重症患者中关注的严重急性呼吸综合征冠状病毒2（SARS-CoV-2）变异株α（B.1.1.7）与β（B.1.351）的比较：一项多中心队列研究。
Comparison of SARS-CoV-2 Variants of Concern Alpha (B.1.1.7) vs. Beta (B.1.351) in Critically Ill Patients: A Multicenter Cohort Study.
作者信息
Louis Guillaume, Belveyre Thibaut, Goetz Christophe, Gibot Sébastien, Dunand Paul, Conrad Marie, Gaci Rostane, Gette Sébastien, Ouamara Nadia, Perez Pascale, Cadoz Cyril, Picard Yoann, Mellati Nouchan
机构信息
Intensive Care Unit, Metz-Thionville Regional Hospital, Mercy Hospital, Metz, France.
Department of Anesthesiology and Intensive Care Medicine, University Hospital of Nancy, Vandoeuvre-Lès-Nancy, France.
出版信息
Front Med (Lausanne). 2022 Mar 10;9:828402. doi: 10.3389/fmed.2022.828402. eCollection 2022.
OBJECTIVES
The clinical outcomes of the Beta (B.1.351) variant of concern (VOC) of the SARS-CoV-2 virus remain poorly understood. In early 2021, northeastern France experienced an outbreak of Beta that was not observed elsewhere. This outbreak slightly preceded and then overlapped with a second outbreak of the better understood VOC Alpha (B.1.1.7) in the region. This situation allowed us to contemporaneously compare Alpha and Beta in terms of the characteristics, management, and outcomes of critically ill patients.
METHODS
A multicenter prospective cohort study was conducted on all consecutive adult patients who had laboratory confirmed SARS CoV-2 infection, underwent variant screening, and were admitted to one of four intensive care units (ICU) for acute respiratory failure between January 9th and May 15th, 2021. Primary outcome was 60-day mortality. Differences between Alpha and Beta in terms of other outcomes, patient variables, management, and vaccination characteristics were also explored by univariate analysis. The factors that associated with 60-day death in Alpha- and Beta-infected patients were examined with logistic regression analysis.
RESULTS
In total, 333 patients (median age, 63 years; 68% male) were enrolled. Of these, 174 and 159 had Alpha and Beta, respectively. The two groups did not differ significantly in terms of 60-day mortality (19 vs. 23%), 28-day mortality (17 vs. 20%), need for mechanical ventilation (60 vs. 61%), mechanical ventilation duration (14 vs. 15 days), other management variables, patient demographic variables, comorbidities, or clinical variables on ICU admission. The vast majority of patients were unvaccinated (94%). The remaining 18 patients had received a partial vaccine course and 2 were fully vaccinated. The vaccinated patients were equally likely to have Alpha and Beta.
CONCLUSIONS
Beta did not differ from Alpha in terms of patient characteristics, management, or outcomes in critically ill patients.
TRIAL REGISTRATION
ClinicalTrials.gov, identifier: NCT04906850.
目的
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）病毒的β（B.1.351）变异株（VOC）的临床结局仍了解甚少。2021年初，法国东北部出现了β变异株疫情，其他地方未观察到这种情况。此次疫情略早于该地区另一次对变异株α（B.1.1.7）疫情的爆发，随后两者出现重叠。这种情况使我们能够同时比较α和β变异株在重症患者的特征、治疗及结局方面的差异。
方法
对2021年1月9日至5月15日期间所有实验室确诊感染SARS-CoV-2、接受变异株筛查并因急性呼吸衰竭入住四个重症监护病房（ICU）之一的连续成年患者进行了一项多中心前瞻性队列研究。主要结局为60天死亡率。还通过单因素分析探讨了α和β变异株在其他结局、患者变量、治疗及疫苗接种特征方面的差异。采用逻辑回归分析研究与α和β感染患者60天死亡相关的因素。
结果
共纳入333例患者（中位年龄63岁；68%为男性）。其中，174例感染α变异株，159例感染β变异株。两组在60天死亡率（19%对23%）、28天死亡率（17%对20%）、机械通气需求（60%对61%）、机械通气持续时间（14天对15天）、其他治疗变量、患者人口统计学变量、合并症或入住ICU时的临床变量方面无显著差异。绝大多数患者未接种疫苗（94%）。其余18例患者接受了部分疫苗接种疗程，2例患者完成了全程接种。接种疫苗的患者感染α和β变异株的可能性相同。
结论
在重症患者的患者特征、治疗或结局方面，β变异株与α变异株没有差异。
试验注册
ClinicalTrials.gov，标识符：NCT04906850。
Zotero 插件