）<94%。根据总住院人数将患有中度至重度疾病的患者进行分组，并使用泊松回归中的惩罚样条模型对 SpO2 水平和氧疗与中度至重度 COVID-19 住院人数的比例进行建模，并按疫苗接种状况进行分层。还评估了地塞米松的使用及其与中度至重度病例的相关性。
在 67025 例 SARS-CoV-2 住院患者中，有低氧血症或需要补充氧气的患者比例从疫苗供应前的 64%下降到 2021 年 11 月的 56%，部分原因是接种疫苗患者的比例较低（接种疫苗者为 52%，未接种疫苗者为 58%）。使用 SpO2 水平和氧疗来确定中度至重度疾病的比例与地塞米松的使用高度相关（相关系数为 0.95），并且自 2021 年 7 月 1 日以来，随着 δ（德尔塔）变异的流行而增加。
使用 SpO2 水平和氧疗来简单而客观地定义 COVID-19 住院可以用来跟踪大流行的严重程度。该指标可用于识别严重突破性感染的危险因素，指导临床治疗算法，并检测随着时间的推移和针对新变体疫苗有效性变化的趋势。
