SARS-CoV-2 变体感染与基于影像学的肺炎及临床结局的关系。
SARS-CoV-2 Variants Infection in Relationship to Imaging-based Pneumonia and Clinical Outcomes.
机构信息
From the Department of Radiology, Chonnam National University Hospital, Gwangju, Korea (J.E.L., Y.H.K.); Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Korea (M.H.); Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (M.J.C.); Department of Radiology, Namwon Medical Center, Namwon, Korea (B.H.S.); Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea (W.G.J.); and Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea (Y.J.J.).
出版信息
Radiology. 2023 Mar;306(3):e221795. doi: 10.1148/radiol.221795. Epub 2022 Sep 27.
Background Few reports have evaluated the effect of the SARS-CoV-2 variant and vaccination on the clinical and imaging features of COVID-19. Purpose To evaluate and compare the effect of vaccination and variant prevalence on the clinical and imaging features of infections by the SARS-CoV-2. Materials and Methods Consecutive adults hospitalized for confirmed COVID-19 at three centers (two academic medical centers and one community hospital) and registered in a nationwide open data repository for COVID-19 between August 2021 and March 2022 were retrospectively included. All patients had available chest radiographs or CT images. Patients were divided into two groups according to predominant variant type over the study period. Differences between clinical and imaging features were analyzed with use of the Pearson χ test, Fisher exact test, or the independent test. Multivariable logistic regression analyses were used to evaluate the effect of variant predominance and vaccination status on imaging features of pneumonia and clinical severity. Results Of the 2180 patients (mean age, 57 years ± 21; 1171 women), 1022 patients (47%) were treated during the Delta variant predominant period and 1158 (53%) during the Omicron period. The Omicron variant prevalence was associated with lower pneumonia severity based on CT scores (odds ratio [OR], 0.71 [95% CI: 0.51, 0.99; = .04]) and lower clinical severity based on intensive care unit (ICU) admission or in-hospital death (OR, 0.43 [95% CI: 0.24, 0.77; = .004]) than the Delta variant prevalence. Vaccination was associated with the lowest odds of severe pneumonia based on CT scores (OR, 0.05 [95% CI: 0.03, 0.13; < .001]) and clinical severity based on ICU admission or in-hospital death (OR, 0.15 [95% CI: 0.07, 0.31; < .001]) relative to no vaccination. Conclusion The SARS-CoV-2 Omicron variant prevalence and vaccination were associated with better clinical outcomes and lower severe pneumonia risk relative to Delta variant prevalence. © RSNA, 2022 See also the editorial by Little in this issue.
背景
目前鲜有研究评估 SARS-CoV-2 变异株和疫苗接种对 COVID-19 临床和影像学特征的影响。目的：评估并比较疫苗接种和变异株流行对 SARS-CoV-2 感染的临床和影像学特征的影响。材料与方法：本研究回顾性纳入 2021 年 8 月至 2022 年 3 月期间在三家中心（两所学术医疗中心和一家社区医院）因确诊 COVID-19 而住院并在一个全国性 COVID-19 开放数据存储库中登记的连续成年患者。所有患者均有胸部 X 线或 CT 图像。根据研究期间的主要变异株类型，患者分为两组。采用 Pearson χ2 检验、Fisher 确切检验或独立样本 t 检验分析临床和影像学特征的差异。采用多变量逻辑回归分析评估变异株流行率和疫苗接种状态对肺炎和临床严重程度的影像学特征的影响。结果：在 2180 例患者中（平均年龄，57 岁±21 岁；1171 例女性），1022 例（47%）患者在 Delta 变异株流行期间接受治疗，1158 例（53%）患者在 Omicron 变异株流行期间接受治疗。与 Delta 变异株流行相比，Omicron 变异株流行与 CT 评分较低的肺炎严重程度（比值比[OR]，0.71[95%CI：0.510.99；P =.04]）和较低的临床严重程度（因入住重症监护病房[ICU]或院内死亡而就诊的 OR，0.43[95%CI：0.240.77；P =.004]）相关。与未接种疫苗相比，接种疫苗与 CT 评分较低的严重肺炎（OR，0.05[95%CI：0.030.13；P <.001]）和因入住 ICU 或院内死亡而就诊的临床严重程度（OR，0.15[95%CI：0.070.31；P <.001]）的最低几率相关。结论：与 Delta 变异株流行相比，SARS-CoV-2 Omicron 变异株流行和疫苗接种与更好的临床结局和更低的严重肺炎风险相关。 ©RSNA，2022 本期杂志中还可见 Little 的评论文章。
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