Mortality and critical care unit admission associated with the SARS-CoV-2 lineage B.1.1.7 in England: an observational cohort study.
Mortality and critical care unit admission associated with the SARS-CoV-2 lineage B.1.1.7 in England: an observational cohort study.
复制标题
与SARS-COV-2血统相关的死亡率和重症监护病房在英格兰B.1.1.7：一项观察队列研究。
DOI：
10.1016/s1473-3099(21)00318-2
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发表时间：
2021-11
期刊：
影响因子：
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通讯作者：
Hippisley-Cox J
中科院分区：
文献类型：
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作者：
Patone M;Thomas K;Hatch R;Tan PS;Coupland C;Liao W;Mouncey P;Harrison D;Rowan K;Horby P;Watkinson P;Hippisley-Cox J
英国出现了一种更具传播性的SARS-CoV-2变种，即关注变种202012/01或谱系B.1.1.7。我们的目的是评估与非B.1.1.7谱系相比，B.1.1.7谱系患者重症监护入院的风险、重症患者的死亡率和总体死亡率。我们还比较了这两组之间的临床结果。对于这项观察性队列研究，我们将大型初级保健（QResearch），国家重症监护（重症监护国家审计和研究中心病例组合计划）和国家COVID-19检测（英格兰公共卫生）数据库联系起来。我们使用S基因分子诊断检测失败（SGTF）的SARS-CoV-2阳性样本作为谱系B.1.1.7存在的代表。我们从数据中提取了两个队列：初级保健队列，包括2020年11月1日至2021年1月26日期间报告的社区COVID-19检测阳性且已知SGTF状态的初级保健患者;重症监护队列，包括2020年11月1日至1月27日期间报告社区COVID-19检测呈阳性的重症监护患者，2021年，已知SGTF状态。我们探讨了SARS-CoV-2感染与B.1.1.7谱系感染和重症监护室（CCU）入院、28天死亡率以及CCU入院后28天死亡率之间的关系。我们使用Royston-Parmar模型调整年龄，性别，地理区域，其他社会人口因素（初级保健队列的贫困指数、种族、家庭住房类别和吸烟状况; CCU队列入院前的种族、体重指数、剥夺指数和依赖性）和合并症（哮喘、慢性阻塞性肺病、1型和2型糖尿病和高血压用于初级护理队列;以及心血管疾病、呼吸系统疾病、转移性疾病和免疫功能低下病症用于CCU队列）。我们报告了B.1.1.7和非B.1.1.7组的器官支持类型和持续时间的信息。初级保健队列包括198420例SARS-CoV-2感染患者。其中117926例（59.4%）为B.1.1.7谱系，836例（0.4%）入住CCU，899例（0.4%）在28天内死亡。重症监护队列包括4272例入住CCU的患者。其中，2685例（62.8%）具有谱系B.1.1.7，662例（15.5%）在重症监护结束时死亡。在初级保健队列中，我们估计与非B.1.1.7谱系组相比，B.1.1.7谱系患者入住CCU的校正风险比（HR）为2.15（95%CI 1.75 - 2.65），28天死亡率的校正风险比（HR）为1.65（1.36 - 2.01）。根据重症监护队列的估计，与非B.1.1.7感染患者相比，B. 1. 1. 7谱系患者重症监护死亡率的校正HR为0. 91（0. 76-1. 09）。与非B.1.1.7 SARS-CoV-2患者相比，B.1.1.7谱系患者的CCU入院风险和28天死亡率增加。对于接受重症监护的患者，死亡率似乎与病毒株无关。我们的研究结果强调了控制COVID-19暴露和感染的措施的重要性。Wellcome Trust，National Institute for Health Research Oxford Biomedical Research Centre，以及牛津大学医学部。
A more transmissible variant of SARS-CoV-2, the variant of concern 202012/01 or lineage B.1.1.7, has emerged in the UK. We aimed to estimate the risk of critical care admission, mortality in patients who are critically ill, and overall mortality associated with lineage B.1.1.7 compared with non-B.1.1.7. We also compared clinical outcomes between these two groups. For this observational cohort study, we linked large primary care (QResearch), national critical care (Intensive Care National Audit & Research Centre Case Mix Programme), and national COVID-19 testing (Public Health England) databases. We used SARS-CoV-2 positive samples with S-gene molecular diagnostic assay failure (SGTF) as a proxy for the presence of lineage B.1.1.7. We extracted two cohorts from the data: the primary care cohort, comprising patients in primary care with a positive community COVID-19 test reported between Nov 1, 2020, and Jan 26, 2021, and known SGTF status; and the critical care cohort, comprising patients admitted for critical care with a positive community COVID-19 test reported between Nov 1, 2020, and Jan 27, 2021, and known SGTF status. We explored the associations between SARS-CoV-2 infection with and without lineage B.1.1.7 and admission to a critical care unit (CCU), 28-day mortality, and 28-day mortality following CCU admission. We used Royston-Parmar models adjusted for age, sex, geographical region, other sociodemographic factors (deprivation index, ethnicity, household housing category, and smoking status for the primary care cohort; and ethnicity, body-mass index, deprivation index, and dependency before admission to acute hospital for the CCU cohort), and comorbidities (asthma, chronic obstructive pulmonary disease, type 1 and 2 diabetes, and hypertension for the primary care cohort; and cardiovascular disease, respiratory disease, metastatic disease, and immunocompromised conditions for the CCU cohort). We reported information on types and duration of organ support for the B.1.1.7 and non-B.1.1.7 groups. The primary care cohort included 198 420 patients with SARS-CoV-2 infection. Of these, 117 926 (59·4%) had lineage B.1.1.7, 836 (0·4%) were admitted to CCU, and 899 (0·4%) died within 28 days. The critical care cohort included 4272 patients admitted to CCU. Of these, 2685 (62·8%) had lineage B.1.1.7 and 662 (15·5%) died at the end of critical care. In the primary care cohort, we estimated adjusted hazard ratios (HRs) of 2·15 (95% CI 1·75–2·65) for CCU admission and 1·65 (1·36–2·01) for 28-day mortality for patients with lineage B.1.1.7 compared with the non-B.1.1.7 group. The adjusted HR for mortality in critical care, estimated with the critical care cohort, was 0·91 (0·76–1·09) for patients with lineage B.1.1.7 compared with those with non-B.1.1.7 infection. Patients with lineage B.1.1.7 were at increased risk of CCU admission and 28-day mortality compared with patients with non-B.1.1.7 SARS-CoV-2. For patients receiving critical care, mortality appeared to be independent of virus strain. Our findings emphasise the importance of measures to control exposure to and infection with COVID-19. Wellcome Trust, National Institute for Health Research Oxford Biomedical Research Centre, and the Medical Sciences Division of the University of Oxford.