Kim Tae Hun, Ji Eunjeong, Song Myung Jin, Lim Sung Yoon, Lee Yeon Joo, Cho Young-Jae
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Medical Research Collaboration Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Tuberc Respir Dis (Seoul). 2023 Apr;86(2):142-149. doi: 10.4046/trd.2022.0151. Epub 2023 Mar 16.
Coronavirus disease 2019 (COVID-19) is an ongoing global public health threat and different variants of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been identified. This study aimed to analyse the factors associated with negative conversion of polymerase chain reaction (PCR) and prognosis in critically ill patients according to the SARS-CoV-2 variant.
This study retrospectively analysed 259 critically ill patients with COVID-19 who were admitted to the intensive care unit of a tertiary medical center between January 2020 and May 2022. The Charlson comorbidity index (CCI) was used to evaluate comorbidity, and a negative PCR test result within 2 weeks was used to define negative PCR conversion. The cases were divided into the following three variant groups, according to the documented variant of SARS-CoV-2 at the time of diagnosis: non-Delta (January 20, 2020-July 6, 2021), Delta (July 7, 2021- January 1, 2022), and Omicron (January 30, 2022-April 24, 2022).
The mean age of the 259 patients was 67.1 years and 93 (35.9%) patients were female. Fifty (19.3%) patients were smokers, and 50 (19.3%) patients were vaccinated. The CCI (hazard ratio [HR], 1.555; p<0.001), vaccination (HR, 0.492; p=0.033), and Delta variant (HR, 2.469; p=0.002) were significant factors for in-hospital mortality. The Delta variant (odds ratio, 0.288; p=0.003) was associated with fewer negative PCR conversion; however, vaccination (p=0.163) and remdesivir (p=0.124) treatments did not.
The Delta variant of SARS-CoV-2 is associated with lower survival and negative PCR conversion. Contrary to expectations, vaccination and remdesivir may not affect negative PCR conversion in critically ill patients with COVID-19.
2019冠状病毒病（COVID-19）是一种持续存在的全球公共卫生威胁，且已发现严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的不同变体。本研究旨在根据SARS-CoV-2变体分析重症患者中与聚合酶链反应（PCR）转阴及预后相关的因素。
本研究回顾性分析了2020年1月至2022年5月期间入住一家三级医疗中心重症监护病房的259例COVID-19重症患者。采用查尔森合并症指数（CCI）评估合并症情况，并将2周内PCR检测结果为阴性定义为PCR转阴。根据诊断时记录的SARS-CoV-2变体，将病例分为以下三个变体组：非德尔塔（2020年1月20日至2021年7月6日）、德尔塔（2021年7月7日至2022年1月1日）和奥密克戎（2022年1月30日至2022年4月24日）。
259例患者的平均年龄为67.1岁，93例（35.9%）为女性。50例（19.3%）患者为吸烟者，50例（19.3%）患者接种过疫苗。CCI（风险比[HR]，1.555；p<0.001）、疫苗接种（HR，0.492；p=0.033）和德尔塔变体（HR，2.469；p=0.002）是院内死亡的显著因素。德尔塔变体（比值比，0.288；p=0.003）与PCR转阴次数较少相关；然而，疫苗接种（p=0.163）和瑞德西韦治疗（p=0.124）则不然。
SARS-CoV-2的德尔塔变体与较低的生存率和PCR转阴相关。与预期相反，疫苗接种和瑞德西韦可能不会影响COVID-重症患者的PCR转阴情况。 19
