奥密克戎-1 变异株与德尔塔变异株所致 SARS-CoV-2 肺炎患者连续住院的真实世界治疗经验和结局。

Real life treatment experience and outcome of consecutively hospitalised patients with SARS-CoV-2 pneumonia by Omicron-1 vs Delta variants.

机构信息

COVID-19 Department, Tzaneio General Hospital, Piraeus, Greece.

Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, ATTIKON University General Hospital, Athens, Greece.

出版信息

Infect Dis (Lond). 2023 Oct;55(10):706-715. doi: 10.1080/23744235.2023.2232445. Epub 2023 Jul 10.

DOI:10.1080/23744235.2023.2232445

PMID:37427461

Abstract

BACKGROUND

Omicron-1 COVID-19 is less invasive in the general population than previous viral variants. However, clinical course and outcome of hospitalised patients with SARS-CoV-2 pneumonia during the shift of the predominance from Delta to Omicron variants are not fully explored.

METHODS

During January 2022 consecutively hospitalised patients with SARS-CoV-2 pneumonia were analysed. SARS-CoV-2 variants were identified by a 2-step pre-screening protocol and randomly confirmed by whole genome sequencing analysis. Clinical, laboratory and treatment data split by type of variant were analysed along with logistic regression of factors associated to mortality.

RESULTS

150 patients [mean age (SD) 67.2(15.8) years, male 54%] were analysed. Compared to Delta ( = 46), Omicron-1 patients ( = 104) were older [mean age (SD): 69.5(15.4) vs 61.9(15.8) years, = 0.007], with more comorbidities (89.4% vs 65.2%, = 0.001), less obesity (BMI >30Kg/m in 24% vs 43.5%, = 0.034) but higher vaccination rates for COVID-19 (52.9% vs 8.7%, < 0.001). Severe pneumonia (48.7%), pulmonary embolism (4.7%), need for invasive mechanical ventilation (8%), administration of dexamethasone (76%) and 60-day mortality (22.6%) did not significantly differ. Severe SARS-CoV-2 pneumonia independently predicted mortality [OR 8.297 (CI95% 2.080-33.095), = 0.003]. Remdesivir administration ( = 135) was protective from death both in unadjusted and adjusted models [OR 0.157 (CI95% 0.026-0.945), = 0.043.

CONCLUSIONS

In a COVID-19 department the severity of pneumonia that did not differ between Omicron-1 and Delta variants predicted mortality whilst remdesivir remained protective in all analyses. Death rates did not differ between SARS-CoV-2 variants. Vigilance and consistency with prevention and treatment guidelines for COVID-19 is mandatory regardless of the predominant SARS-CoV-2 variant.

摘要

背景

奥密克戎变异株（Omicron-1）在普通人群中的侵袭性较以往的病毒变异株低。然而，德尔塔（Delta）变异株为主导时向奥密克戎变异株为主导转变期间，住院的 SARS-CoV-2 肺炎患者的临床病程和结局尚未完全明确。

方法

分析 2022 年 1 月连续住院的 SARS-CoV-2 肺炎患者。通过两步预筛选方案和全基因组测序分析随机确认 SARS-CoV-2 变异株。对不同变异株类型的临床、实验室和治疗数据进行分析，并对与死亡率相关的因素进行逻辑回归分析。

结果

共分析了 150 例患者[平均年龄（标准差）67.2（15.8）岁，男性占 54%]。与德尔塔（ = 46）相比，奥密克戎-1 患者（ = 104）年龄更大[平均年龄（标准差）：69.5（15.4）岁 vs 61.9（15.8）岁， = 0.007]，合并症更多（89.4% vs 65.2%， = 0.001），肥胖症更少（BMI >30kg/m2 占 24% vs 43.5%， = 0.034），但 COVID-19 疫苗接种率更高（52.9% vs 8.7%， < 0.001）。严重肺炎（48.7%）、肺栓塞（4.7%）、需要有创机械通气（8%）、地塞米松治疗（76%）和 60 天死亡率（22.6%）无显著差异。严重的 SARS-CoV-2 肺炎独立预测死亡率[比值比（OR）8.297（95%置信区间 2.080-33.095）， = 0.003]。在未调整和调整模型中，瑞德西韦治疗（ = 135）均能降低死亡风险[比值比（OR）0.157（95%置信区间 0.026-0.945）， = 0.043]。