在奥密克戎毒株流行期间，不列颠哥伦比亚省、安大略省和魁北克省因新冠病毒疾病住院患者的治疗结果及特征

Outcomes and characteristics of patients hospitalized for COVID-19 in British Columbia, Ontario and Quebec during the Omicron wave.

作者信息

Lee Terry, Cheng Matthew P, Vinh Donald C, Lee Todd C, Tran Karen C, Winston Brent W, Sweet David, Boyd John H, Walley Keith R, Haljan Greg, McGeer Allison, Lamontagne Francois, Fowler Robert, Maslove David M, Singer Joel, Patrick David M, Marshall John C, Burns Kevin D, Murthy Srinivas, Mann Puneet K, Hernandez Geraldine, Donohoe Kathryn, Russell James A

机构信息

Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC.

出版信息

CMAJ Open. 2023 Aug 1;11(4):E672-E683. doi: 10.9778/cmajo.20220194. Print 2023 Jul-Aug.

BACKGROUND

Omicron is the current predominant variant of concern of SARS-CoV-2. We hypothesized that vaccination alters outcomes of patients hospitalized with COVID-19 during the Omicron wave and that these patients have different characteristics and outcomes than in previous waves.

METHODS

This is a substudy of the Host Response Mediators in Coronavirus (COVID-19) Infection (ARBs CORONA I) trial, which included adults admitted to hospital with acute COVID-19 up to July 2022 from 9 hospitals in British Columbia, Ontario and Quebec. We excluded emergency department visits without hospital admission, readmissions and admissions for another reason. Using adjusted regression analysis, we compared mortality and organ dysfunction between vaccinated (≥ 2 doses) and unvaccinated patients during the Omicron wave, as well as between all patients in the Omicron and first 3 waves of the COVID-19 pandemic.

RESULTS

During the Omicron wave, 28-day mortality was significantly lower in vaccinated ( = 19/237) than unvaccinated hospitalized patients ( = 12/127) (adjusted odds ratio [OR] 0.36, 95% confidence interval [CI] 0.15-0.89); vaccinated patients had lower risk of admission to the intensive care unit, invasive ventilation and acute respiratory distress syndrome and shorter hospital length of stay. Patients hospitalized during the Omicron wave had more comorbidities than in previous waves, and lower 28-day mortality than in waves 1 and 2 (adjusted OR 0.38, 95% CI 0.24-0.59; and 0.42, 95% CI 0.26-0.65) but not wave 3 (adjusted OR 0.81, 95% CI 0.43-1.51) and had less organ dysfunction than in the first 2 waves.

INTERPRETATION

Patients who were at least double vaccinated had lower mortality than unvaccinated patients hospitalized during the Omicron wave. Patients hospitalized during the Omicron wave had more chronic disease and lower mortality than in the first 2 waves, but not wave 3. Changes in vaccination, treatments and predominant SARS-CoV-2 variant may have decreased mortality in patients hospitalized during the Omicron wave.

背景

奥密克戎是目前引起关注的严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的主要变体。我们假设，在奥密克戎毒株流行期间，接种疫苗会改变新冠肺炎住院患者的治疗结果，并且这些患者与之前毒株流行期间的患者具有不同的特征和治疗结果。

方法

这是冠状病毒（COVID-19）感染宿主反应介质（ARBs CORONA I）试验的一项子研究，该试验纳入了2022年7月之前从不列颠哥伦比亚省、安大略省和魁北克省的9家医院因急性新冠肺炎住院的成年人。我们排除了未住院的急诊科就诊患者、再次入院患者以及因其他原因入院的患者。通过调整回归分析，我们比较了奥密克戎毒株流行期间接种疫苗（≥2剂）和未接种疫苗的患者之间的死亡率和器官功能障碍，以及新冠肺炎大流行奥密克戎毒株流行期和前三波疫情期间所有患者之间的死亡率和器官功能障碍。

结果

在奥密克戎毒株流行期间，接种疫苗的住院患者（=19/237）28天死亡率显著低于未接种疫苗的住院患者（=12/127）（调整后的优势比[OR]为0.36，95%置信区间[CI]为0.15-0.89）；接种疫苗的患者入住重症监护病房、有创通气和急性呼吸窘迫综合征的风险较低，住院时间较短。与之前毒株流行期间相比，奥密克戎毒株流行期间住院的患者合并症更多，28天死亡率低于第一波和第二波疫情期间（调整后的OR为0.38，95%CI为0.24-0.59；以及0.42，95%CI为0.26-0.65），但不低于第三波疫情期间（调整后的OR为0.81，95%CI为0.43-1.51），并且器官功能障碍比前两波疫情期间少。