与流感感染相比，SARS-CoV-2奥密克戎变异株感染的院内死亡率更高——来自德国CORONA研究的见解
Higher in-hospital mortality in SARS-CoV-2 omicron variant infection compared to influenza infection-Insights from the CORONA Germany study.
作者信息
Dickow Jannis, Gunawardene Melanie A, Willems Stephan, Feldhege Johannes, Wohlmuth Peter, Bachmann Martin, Bergmann Martin W, Gesierich Wolfgang, Nowak Lorenz, Pape Ulrich-Frank, Schreiber Ruediger, Wirtz Sebastian, Twerenbold Raphael, Sheikhzadeh Sara, Gessler Nele
机构信息
Asklepios Hospital St. Georg, Department of Cardiology and Internal Intensive Care Medicine, Hamburg, Germany.
Semmelweis University, Budapest, Hungary.
出版信息
PLoS One. 2023 Sep 27;18(9):e0292017. doi: 10.1371/journal.pone.0292017. eCollection 2023.
BACKGROUND
With the emergence of new subvariants, the disease severity of Severe Acute Respiratory Syndrome Coronavirus-2 has attenuated. This study aimed to compare the disease severity in patients hospitalized with omicron variant infection to those with influenza infection.
METHODS
We compared data from the multicenter observational, prospective, epidemiological "CORONA Germany" (Clinical Outcome and Risk in hospitalized COVID-19 patients) study on patients infected with Severe Acute Respiratory Syndrome Coronavirus-2 to retrospective data on influenza infection cases from November 2016 to August 2022. Severe Acute Respiratory Syndrome Coronavirus-2 cases were classified as wild-type/delta variant before January 2022, or omicron variant from January 2022 onward. The primary outcome was in-hospital mortality, adjusted for age, gender, and comorbidities.
RESULTS
The study included 35,806 patients from 53 hospitals in Germany, including 4,916 patients (13.7%) with influenza infection, 16,654 patients (46.5%) with wild-type/delta variant infection, and 14,236 patients (39.8%) with omicron variant infection. In-hospital mortality was highest in patients with wild-type/delta variant infection (16.8%), followed by patients with omicron variant infection (8.4%) and patients with influenza infection (4.7%). In the adjusted analysis, higher age was the strongest predictor for in-hospital mortality (age 80 years vs. age 50 years: OR 4.25, 95% CI 3.10-5.83). Both, patients with wild-type/delta variant infection (OR 3.54, 95% CI 3.02-4.15) and patients with omicron variant infection (OR 1.56, 95% CI 1.32-1.84) had a higher risk for in-hospital mortality than patients with influenza infection.
CONCLUSION
After adjusting for age, gender and comorbidities, patients with wild-type/delta variant infection had the highest risk for in-hospital mortality compared to patients with influenza infection. Even for patients with omicron variant infection, the adjusted risk for in-hospital mortality was higher than for patients with influenza infection. The adjusted risk for in-hospital mortality showed a strong age dependency across all virus types and variants.
TRIAL REGISTRATION NUMBER
NCT04659187.
背景
随着新冠病毒新亚型的出现，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的疾病严重程度有所减弱。本研究旨在比较感染奥密克戎变异株住院患者与感染流感患者的疾病严重程度。
方法
我们将多中心观察性、前瞻性、流行病学“德国新冠研究”（住院COVID-19患者的临床结局和风险）中感染SARS-CoV-2患者的数据与2016年11月至2022年8月流感感染病例的回顾性数据进行了比较。2022年1月之前的SARS-CoV-2病例分类为野生型/德尔塔变异株，2022年1月起为奥密克戎变异株。主要结局是校正年龄、性别和合并症后的院内死亡率。
结果
该研究纳入了德国53家医院的35806例患者，其中4916例（13.7%）为流感感染患者，16654例（46.5%）为野生型/德尔塔变异株感染患者，14236例（39.8%）为奥密克戎变异株感染患者。野生型/德尔塔变异株感染患者的院内死亡率最高（16.8%），其次是奥密克戎变异株感染患者（8.4%）和流感感染患者（4.7%）。在校正分析中，年龄越大是院内死亡率最强的预测因素（80岁 vs. 50岁：OR 4.25，95%CI 3.10-5.83）。野生型/德尔塔变异株感染患者（OR 3.54，95%CI 3.02-4.15）和奥密克戎变异株感染患者（OR 1.56，95%CI 1.32-1.84）的院内死亡风险均高于流感感染患者。
结论
校正年龄、性别和合并症后，野生型/德尔塔变异株感染患者的院内死亡风险高于流感感染患者。即使是奥密克戎变异株感染患者，校正后的院内死亡风险也高于流感感染患者。所有病毒类型和变异株的校正院内死亡风险均显示出强烈的年龄依赖性。
试验注册号
NCT04659187。
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