瑞士社区获得性 SARS-CoV-2 奥密克戎变异株感染与流感感染的住院结局比较。

Hospital Outcomes of Community-Acquired SARS-CoV-2 Omicron Variant Infection Compared With Influenza Infection in Switzerland.

机构信息

Department of Health Sciences and Medicine, Clinic St Anna, University of Lucerne, Lucerne, Switzerland.

Geneva University Hospitals and Faculty of Medicine, Infection Control Program and WHO Collaborating Center, Geneva, Switzerland.

出版信息

JAMA Netw Open. 2023 Feb 1;6(2):e2255599. doi: 10.1001/jamanetworkopen.2022.55599.

DOI:10.1001/jamanetworkopen.2022.55599

PMID:36790812

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9932839/

Abstract

IMPORTANCE

With the ongoing COVID-19 pandemic, it is crucial to assess the current burden of disease of community-acquired SARS-CoV-2 Omicron variant in hospitalized patients to tailor appropriate public health policies. Comparisons with better-known seasonal influenza infections may facilitate such decisions.

OBJECTIVE

To compare the in-hospital outcomes of patients hospitalized with the SARS-CoV-2 Omicron variant with patients with influenza.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was based on a national COVID-19 and influenza registry. Hospitalized patients aged 18 years and older with community-acquired SARS-CoV-2 Omicron variant infection who were admitted between January 15 and March 15, 2022 (when B.1.1.529 Omicron predominance was >95%), and hospitalized patients with influenza A or B infection from January 1, 2018, to March 15, 2022, where included. Patients without a study outcome by August 30, 2022, were censored. The study was conducted at 15 hospitals in Switzerland.

EXPOSURES

Community-acquired SARS-CoV-2 Omicron variant vs community-acquired seasonal influenza A or B.

MAIN OUTCOMES AND MEASURES

Primary and secondary outcomes were defined as in-hospital mortality and admission to the intensive care unit (ICU) for patients with the SARS-CoV-2 Omicron variant or influenza. Cox regression (cause-specific and Fine-Gray subdistribution hazard models) was used to account for time-dependency and competing events, with inverse probability weighting to adjust for confounders with right-censoring at day 30.

RESULTS

Of 5212 patients included from 15 hospitals, 3066 (58.8%) had SARS-CoV-2 Omicron variant infection in 14 centers and 2146 patients (41.2%) had influenza A or B in 14 centers. Of patients with the SARS-CoV-2 Omicron variant, 1485 (48.4%) were female, while 1113 patients with influenza (51.9%) were female (P = .02). Patients with the SARS-CoV-2 Omicron variant were younger (median [IQR] age, 71 [53-82] years) than those with influenza (median [IQR] age, 74 [59-83] years; P < .001). Overall, 214 patients with the SARS-CoV-2 Omicron variant (7.0%) died during hospitalization vs 95 patients with influenza (4.4%; P < .001). The final adjusted subdistribution hazard ratio (sdHR) for in-hospital death for SARS-CoV-2 Omicron variant vs influenza was 1.54 (95% CI, 1.18-2.01; P = .002). Overall, 250 patients with the SARS-CoV-2 Omicron variant (8.6%) vs 169 patients with influenza (8.3%) were admitted to the ICU (P = .79). After adjustment, the SARS-CoV-2 Omicron variant was not significantly associated with increased ICU admission vs influenza (sdHR, 1.08; 95% CI, 0.88-1.32; P = .50).

CONCLUSIONS AND RELEVANCE

The data from this prospective, multicenter cohort study suggest a significantly increased risk of in-hospital mortality for patients with the SARS-CoV-2 Omicron variant vs those with influenza, while ICU admission rates were similar.

摘要

重要性

随着持续的 COVID-19 大流行，评估社区获得性 SARS-CoV-2 奥密克戎变异株在住院患者中的当前疾病负担至关重要，以便制定适当的公共卫生政策。与更为人熟知的季节性流感感染进行比较可能有助于做出此类决策。

目的

比较住院的 SARS-CoV-2 奥密克戎变异株患者与流感患者的住院结局。

设计、设置和参与者：本队列研究基于一项全国性的 COVID-19 和流感登记研究。纳入了 2022 年 1 月 15 日至 3 月 15 日期间因社区获得性 SARS-CoV-2 奥密克戎变异株感染而住院的年龄在 18 岁及以上的患者，以及 2018 年 1 月 1 日至 2022 年 3 月 15 日期间因感染甲型或乙型流感而住院的患者。截至 2022 年 8 月 30 日未出现研究结局的患者被删失。该研究在瑞士的 15 家医院进行。

暴露因素

社区获得性 SARS-CoV-2 奥密克戎变异株与社区获得性季节性甲型或乙型流感。

主要和次要结局

主要结局定义为 SARS-CoV-2 奥密克戎变异株或流感患者的住院死亡率，次要结局定义为因 SARS-CoV-2 奥密克戎变异株或流感而入住重症监护病房（ICU）的患者比例。采用因果特异性和 Fine-Gray 亚分布风险模型的 Cox 回归，以考虑时间依赖性和竞争事件，并使用逆概率加权法调整右删失的混杂因素。

结果

从 15 家医院纳入的 5212 例患者中，14 家中心的 3066 例（58.8%）患者感染了 SARS-CoV-2 奥密克戎变异株，14 家中心的 2146 例（41.2%）患者感染了甲型或乙型流感。在 SARS-CoV-2 奥密克戎变异株患者中，1485 例（48.4%）为女性，而流感患者中 1113 例（51.9%）为女性（P = .02）。与流感患者相比，SARS-CoV-2 奥密克戎变异株患者年龄更小（中位数[IQR]年龄，71 [53-82] 岁）（P < .001）。总体而言，214 例 SARS-CoV-2 奥密克戎变异株患者（7.0%）在住院期间死亡，95 例流感患者（4.4%）死亡（P < .001）。SARS-CoV-2 奥密克戎变异株与流感相比，调整后的亚分布风险比（sdHR）为 1.54（95%CI，1.18-2.01；P = .002）。总体而言，250 例 SARS-CoV-2 奥密克戎变异株患者（8.6%）与 169 例流感患者（8.3%）入住 ICU（P = .79）。调整后，SARS-CoV-2 奥密克戎变异株与流感相比，入住 ICU 的风险无显著差异（sdHR，1.08；95%CI，0.88-1.32；P = .50）。