希腊在德尔塔和奥密克戎变异株主导时期因新冠病毒病住院的患者：严重程度和死亡率的决定因素
Patients Hospitalized for COVID-19 in the Periods of Delta and Omicron Variant Dominance in Greece: Determinants of Severity and Mortality.
作者信息
Karageorgou Vagia, Papaioannou Andriana I, Kallieri Maria, Blizou Myrto, Lampadakis Stefanos, Sfika Maria, Krouskos Antonios, Papavasileiou Vasileios, Strakosha Franceska, Vandorou Kalliopi Theoni, Siozos Pavlos, Moustaka Christodoulou Marina, Kontonasiou Georgia, Apollonatou Vasiliki, Antonogiannaki Elvira Markella, Kyriakopoulos Christos, Aggelopoulou Christina, Chronis Christos, Kostikas Konstantinos, Koukaki Evangelia, Sotiropoulou Zoi, Athanasopoulou Athanasia, Bakakos Petros, Schoini Pinelopi, Alevrakis Emmanouil, Poupos Sotirios, Chondrou Evangelia, Tsoukalas Dionisios, Chronaiou Alexia, Tsoukalas George, Koukidou Sofia, Hillas Georgios, Dimakou Katerina, Roukas Konstantinos, Nakou Ifigeneia, Chloros Diamantis, Fouka Evangelia, Papiris Spyros A, Loukides Stelios
机构信息
2nd Respiratory Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece.
1st Respiratory Medicine Department, "Sotiria" Chest Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece.
出版信息
J Clin Med. 2023 Sep 11;12(18):5904. doi: 10.3390/jcm12185904.
BACKGROUND
Coronavirus disease 2019 (COVID-19) has been a pandemic since 2020, and depending on the SARS-CoV-2 mutation, different pandemic waves have been observed. The aim of this study was to compare the baseline characteristics of patients in two phases of the pandemic and evaluate possible predictors of mortality.
METHODS
This is a retrospective multicenter observational study that included patients with COVID-19 in 4 different centers in Greece. Patients were divided into two groups depending on the period during which they were infected during the Delta and Omicron variant predominance.
RESULTS
A total of 979 patients (433 Delta, 546 Omicron) were included in the study (median age 67 years (54, 81); 452 [46.2%] female). Compared to the Omicron period, the patients during the Delta period were younger (median age [IQR] 65 [51, 77] vs. 70 [55, 83] years, < 0.001) and required a longer duration of hospitalization (8 [6, 13] vs. 7 [5, 12] days, = 0.001), had higher procalcitonin levels (ng/mL): 0.08 [0.05, 0.17] vs. 0.06 [0.02, 0.16], = 0.005, ferritin levels (ng/mL): 301 [159, 644] vs. 239 [128, 473], = 0.002, C- reactive protein levels (mg/L): 40.4 [16.7, 98.5] vs. 31.8 [11.9, 81.7], = 0.003, and lactate dehydrogenase levels (U/L): 277 [221, 375] vs. 255 [205, 329], < 0.001. The Charlson Comorbidity Index was lower (3 [0, 5] vs. 4 [1, 6], < 0.001), and the extent of disease on computed tomography (CT) was greater during the Delta wave ( < 0.001). No evidence of a difference in risk of death or admission to the intensive care unit was found between the two groups. Age, cardiovascular events, acute kidney injury during hospitalization, extent of disease on chest CT, D-dimer, and neutrophil/lymphocyte ratio values were identified as independent predictors of mortality for patients in the Delta period. Cardiovascular events and acute liver injury during hospitalization and the PaO/FiO ratio on admission were identified as independent predictors of mortality for patients in the Omicron period.
CONCLUSIONS
In the Omicron wave, patients were older with a higher number of comorbidities, but patients with the Delta variant had more severe disease and a longer duration of hospitalization.
背景
自2020年以来，2019冠状病毒病（COVID-19）已成为大流行病，根据严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的变异情况，观察到了不同的疫情波。本研究的目的是比较疫情两个阶段患者的基线特征，并评估可能的死亡预测因素。
方法
这是一项回顾性多中心观察性研究，纳入了希腊4个不同中心的COVID-19患者。根据患者在德尔塔变异株和奥密克戎变异株占主导期间的感染时间，将患者分为两组。
结果
本研究共纳入979例患者（433例感染德尔塔变异株，546例感染奥密克戎变异株）（中位年龄67岁[54, 81]；452例[46.2%]为女性）。与奥密克戎时期相比，德尔塔时期的患者更年轻（中位年龄[四分位间距]65[51, 77]岁对70[55, 83]岁，<0.001），住院时间更长（8[6, 13]天对7[5, 12]天，=0.001），降钙素原水平更高（ng/mL）：0.08[0.05, 0.17]对0.06[0.02, 0.16]，=0.005，铁蛋白水平（ng/mL）：301[159, 644]对239[128, 473]，=0.002，C反应蛋白水平（mg/L）：40.4[16.7, 98.5]对31.8[11.9, 81.7]，=0.003，乳酸脱氢酶水平（U/L）：277[221, 375]对255[205, 329]，<0.001。查尔森合并症指数更低（3[0, 5]对4[1, 6]，<0.001），德尔塔波期间计算机断层扫描（CT）上的疾病范围更大（<0.001）。两组之间在死亡风险或入住重症监护病房方面未发现差异。年龄、心血管事件、住院期间急性肾损伤、胸部CT上的疾病范围、D-二聚体以及中性粒细胞/淋巴细胞比值被确定为德尔塔时期患者死亡的独立预测因素。心血管事件、住院期间急性肝损伤以及入院时的PaO/FiO比值被确定为奥密克戎时期患者死亡的独立预测因素。
结论
在奥密克戎波期间，患者年龄更大，合并症更多，但感染德尔塔变异株的患者疾病更严重，住院时间更长。
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