Clinical features and outcomes of hospitalized patients with COVID-19 during the Omicron wave in Shanghai, China.
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ABSTRACT:
SUBMITTER: Wang B
PROVIDER: S-EPMC9550297 | biostudies-literature | 2022 Oct
REPOSITORIES: biostudies-literature
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Clinical features and outcomes of hospitalized patients with COVID-19 during the Omicron wave in Shanghai, China.
Wang Bin B Yu Yuefeng Y Yu Yuetian Y Wang Ningjian N Chen Fengling F Jiang Boren B Chen Yi Y Zhang Junfeng J Liu Jianren J Wang Haiya H Ding Feng F Zhang Wenchuan W Fang Yuming Y Meng Xiangjun X Ying Youguo Y He Liu L Jiang Bin B Tao Xiaofeng X Xiong Weining W Wang Changqian C Wu Hao H Lu Yingli Y
The Journal of infection 20221011 1
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Project description:Shanghai has been experiencing the Omicron wave since March 2022. Though several studies have evaluated the risk factors of severe infections, the analyses of BA.2 infection risk and protective factors among geriatric people were much limited. This multicentre cohort study described clinical characteristics, and assessed risk and protective factors for geriatric Omicron severe infections. A total of 1377 patients older than 60 were enrolled, with 75.96% having comorbidities. The median viral shedding time and hospitalization time were nine and eight days, respectively. Severe and critical were associated with longer virus clearance time (aOR [95%CI]:0.706 (0.533-0.935), P = .015), while fully vaccinated/booster and paxlovid use shortened viral shedding time (1.229 [1.076-1.402], P = .002; 1.140 [0.019-1.274], P = .022, respectively). Older age (>80), cerebrovascular disease, and chronic kidney disease were risk factors of severe/critical. Fully vaccination was a significant protective factor against severe infections (0.237 [0.071-0.793], P = .019). We found patients with more than two comorbidities were more likely to get serious outcomes. These findings demonstrated that in the elderly older than 60 years old, older age (aged over 80), cerebrovascular disease, and chronic kidney disease were risk factors for severe infection. Patients with more than two comorbidities were more likely to get serious outcomes. Fully vaccinated/booster patients were less likely to be severe and vaccinations could shorten viral shedding time. The limitation of lacking an overall spectrum of COVID-19 infections among elders could be compensated in other larger-scale studies in the future.
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Project description:Background The effect of and optimal timing for initiating oral nutritional supplement (ONS) on hospitalized older patients with the Omicron variant infection remain unclear. Methods We collected data from confirmed COVID-19 patients between April 2022 to June 2022 at Shanghai Fourth People's Hospital, one of the designated medical centers for COVID-19 in Shanghai, China. Patients were identified as ONS users or non-ONS users, and the former was further defined as early ONS (ONS initiated within 48h from hospital admission), and late ONS (ONS initiated after 48 h) users. We conducted a retrospective cohort design as primary analysis and a case-control design as sensitivity analysis to explore the associations between ONS and clinical outcomes. Results A total of 1181 hospitalized patients ≥60 years old were included in our study. The mean age of the entire cohort was 78.0, and most patients were female (57.7%). The mortalities after PSM were 1.2% and 4.3% in the ONS group and non-ONS groups, respectively (P = 0.032). Subgroup analysis results showed that patients with early-ONS had significantly shorter hospital length of stay and length from symptom onset to viral clearance when compared to patients with late-ONS (9.0 [6.0-13.0] vs 14.0 [11.0-18.0] and 11.0 [8.0, 17.0] vs 17.0 [13.0-21.8], respectively). The findings from case-control analysis supported those from the primary analysis. Conclusions Early ONS could significantly lower risk of in-hospital death, as well as reduce hospital length of stay and days of viral clearance in COVID-19 older patients during the omicron wave. Graphric abstract Image, graphical abstract
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Project description:BackgroundOmicron is the current predominant variant of concern of SARS-CoV-2. We hypothesized that vaccination alters outcomes of patients hospitalized with COVID-19 during the Omicron wave and that these patients have different characteristics and outcomes than in previous waves.MethodsThis is a substudy of the Host Response Mediators in Coronavirus (COVID-19) Infection (ARBs CORONA I) trial, which included adults admitted to hospital with acute COVID-19 up to July 2022 from 9 hospitals in British Columbia, Ontario and Quebec. We excluded emergency department visits without hospital admission, readmissions and admissions for another reason. Using adjusted regression analysis, we compared mortality and organ dysfunction between vaccinated (≥ 2 doses) and unvaccinated patients during the Omicron wave, as well as between all patients in the Omicron and first 3 waves of the COVID-19 pandemic.ResultsDuring the Omicron wave, 28-day mortality was significantly lower in vaccinated (n = 19/237) than unvaccinated hospitalized patients (n = 12/127) (adjusted odds ratio [OR] 0.36, 95% confidence interval [CI] 0.15-0.89); vaccinated patients had lower risk of admission to the intensive care unit, invasive ventilation and acute respiratory distress syndrome and shorter hospital length of stay. Patients hospitalized during the Omicron wave had more comorbidities than in previous waves, and lower 28-day mortality than in waves 1 and 2 (adjusted OR 0.38, 95% CI 0.24-0.59; and 0.42, 95% CI 0.26-0.65) but not wave 3 (adjusted OR 0.81, 95% CI 0.43-1.51) and had less organ dysfunction than in the first 2 waves.InterpretationPatients who were at least double vaccinated had lower mortality than unvaccinated patients hospitalized during the Omicron wave. Patients hospitalized during the Omicron wave had more chronic disease and lower mortality than in the first 2 waves, but not wave 3. Changes in vaccination, treatments and predominant SARS-CoV-2 variant may have decreased mortality in patients hospitalized during the Omicron wave.
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