Beltran Christian, Hood Jennifer, Danesh Valerie, Shrestha Anisha, Ogola Gerald, Boethel Carl, Arroliga Alejandro C, Ghamande Shekhar
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Baylor Scott & White Medical Center - Temple, Temple, Texas, USA.
Center for Applied Health Research, Baylor Scott & White Health, Dallas, Texas, USA.
Proc (Bayl Univ Med Cent). 2024 Jul 31;37(5):750-754. doi: 10.1080/08998280.2024.2379723. eCollection 2024.
In previous studies, there was an increase in mortality with secondary coinfections in all COVID-19 variants. However, no prior study has explored the association of coinfection with outcomes of hospitalized patients among the COVID-19 variants (Alpha, Delta, and Omicron).
This observational cohort study involved 21,186 patients hospitalized with COVID-19 in 25 hospitals in Texas. Patients were divided into groups by surges of COVID-19: Alpha (November 1, 2020-February 10, 2021), Delta (July 10, 2021-October 14, 2021), and Omicron (December 21, 2021-March 3, 2022). Data were collected from electronic health records using methodology from the Viral Respiratory Illness Universal Study COVID-19 registry (NCT04323787) of COVID-19 hospitalizations. Multivariable Cox-proportional hazard regression model assessed the adjusted effect of different surge periods on mortality.
Bacterial coinfections varied among hospitalization surges associated with Alpha (8.5%), Delta (11.7%), and Omicron (11.9%) variants. Adjusted analyses showed a higher 30-day and 90-day mortality in all variants when coinfections were present compared with isolated COVID-19 infection. In particular, 30-day and 90-day mortality were significantly worse with Delta compared to Alpha and Omicron.
All variants were associated with a higher mortality when bacterial coinfections were present. Delta was associated with a higher risk-adjusted mortality at 30 days and thereafter.
在先前的研究中，所有新冠病毒变异株的继发性合并感染都会导致死亡率上升。然而，此前尚无研究探讨新冠病毒变异株（阿尔法、德尔塔和奥密克戎）中合并感染与住院患者预后之间的关联。
这项观察性队列研究纳入了德克萨斯州25家医院的21186例新冠病毒住院患者。患者按新冠病毒感染高峰分为几组：阿尔法组（2020年11月1日至2021年2月10日）、德尔塔组（2021年7月10日至2021年10月14日）和奥密克戎组（2021年12月21日至2022年3月3日）。使用新冠病毒住院患者的病毒呼吸道疾病通用研究新冠病毒注册库（NCT04323787）中的方法，从电子健康记录中收集数据。多变量Cox比例风险回归模型评估了不同感染高峰时期对死亡率的调整影响。
与阿尔法变异株（8.5%）、德尔塔变异株（11.7%）和奥密克戎变异株（11.9%）相关的住院高峰期间，细菌合并感染情况有所不同。校正分析显示，与单纯新冠病毒感染相比，所有变异株出现合并感染时，30天和90天死亡率更高。特别是，与阿尔法和奥密克戎变异株相比，德尔塔变异株的30天和90天死亡率明显更高。
出现细菌合并感染时，所有变异株都与较高的死亡率相关。德尔塔变异株在30天及之后与更高的风险调整死亡率相关。
