奥密克戎和阿尔法毒株主导时期入住重症监护病房的新冠病毒肺炎患者的特征及结局

Characteristics and outcomes of ICU-admitted COVID-19 patients in the Omicron and Alpha-dominated periods.

作者信息

Chang Chih-Jung, Huang Jhong-Ru, Shen Hsiao-Chin, Sun Chuan-Yen, Liao Ying-Ting, Ko Hung-Jui, Chen Yuh-Min, Chen Wei-Chih, Feng Jia-Yih, Yang Kuang-Yao

机构信息

Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.

Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

出版信息

J Formos Med Assoc. 2025 May;124(5):413-418. doi: 10.1016/j.jfma.2024.10.025. Epub 2024 Nov 2.

DOI:10.1016/j.jfma.2024.10.025

PMID:39488498

Abstract

BACKGROUND

Comparing the outcomes of intensive care unit (ICU) admitted COVID-19 patients during the Alpha and Omicron-dominated periods.

METHODS

Patients with critical COVID-19 disease, requiring ICU admission from May to September 2021 and February to August 2022, were enrolled from a single medical center in Northern Taiwan. Clinical demographics, comorbidities, disease severity, and management strategies were recorded. The 28-day mortality from the two periods were compared both in the original and propensity score (PS)-matched cohort.

RESULTS

Of 231 patients, 72 (31.2%) were from the Alpha period and 159 (68.8%) from the Omicron period. Patients in the Omicron period were older, had a lower body mass index, more comorbidities, higher disease severities, and increased 28-day mortality (26.4% vs. 13.9%, p = 0.035). In multivariable analysis, the Omicron-dominated period was not identified as an independent factor associated with increased 28-day mortality. COVID-19 patients in Alpha- and Omicron-dominated periods had comparable 28-day mortality in PS-matched cohort (12.1% vs. 18.2%, p = 0.733). Independent factors associated with 28-day mortality were a lower PF ratio (PF ratio <100, adjusted odds ratio [aOR] 2.68, 95% confidence interval, CI 1.21-5.94), septic shock ([aOR] 2.39, 95% CI 1.12-5.09) and absence of remdesivir ([aOR] 0.36, 95% CI 0.16-0.83).

CONCLUSION

While patients in the Omicron period exhibited greater severity, the variant was not independently linked to higher 28-day mortality in ICU-admitted patients.

摘要

背景

比较在以阿尔法毒株和奥密克戎毒株为主的时期，入住重症监护病房（ICU）的新冠肺炎患者的治疗结果。

方法

选取2021年5月至9月以及2022年2月至8月期间因重症新冠肺炎疾病需要入住ICU的患者，这些患者来自台湾北部的一家医疗中心。记录患者的临床人口统计学特征、合并症、疾病严重程度和治疗策略。比较两个时期的28天死亡率，包括原始队列和倾向评分（PS）匹配队列。

结果

231例患者中，72例（31.2%）来自阿尔法毒株时期，159例（68.8%）来自奥密克戎毒株时期。奥密克戎毒株时期的患者年龄更大，体重指数更低，合并症更多，疾病严重程度更高，28天死亡率更高（26.4%对13.9%，p = 0.035）。在多变量分析中，奥密克戎毒株为主的时期未被确定为与28天死亡率增加相关的独立因素。在PS匹配队列中，以阿尔法毒株和奥密克戎毒株为主的时期的新冠肺炎患者28天死亡率相当（12.1%对18.2%，p = 0.733）。与28天死亡率相关的独立因素包括较低的氧合指数（氧合指数<100，调整后比值比[aOR] 2.68，95%置信区间[CI] 1.21 - 5.94）、感染性休克（[aOR] 2.39，95% CI 1.12 - 5.09）以及未使用瑞德西韦（[aOR] 0.36，95% CI 0.16 - 0.83）。