英国布里斯托尔住院成人中奥密克戎（B.1.1.529）和德尔塔（B.1.617.2）新冠病毒感染的严重程度：一项前瞻性队列研究
Severity of Omicron (B.1.1.529) and Delta (B.1.617.2) SARS-CoV-2 infection among hospitalised adults: A prospective cohort study in Bristol, United Kingdom.
作者信息
Hyams Catherine, Challen Robert, Marlow Robin, Nguyen Jennifer, Begier Elizabeth, Southern Jo, King Jade, Morley Anna, Kinney Jane, Clout Madeleine, Oliver Jennifer, Gray Sharon, Ellsbury Gillian, Maskell Nick, Jodar Luis, Gessner Bradford, McLaughlin John, Danon Leon, Finn Adam
机构信息
Population Health Sciences, University of Bristol, Bristol, UK.
Bristol Vaccine Centre, Population Health Sciences, University of Bristol, Bristol, UK.
出版信息
Lancet Reg Health Eur. 2023 Feb;25:100556. doi: 10.1016/j.lanepe.2022.100556. Epub 2022 Dec 12.
BACKGROUND
There is an urgent public health need to evaluate disease severity in adults hospitalised with Delta and Omicron SARS-CoV-2 variant infections. However, limited data exist assessing severity of disease in adults hospitalised with Omicron SARS-CoV-2 infections, and to what extent patient-factors, including vaccination, age, frailty and pre-existing disease, affect variant-dependent disease severity.
METHODS
A prospective cohort study of adults (≥18 years of age) hospitalised with acute lower respiratory tract disease at acute care hospitals in Bristol, UK conducted over 10-months. Delta or Omicron SARS-CoV-2 infection was defined by positive SARS-CoV-2 PCR and variant identification or inferred by dominant circulating variant. We constructed adjusted regression analyses to assess disease severity using three different measures: FiO >28% (fraction inspired oxygen), World Health Organization (WHO) outcome score >5 (assessing need for ventilatory support), and hospital length of stay (LOS) >3 days following admission for Omicron or Delta infection.
FINDINGS
Independent of other variables, including vaccination, Omicron variant infection in hospitalised adults was associated with lower severity than Delta. Risk reductions were 58%, 67%, and 16% for supplementary oxygen with >28% FiO [Relative Risk (RR) = 0.42 (95%CI: 0.34-0.52), < 0.001], WHO outcome score >5 [RR = 0.33 (95%CI: 0.21-0.50), < 0.001], and to have had a LOS > 3 days [RR = 0.84 (95%CI: 0.76-0.92), < 0.001]. Younger age and vaccination with two or three doses were also independently associated with lower COVID-19 severity.
INTERPRETATION
We provide reassuring evidence that Omicron infection results in less serious adverse outcomes than Delta in hospitalised patients. Despite lower severity relative to Delta, Omicron infection still resulted in substantial patient and public health burden and an increased admission rate of older patients with Omicron which counteracts some of the benefit arising from less severe disease.
FUNDING
AvonCAP is an investigator-led project funded under a collaborative agreement by Pfizer.
背景
迫切需要从公共卫生角度评估感染新冠病毒德尔塔和奥密克戎变异株的住院成人患者的疾病严重程度。然而，关于感染奥密克戎变异株的住院成人患者疾病严重程度的数据有限，且患者因素（包括疫苗接种情况、年龄、身体虚弱程度和基础疾病）在多大程度上影响变异株相关疾病严重程度的数据也很有限。
方法
在英国布里斯托尔的急症医院对因急性下呼吸道疾病住院的成人（≥18岁）进行了为期10个月的前瞻性队列研究。通过新冠病毒聚合酶链式反应（PCR）检测呈阳性及变异株鉴定来定义德尔塔或奥密克戎新冠病毒感染，或根据主要流行变异株推断感染情况。我们构建了校正回归分析，使用三种不同指标评估疾病严重程度：吸入氧分数（FiO₂）>28%、世界卫生组织（WHO）结局评分>5（评估是否需要通气支持），以及奥密克戎或德尔塔感染入院后住院时间（LOS）>3天。
研究结果
独立于包括疫苗接种情况在内的其他变量，住院成人感染奥密克戎变异株的疾病严重程度低于感染德尔塔变异株。对于FiO₂>28%的补充氧气需求，风险降低了58%，WHO结局评分>5的风险降低了67%，住院时间>3天的风险降低了16%[相对风险（RR）=0.42（95%置信区间：0.34 - 0.52），P<0.001]；[RR = 0.33（95%置信区间：0.21 - 0.50），P<0.001]；[RR = 0.84（95%置信区间：0.76 - 0.92），P<0.001]。年龄较小以及接种两剂或三剂疫苗也与较低的新冠严重程度独立相关。
解读
我们提供了令人安心的证据，即住院患者感染奥密克戎变异株导致的不良后果比感染德尔塔变异株轻。尽管相对于德尔塔变异株严重程度较低，但奥密克戎感染仍给患者和公共卫生带来了巨大负担，且奥密克戎感染导致老年患者入院率增加，抵消了部分因疾病严重程度较低带来的益处。
资金来源
雅芳社区抗新冠项目（AvonCAP）是一项由研究人员主导的项目，由辉瑞公司根据合作协议提供资金。
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