de Prost Nicolas, Audureau Etienne, Préau Sébastien, Favory Raphaël, Guigon Aurélie, Bay Pierre, Heming Nicholas, Gault Elyanne, Pham Tài, Chaghouri Amal, Voiriot Guillaume, Morand-Joubert Laurence, Jochmans Sébastien, Pitsch Aurélia, Meireles Sylvie, Contou Damien, Henry Amandine, Joseph Adrien, Chaix Marie-Laure, Uhel Fabrice, Descamps Diane, Emery Malo, Garcia-Sanchez Claudio, Luyt Charles-Edouard, Marot Stéphane, Pène Frédéric, Lhonneur Anne-Sophie, Gaudry Stéphane, Brichler Ségolène, Picard Lucile, Mekontso Dessap Armand, Rodriguez Christophe, Pawlotsky Jean-Michel, Fourati Slim
Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique, Hôpitaux de Paris (AP-HP), Créteil, France.
Groupe de Recherche Clinique CARMAS, Université Paris-Est-Créteil (UPEC), Créteil, France.
Intensive Care Med Exp. 2023 Aug 7;11(1):48. doi: 10.1186/s40635-023-00536-0.
Despite current broad natural and vaccine-induced protection, a substantial number of patients infected with emerging SARS-CoV-2 variants (e.g., BF.7 and BQ.1.1) still experience severe COVID-19. Real-life studies investigating the impact of these variants on clinical outcomes of severe cases are currently not available. We performed a prospective multicenter observational cohort study. Adult patients with acute respiratory failure admitted between December 7, 2021 and December 15, 2022, in one of the 20 participating intensive care units (17 from the Greater Paris area and 3 from the North of France) were eligible for inclusion if they had SARS-CoV-2 infection confirmed by a positive reverse transcriptase-polymerase chain reaction (RT-PCR). Full-length SARS-CoV-2 genomes from all included patients were sequenced by means of next-generation sequencing. The primary endpoint of the study was day-28 mortality.
The study included 158 patients infected with three groups of Omicron sublineages, including (i) BA.2 variants and their early sublineages referred as "BA.2" (n = 50), (ii) early BA.4 and BA.5 sublineages (including BA.5.1 and BA.5.2, n = 61) referred as "BA.4/BA.5", and (iii) recent emerging BA.5 sublineages (including BQ.1, BQ.1.1, BF.7, BE.1 and CE.1, n = 47) referred as "BQ.1.1". The clinical phenotype of BQ1.1-infected patients compared to earlier BA.2 and BA.4/BA.5 sublineages, showed more frequent obesity and less frequent immunosuppression. There was no significant difference between Omicron sublineage groups regarding the severity of the disease at ICU admission, need for organ failure support during ICU stay, nor day 28 mortality (21.7%, n = 10/47 in BQ.1.1 group vs 26.7%, n = 16/61 in BA.4/BA.5 vs 22.0%, n = 11/50 in BA.2, p = 0.791). No significant relationship was found between any SARS-CoV-2 substitution and/or deletion on the one hand and survival on the other hand over hospital follow-up.
Critically-ill patients with Omicron BQ.1.1 infection showed a different clinical phenotype than other patients infected with earlier Omicron sublineage but no day-28 mortality difference.
尽管目前有广泛的自然免疫和疫苗诱导的保护，但仍有相当数量感染新型严重急性呼吸综合征冠状病毒2（SARS-CoV-2）变体（如BF.7和BQ.1.1）的患者会出现重症冠状病毒病（COVID-19）。目前尚无关于这些变体对重症病例临床结局影响的真实世界研究。我们开展了一项前瞻性多中心观察性队列研究。2021年12月7日至2022年12月15日期间，在20个参与研究的重症监护病房之一（17个来自大巴黎地区，3个来自法国北部）收治的急性呼吸衰竭成年患者，若其逆转录聚合酶链反应（RT-PCR）检测结果呈阳性，确诊感染SARS-CoV-2，则符合纳入标准。通过下一代测序对所有纳入患者的全长SARS-CoV-2基因组进行测序。该研究的主要终点为第28天死亡率。
该研究纳入了158例感染三组奥密克戎亚谱系的患者，包括：（i）BA.2变体及其早期亚谱系，称为“BA.2”（n = 50）；（ii）早期BA.4和BA.5亚谱系（包括BA.5.1和BA.5.2，n = 61），称为“BA.4/BA.5”；（iii）近期出现的BA.5亚谱系（包括BQ.1、BQ.1.1、BF.7、BE.1和CE.1，n = 47），称为“BQ.1.1”。与早期的BA.2和BA.4/BA.5亚谱系相比，感染BQ.1.1的患者临床表型显示肥胖更为常见，免疫抑制更为少见。在奥密克戎亚谱系组之间，入住重症监护病房时疾病严重程度、重症监护病房住院期间器官功能衰竭支持需求以及第28天死亡率方面均无显著差异（BQ.1.1组为21.7%，n = 10/47；BA.4/BA.5组为26.7%，n = 16/61；BA.2组为22.0%，n = 11/50，p = 0.791）。在医院随访期间，一方面任何SARS-CoV-2的替换和/或缺失与另一方面的生存之间均未发现显著关联。
感染奥密克戎BQ.1.1的重症患者与感染早期奥密克戎亚谱系的其他患者相比，临床表型不同，但第28天死亡率无差异。
