Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany.
Institute of Medical Biometry and Statistics, Medical Center-University of Freiburg, Stefan-Meier-Straße 26, 79104, Freiburg, Germany.
BMC Health Serv Res. 2024 Sep 23;24(1):1107. doi: 10.1186/s12913-024-11493-z.
The spread of several severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) variants of concern (VOCs) has repeatedly led to increasing numbers of coronavirus disease 2019 (COVID-19) patients in German intensive care units (ICUs), resulting in capacity shortages and even transfers of COVID-19 intensive care patients between federal states in late 2021. In this respect, there is scarce evidence on the impact of predominant VOCs in German ICUs at the population level.
A retrospective cohort study was conducted from July 01, 2021, to May 31, 2022, using daily nationwide inpatient billing data from German hospitals on COVID-19 intensive care patients and SARS-CoV-2 sequence data from Germany. A multivariable Poisson regression analysis was performed to estimate the incidence rate ratios (IRRs) of transfer (to another hospital during inpatient care), discharge (alive) and death of COVID-19 intensive care patients associated with Delta or Omicron, adjusted for age group and sex. In addition, a multistate approach was used for the clinical trajectories of COVID-19 intensive care patients to estimate their competing risk of transfer, discharge or death associated with Delta or Omicron, specifically concerning patient age.
A total of 6046 transfers, 33256 discharges, and 12114 deaths were included. Poisson regression analysis comparing Omicron versus Delta yielded an estimated adjusted IRR of 1.23 (95% CI 1.16-1.30) for transfers, 2.27 (95% CI 2.20-2.34) for discharges and 0.98 (95% CI 0.94-1.02) for deaths. For ICU deaths in particular, the estimated adjusted IRR increased from 0.14 (95% CI 0.08-0.22) for the 0-9 age group to 4.09 (95% CI 3.74-4.47) for those aged 90 and older compared to the reference group of 60-69-year-olds. Multistate analysis revealed that Omicron was associated with a higher estimated risk of discharge for COVID-19 intensive care patients across all ages, while Delta infection was associated with a higher estimated risk of transfer and death.
Retrospective, nationwide comparisons of transfers, discharges and deaths of COVID-19 intensive care patients during Delta- and Omicron-dominated periods in Germany suggested overall less severe clinical trajectories associated with Omicron. Age was confirmed to be an important determinant of fatal clinical outcomes in COVID-19 intensive care patients, necessitating close therapeutic care for elderly people and appropriate public health control measures.
几种严重急性呼吸综合征冠状病毒 2 型（SARS-CoV-2）关切变种（VOC）的传播导致德国重症监护病房（ICU）的 2019 年冠状病毒病（COVID-19）患者数量不断增加，导致容量短缺，甚至在 2021 年底各州之间转移 COVID-19 重症监护患者。在这方面，关于德国 ICU 中主要 VOC 对人群水平的影响的证据很少。
使用德国医院每日全国住院计费数据和德国 SARS-CoV-2 序列数据，从 2021 年 7 月 1 日至 2022 年 5 月 31 日进行了回顾性队列研究。采用多变量泊松回归分析估计与 Delta 或 Omicron 相关的 COVID-19 重症监护患者转移（住院期间转至另一家医院）、出院（存活）和死亡的发病率比（IRR），并按年龄组和性别进行调整。此外，还采用多状态方法对 COVID-19 重症监护患者的临床轨迹进行了评估，以估计与 Delta 或 Omicron 相关的转移、出院或死亡的竞争风险，特别是针对患者年龄。
共纳入 6046 例转移、33256 例出院和 12114 例死亡。与 Delta 相比，泊松回归分析估计 Omicron 的调整后 IRR 为 1.23（95%CI 1.16-1.30）用于转移，2.27（95%CI 2.20-2.34）用于出院，0.98（95%CI 0.94-1.02）用于死亡。特别是对于 ICU 死亡，从 0-9 岁年龄组的估计调整后 IRR 为 0.14（95%CI 0.08-0.22）增加到 90 岁及以上年龄组的 4.09（95%CI 3.74-4.47）与 60-69 岁年龄组的参考组相比。多状态分析显示，Omicron 与所有年龄段 COVID-19 重症监护患者出院的估计风险增加有关，而 Delta 感染与转移和死亡的估计风险增加有关。
在德国 Delta 和 Omicron 主导时期对 COVID-19 重症监护患者的转移、出院和死亡进行回顾性、全国性比较表明，Omicron 与总体上较轻的临床轨迹有关。年龄被确认为 COVID-19 重症监护患者致命临床结局的重要决定因素，需要对老年人进行密切的治疗护理和适当的公共卫生控制措施。
