Severity of Illness in Persons Infected With the SARS-CoV-2 Delta Variant vs Beta Variant in Qatar
Severity of Illness in Persons Infected With the SARS-CoV-2 Delta Variant vs Beta Variant in Qatar
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DOI：
10.1001/jamainternmed.2021.7949
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发表时间：
2021-12-22
影响因子：
39
通讯作者：
Abu-Raddad, Laith J.
中科院分区：
文献类型：
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作者：
Butt, Adeel A.;Dargham, Soha R.;Abu-Raddad, Laith J.
Delta变异体现在是全球主要的SARS-CoV-2病毒株。SARS-CoV-2 Delta变异体感染者与Beta变异体感染者的疾病严重程度尚不清楚。目的直接比较卡塔尔SARS-CoV-2 Delta变异体感染者与Beta变异体感染者的临床结局。设计、设置和参与者这项回顾性队列研究使用来自卡塔尔国家COVID-19数据库的数据，其中包括在卡塔尔使用逆转录酶-聚合酶链反应测试进行SARS-CoV-2测试的所有个人以及接受任何SARS-CoV-2疫苗的所有个人的信息。在2021年3月22日至7月7日期间确诊的SARS-CoV-2感染者中，确定了感染Delta变体的人，并与感染Beta变体的对照个体进行了倾向评分匹配。通过对阳性样本进行变异基因分型来确定变异体。暴露SARS-CoV-2感染Delta或Beta变异体。主要结局和指标主要结局为入院、入住重症监护室、使用辅助供氧、使用高流量氧气、接受机械通气、结果在1427例Delta变异体感染者中，（252名[55.9%]男性;中位年龄，34岁[IQR，17-43岁]）和5353名感染β变体的人（233名[51.7%]男性;中位年龄，34岁[IQR，17-45岁]），确定了451个倾向评分匹配对。感染德尔塔变异病毒的人更有可能住院治疗（27.3% [95%CI，23.2%-31.6%] vs 20.0%[95%CI，16.4-24.0]; P = 0.01）或具有轻-中度或严重-危重疾病结局（27.9%[95% CI，23.8%-32.3%] vs 20.2%[95% CI，16.6%-24.2%]; P = 0.01）与感染β变体的人相比。Delta变体感染与出现任何不良后果的几率较高独立相关（调整后的比值比[aOR]，2.53; 95%CI，1.72-3.72）。与未接种疫苗相比，在感染Delta变异体（aOR，0.11; 95%CI，0.04-0.26）和感染Beta变异体（aOR，0.22; 95%CI，0.05-0.98）的人群中，在感染前3个月以上接种第二剂疫苗与任何不良结局的几率较低相关。在感染前不到3个月接受第二剂疫苗的人中，保护作用相似，但在感染Delta变体的人中，仅接受单剂疫苗与任何严重后果的可能性较低无关（aOR，1.12; 95% CI，0.41-3.06）或感染β变体的受试者（aOR，0.74; 95%CI，0.20-2.72）。结论和相关性在卡塔尔COVID-19患者的队列研究中，SARS-CoV-2 Delta变异体感染比Beta变异体感染与更严重的疾病相关。未接种疫苗与严重危重疾病的几率更大有关。
IMPORTANCE The Delta variant is now the predominant circulating SARS-CoV-2 strain worldwide. Severity of illness in persons infected with the SARS-CoV-2 Delta variant compared with the Beta variant is not known.OBJECTIVE To directly compare clinical outcomes in persons infected with the SARS-CoV-2 Delta variant vs those infected with the Beta variant in Qatar.DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the national COVID-19 database in Qatar, which includes information on all individuals who were ever tested for SARS-CoV-2 using a reverse transcriptase-polymerase chain reaction test and all individuals who received any SARS-CoV-2 vaccine in Qatar. Among persons with confirmed SARS-CoV-2 infection between March 22 and July 7, 2021, those infected with the Delta variant were identified and were propensity score matched with control individuals infected with the Beta variant. The variants were ascertained by variant genotyping of the positive samples. EXPOSURES SARS-CoV-2 infection with the Delta or Beta variant.MAIN OUTCOMES AND MEASURES The main outcomes were admission to the hospital, admission to the intensive care unit, use of supplemental oxygen, use of high-flow oxygen, receipt of mechanical ventilation, or death among those infected with the Delta or Beta variant overall and stratified by vaccination status.RESULTS Among 1427 persons infected with the Delta variant (252 [55.9%] male; median age, 34 years [IQR, 17-43 years]) and 5353 persons infected with the Beta variant (233 [51.7%] male; median age, 34 years [IQR, 17-45 years]), 451 propensity score-matched pairs were identified. Persons infected with the Delta variant were more likely to be hospitalized (27.3% [95% CI, 23.2%-31.6%] vs 20.0%[95% CI, 16.4-24.0]; P =.01) or to have mild-moderate or severe-critical disease outcomes (27.9%[95% CI, 23.8%-32.3%] vs 20.2%[95% CI, 16.6%-24.2%]; P =.01) compared with persons infected with the Beta variant. Infection with the Delta variant was independently associated with higher odds of experiencing any adverse outcome (adjusted odds ratio [aOR], 2.53; 95% CI, 1.72-3.72). Compared with being unvaccinated, being vaccinated with a second dose more than 3 months before infection was associated with lower odds of any adverse outcome among persons infected with the Delta variant (aOR, 0.11; 95% CI, 0.04-0.26) and among those infected with the Beta variant (aOR, 0.22; 95% CI, 0.05-0.98). Protection was similar among those who received a second vaccine dose less than 3 months before infection, but having received only a single dose was not associated with a lower odds of any severe outcome among those infected with the Delta variant (aOR, 1.12; 95% CI, 0.41-3.06) or those infected with the Beta variant (aOR, 0.74; 95% CI, 0.20-2.72).CONCLUSIONS AND RELEVANCE In this cohort study of persons with COVID-19 in Qatar, infection with the SARS-CoV-2 Delta variant was associated with more severe disease than was infection with the Beta variant. Being unvaccinated was associated with greater odds of severe-critical disease.