新冠病毒疾病（COVID-19）的演变态势：与JN.1亚变体主导的2023 - 2024阶段住院COVID-19相关死亡率相关的因素
The evolving landscape of COVID-19: factors associated with in-hospital COVID-19 related mortality during the 2023-2024 phase of JN.1 subvariant dominance.
作者信息
Zaçe Drieda, Çekrezi Albiana, Jones Christopher, Ferrari Ludovica, De Simone Giuseppe, Teti Elisabetta, Malagnino Vincenzo, Iannetta Marco, Sarmati Loredana, Geretti Anna Maria
机构信息
Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, Rome, 00133, Italy.
Department of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, UK.
出版信息
BMC Infect Dis. 2025 Jan 27;25(1):130. doi: 10.1186/s12879-025-10480-x.
BACKGROUND
COVID-19 remains a complex health challenge. We analysed the characteristics and outcomes of COVID-19-related hospitalisations during JN.1 variant dominance.
METHODS
Conducted in a hospital serving a socioeconomically deprived population, this study included all adults hospitalised with COVID-19 from 1st November 2023 to 31st August 2024. The primary outcome was in-hospital mortality, analysed in relation to demographic, clinical, and laboratory parameters.
RESULTS
Among 122 individuals (median age 76 years, 58.2% males, median comorbidity index 5), 114/122 (93.4%) had received ≥ 1 SARS-CoV-2 vaccination, with a median of 23 months elapsed since the last dose. Fever (67/122, 54.9%) and dyspnoea (49/122, 40.2%) were common presenting symptoms, with 78/122 (64%) showing CT evidence of SARS-CoV-2 pneumonia; 25/122 (20%) had purely neurological presentations. Treatment included remdesivir (115/122, 94.3%) and/or nirmatrelvir/ritonavir (9/122, 7.4%), sotrovimab (15/122, 12.3%), corticosteroids (61/122, 50.0%), and oxygen supplementation (76/122, 62.3%). Whereas 107/122 (87.7%) were discharged after a median of seven days, in-hospital mortality was 15/122 (12.3%) after a median of 16 days. Baseline factors associated with mortality were neutrophil-lymphocyte ratio > 8, D-dimer ≥ 1800 ng/mL, procalcitonin ≥ 1.0 ng/mL, and albumin < 3.2 g/dL; during admission, nasopharyngeal SARS-CoV-2 antigen positivity persisting for > 12 days, hospitalisation for ≥ 10 days, higher oxygen requirements with the resulting corticosteroid use, and healthcare-associated bacteraemia were associated with increased odds of mortality.
CONCLUSIONS
Baseline laboratory parameters and persistent SARS-CoV-2 antigen positivity despite antiviral therapy offer readily available prognostic insights for patients hospitalised with COVID-19. It is imperative to advocate for up-to-date COVID-19 vaccination among older people and other vulnerable groups.
背景
新型冠状病毒肺炎（COVID-19）仍然是一项复杂的健康挑战。我们分析了JN.1变异株占主导期间COVID-19相关住院病例的特征和结局。
方法
本研究在一家服务于社会经济贫困人群的医院开展，纳入了2023年11月1日至2024年8月31日期间因COVID-19住院的所有成年人。主要结局是住院死亡率，并根据人口统计学、临床和实验室参数进行分析。
结果
在122例患者中（中位年龄76岁，男性占58.2%，中位合并症指数为5），114/122（93.4%）接受了≥1剂严重急性呼吸综合征冠状病毒2（SARS-CoV-2）疫苗接种，自最后一剂接种后中位间隔时间为23个月。发热（67/122，54.9%）和呼吸困难（49/122，40.2%）是常见的首发症状，78/122（64%）有SARS-CoV-2肺炎的CT证据；25/122（20%）有单纯神经系统表现。治疗包括使用瑞德西韦（115/122，94.3%）和/或奈玛特韦/利托那韦（9/122，7.4%）、索托维单抗（15/122，12.3%）、皮质类固醇（61/122，50.0%）以及吸氧（76/122，62.3%）。107/122（87.7%）患者在中位住院7天后出院，15/122（12.3%）患者在中位住院16天后死亡。与死亡率相关的基线因素包括中性粒细胞与淋巴细胞比值>8、D-二聚体≥1800 ng/mL、降钙素原≥1.0 ng/mL以及白蛋白<3.2 g/dL；入院期间，鼻咽SARS-CoV-2抗原持续阳性>12天、住院≥10天、因吸氧需求增加而使用皮质类固醇以及医院获得性菌血症与死亡几率增加相关。
结论
基线实验室参数以及抗病毒治疗后SARS-CoV-2抗原持续阳性可为COVID-19住院患者提供易于获得的预后信息。必须倡导老年人和其他弱势群体接种最新的COVID-19疫苗。
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