Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Department of Emergency Medicine and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Clin Infect Dis. 2023 Aug 22;77(4):547-557. doi: 10.1093/cid/ciad276.
Understanding the changing epidemiology of adults hospitalized with coronavirus disease 2019 (COVID-19) informs research priorities and public health policies.
Among adults (≥18 years) hospitalized with laboratory-confirmed, acute COVID-19 between 11 March 2021, and 31 August 2022 at 21 hospitals in 18 states, those hospitalized during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron-predominant period (BA.1, BA.2, BA.4/BA.5) were compared to those from earlier Alpha- and Delta-predominant periods. Demographic characteristics, biomarkers within 24 hours of admission, and outcomes, including oxygen support and death, were assessed.
Among 9825 patients, median (interquartile range [IQR]) age was 60 years (47-72), 47% were women, and 21% non-Hispanic Black. From the Alpha-predominant period (Mar-Jul 2021; N = 1312) to the Omicron BA.4/BA.5 sublineage-predominant period (Jun-Aug 2022; N = 1307): the percentage of patients who had ≥4 categories of underlying medical conditions increased from 11% to 21%; those vaccinated with at least a primary COVID-19 vaccine series increased from 7% to 67%; those ≥75 years old increased from 11% to 33%; those who did not receive any supplemental oxygen increased from 18% to 42%. Median (IQR) highest C-reactive protein and D-dimer concentration decreased from 42.0 mg/L (9.9-122.0) to 11.5 mg/L (2.7-42.8) and 3.1 mcg/mL (0.8-640.0) to 1.0 mcg/mL (0.5-2.2), respectively. In-hospital death peaked at 12% in the Delta-predominant period and declined to 4% during the BA.4/BA.5-predominant period.
Compared to adults hospitalized during early COVID-19 variant periods, those hospitalized during Omicron-variant COVID-19 were older, had multiple co-morbidities, were more likely to be vaccinated, and less likely to experience severe respiratory disease, systemic inflammation, coagulopathy, and death.
了解 2019 年冠状病毒病（COVID-19）成年住院患者流行病学的变化情况，可为研究重点和公共卫生政策提供信息。
在 21 家医院的 18 个州，对 2021 年 3 月 11 日至 2022 年 8 月 31 日期间实验室确诊的、急性 COVID-19 成年住院患者（≥18 岁）进行研究，将住院期间处于严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）Omicron 为主的时期（BA.1、BA.2、BA.4/BA.5）与早期 Alpha 和 Delta 为主的时期进行比较。评估了人口统计学特征、入院 24 小时内的生物标志物以及结局，包括氧支持和死亡。
在 9825 例患者中，中位（四分位距[IQR]）年龄为 60 岁（47-72），47%为女性，21%为非西班牙裔黑人。从 Alpha 为主的时期（2021 年 3 月至 7 月；N=1312）到 Omicron BA.4/BA.5 亚谱系为主的时期（2022 年 6 月至 8 月；N=1307）：有≥4 类基础疾病的患者比例从 11%增加到 21%；至少接种过一次 COVID-19 初级疫苗系列的患者比例从 7%增加到 67%；≥75 岁的患者比例从 11%增加到 33%；未接受任何补充氧气的患者比例从 18%增加到 42%。最高 C 反应蛋白和 D-二聚体浓度的中位数（IQR）从 42.0mg/L（9.9-122.0）降至 11.5mg/L（2.7-42.8）和 3.1mcg/mL（0.8-640.0）至 1.0mcg/mL（0.5-2.2）。住院期间的死亡率在 Delta 为主的时期达到 12%的峰值，在 BA.4/BA.5 为主的时期下降到 4%。
与 COVID-19 早期变异时期住院的成年人相比，在 Omicron 变异 COVID-19 期间住院的成年人年龄更大，合并多种合并症，更有可能接种疫苗，发生严重呼吸道疾病、全身炎症、凝血功能障碍和死亡的可能性更小。
