Risk of hospitalisation associated with infection with SARS-CoV-2 lineage B.1.1.7 in Denmark: an observational cohort study.
Risk of hospitalisation associated with infection with SARS-CoV-2 lineage B.1.1.7 in Denmark: an observational cohort study.
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与SARS-COV-2谱系感染有关的住院风险B.1.1.7在丹麦：一项观察队列研究。
DOI：
10.1016/s1473-3099(21)00290-5
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发表时间：
2021-11
期刊：
影响因子：
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通讯作者：
Danish Covid-19 Genome Consortium
中科院分区：
文献类型：
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作者：
Bager P;Wohlfahrt J;Fonager J;Rasmussen M;Albertsen M;Michaelsen TY;Møller CH;Ethelberg S;Legarth R;Button MSF;Gubbels S;Voldstedlund M;Mølbak K;Skov RL;Fomsgaard A;Krause TG;Danish Covid-19 Genome Consortium
2020年12月后，传染性更强的SARS-CoV-2谱系B.1.1.7在欧洲迅速传播，人们担心B.1.1.7可能导致更严重的疾病。利用丹麦较高的RT-PCR检测和全基因组测序能力，我们使用国家健康登记数据评估了感染B.1.1.7的个体与感染其他SARS-CoV-2谱系的个体相比的COVID-19住院风险。我们对2021年1月1日至3月24日期间在丹麦通过RT-PCR确诊的所有SARS-CoV-2阳性病例进行了一项观察性队列研究，并对COVID-19住院进行了14天的随访。病例是在国家COVID-19监测系统数据库中确定的，其中包括来自丹麦微生物学数据库（RT-PCR检测结果）、丹麦COVID-19基因组联盟、国家患者登记处、民事登记系统以及其他全国性登记处的数据。在所有病例中，COVID-19住院治疗定义为在RT-PCR结果呈阳性的样本14天内首次入院持续时间超过12小时。研究人群和主要分析仅限于具有病毒基因组数据的病例比例。我们根据B.1.1.7感染与其他共存谱系感染，采用具有稳健SE的Poisson回归模型计算入院风险比（RR），并根据性别、年龄、日历时间、地区和合并症进行先验调整。随后通过逐步向前纳入评价每个协变量对粗RR混杂的贡献。在2021年1月1日至3月24日期间，确定了50958名SARS-CoV-2检测阳性并至少住院14天的患者; 30572人（60.0%）有基因组数据，其中10544人（34.5%）感染了B.1.1.7。1944人（6.4%）因COVID-19住院治疗，其中571人（29.4%）感染B.1.1.7，1373人（70.6%）感染其他SARS-CoV-2谱系。虽然在研究期间住院的总人数减少，但感染B.1.1.7的个体比例从每周3.5%增加到92.1%。B.1.1.7与入院的粗RR 0.79（95% CI 0.72 - 0.87; p<0.0001）和校正RR 1.42（95% CI 1.25 - 1.60; p<0.0001）相关。调整后的RR在年龄和日历周期的所有分层中均增加，这两个协变量对粗RR的混淆贡献最大。在调整协变量的分析中，与其他谱系相比，SARS-CoV-2谱系B.1.1.7感染与住院风险增加相关。由于严格的封锁，丹麦对住院的总体影响有所减轻，但我们的研究结果可以支持医院的准备工作，并对B.1.1.7不受控制的国家的流行病的预期影响进行建模。一个也没有。
The more infectious SARS-CoV-2 lineage B.1.1.7 rapidly spread in Europe after December, 2020, and a concern that B.1.1.7 could cause more severe disease has been raised. Taking advantage of Denmark's high RT-PCR testing and whole genome sequencing capacities, we used national health register data to assess the risk of COVID-19 hospitalisation in individuals infected with B.1.1.7 compared with those with other SARS-CoV-2 lineages. We did an observational cohort study of all SARS-CoV-2-positive cases confirmed by RT-PCR in Denmark, sampled between Jan 1 and March 24, 2021, with 14 days of follow-up for COVID-19 hospitalisation. Cases were identified in the national COVID-19 surveillance system database, which includes data from the Danish Microbiology Database (RT-PCR test results), the Danish COVID-19 Genome Consortium, the National Patient Registry, the Civil Registration System, as well as other nationwide registers. Among all cases, COVID-19 hospitalisation was defined as first admission lasting longer than 12 h within 14 days of a sample with a positive RT-PCR result. The study population and main analysis were restricted to the proportion of cases with viral genome data. We calculated the risk ratio (RR) of admission according to infection with B.1.1.7 versus other co-existing lineages with a Poisson regression model with robust SEs, adjusted a priori for sex, age, calendar time, region, and comorbidities. The contribution of each covariate to confounding of the crude RR was evaluated afterwards by a stepwise forward inclusion. Between Jan 1 and March 24, 2021, 50 958 individuals with a positive SARS-CoV-2 test and at least 14 days of follow-up for hospitalisation were identified; 30 572 (60·0%) had genome data, of whom 10 544 (34·5%) were infected with B.1.1.7. 1944 (6·4%) individuals had a COVID-19 hospitalisation and of these, 571 (29·4%) had a B.1.1.7 infection and 1373 (70·6%) had an infection with other SARS-CoV-2 lineages. Although the overall number of hospitalisations decreased during the study period, the proportion of individuals infected with B.1.1.7 increased from 3·5% to 92·1% per week. B.1.1.7 was associated with a crude RR of hospital admission of 0·79 (95% CI 0·72–0·87; p<0·0001) and an adjusted RR of 1·42 (95% CI 1·25–1·60; p<0·0001). The adjusted RR was increased in all strata of age and calendar period—the two covariates with the largest contribution to confounding of the crude RR. Infection with SARS-CoV-2 lineage B.1.1.7 was associated with an increased risk of hospitalisation compared with that of other lineages in an analysis adjusted for covariates. The overall effect on hospitalisations in Denmark was lessened due to a strict lockdown, but our findings could support hospital preparedness and modelling of the projected impact of the epidemic in countries with uncontrolled spread of B.1.1.7. None.