학술논문
Changing Severity and Epidemiology of Adults Hospitalized With Coronavirus Disease 2019 (COVID-19) in the United States After Introduction of COVID-19 Vaccines, March 2021–August 2022.
Document Type
Article
Author
Kojima, Noah; Adams, Katherine; Self, Wesley H; Gaglani, Manjusha; McNeal, Tresa; Ghamande, Shekhar; Steingrub, Jay S; Shapiro, Nathan I; Duggal, Abhijit; Busse, Laurence W; Prekker, Matthew E; Peltan, Ithan D; Brown, Samuel M; Hager, David N; Ali, Harith; Gong, Michelle N; Mohamed, Amira; Exline, Matthew C; Khan, Akram; Wilson, Jennifer G
Source
Subject
*EVALUATION of medical care
*BIOMARKERS
*C-reactive protein
*PUBLIC health surveillance
*COVID-19
*SEQUENCE analysis
*COVID-19 vaccines
*AGE distribution
*ACQUISITION of data
*SEVERITY of illness index
*HOSPITAL care
*OXYGEN therapy
*DESCRIPTIVE statistics
*SYMPTOMS
*MESSENGER RNA
*LEUKOCYTE count
*MEDICAL records
*RESEARCH funding
*POLYMERASE chain reaction
*VACCINATION status
*DATA analysis software
*FIBRIN fibrinogen degradation products
*COMORBIDITY
*LONGITUDINAL method
*DISCHARGE planning
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Language
ISSN
1058-4838
Abstract
Introduction Understanding the changing epidemiology of adults hospitalized with coronavirus disease 2019 (COVID-19) informs research priorities and public health policies. Methods Among adults (≥18 years) hospitalized with laboratory-confirmed, acute COVID-19 between 11 March 2021, and 31 August 2022 at 21 hospitals in 18 states, those hospitalized during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron-predominant period (BA.1, BA.2, BA.4/BA.5) were compared to those from earlier Alpha- and Delta-predominant periods. Demographic characteristics, biomarkers within 24 hours of admission, and outcomes, including oxygen support and death, were assessed. Results Among 9825 patients, median (interquartile range [IQR]) age was 60 years (47–72), 47% were women, and 21% non-Hispanic Black. From the Alpha-predominant period (Mar–Jul 2021; N = 1312) to the Omicron BA.4/BA.5 sublineage-predominant period (Jun–Aug 2022; N = 1307): the percentage of patients who had ≥4 categories of underlying medical conditions increased from 11% to 21%; those vaccinated with at least a primary COVID-19 vaccine series increased from 7% to 67%; those ≥75 years old increased from 11% to 33%; those who did not receive any supplemental oxygen increased from 18% to 42%. Median (IQR) highest C-reactive protein and D-dimer concentration decreased from 42.0 mg/L (9.9–122.0) to 11.5 mg/L (2.7–42.8) and 3.1 mcg/mL (0.8–640.0) to 1.0 mcg/mL (0.5–2.2), respectively. In-hospital death peaked at 12% in the Delta-predominant period and declined to 4% during the BA.4/BA.5-predominant period. Conclusions Compared to adults hospitalized during early COVID-19 variant periods, those hospitalized during Omicron-variant COVID-19 were older, had multiple co-morbidities, were more likely to be vaccinated, and less likely to experience severe respiratory disease, systemic inflammation, coagulopathy, and death. [ABSTRACT FROM AUTHOR]