Hospital admission and emergency care attendance risk for SARS-CoV-2 delta (B.1.617.2) compared with alpha (B.1.1.7) variants of concern: a cohort study.
Hospital admission and emergency care attendance risk for SARS-CoV-2 delta (B.1.617.2) compared with alpha (B.1.1.7) variants of concern: a cohort study.
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DOI：
10.1016/s1473-3099(21)00475-8
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发表时间：
2022-01
期刊：
影响因子：
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通讯作者：
COVID-19 Genomics UK (COG-UK) consortium
中科院分区：
文献类型：
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作者：
Twohig KA;Nyberg T;Zaidi A;Thelwall S;Sinnathamby MA;Aliabadi S;Seaman SR;Harris RJ;Hope R;Lopez-Bernal J;Gallagher E;Charlett A;De Angelis D;Presanis AM;Dabrera G;COVID-19 Genomics UK (COG-UK) consortium
SARS-CoV-2 Delta(B.1.617.2)变种于2021年3月在英国首次发现。自那以后，由于高度的传播性，它迅速成为主要的谱系。人们怀疑，与以前占主导地位的阿尔法(B.1.1.7)变异相比，Delta变异与更严重的疾病有关。我们的目的是通过确定医院就诊结果的相对风险来描述与阿尔法变量相比，增量变量的严重性。这项队列研究是在2021年3月29日至5月23日期间在英国进行的所有新冠肺炎患者中进行的，通过全基因组测序，这些患者被确认感染了阿尔法或德尔塔SARS-CoV-2变种。这些患者的个人数据与常规卫生保健数据集(来自英国公共卫生第二代监测系统和新冠肺炎相关死亡数据集；国家免疫接种管理系统；以及国民健康保险数字二次使用服务和紧急护理数据集)相关联。在整个队列和疫苗接种状态亚组中，比较了测序确认的Delta和Alpha变异患者的住院和急救就诊风险。分层COX回归被用于调整年龄、性别、种族、剥夺、最近的国际旅行、居住地区、日历周和接种情况。我们的分析包括了43名 338名新冠肺炎阳性患者的个体水平数据(8682名Delta变异型，34名 656变异型；平均年龄31岁[IQR17-43])。196名(2.3%)Delta变异型患者和764名(2.2%)Alpha变异型患者在标本采集后14天内入院(调整后的风险比[HR]2·26[95%CI 1·32-3·89])。498名(5.7%)Delta变异型患者在14天内入院或接受急救(调整后的HR 1·45[1·08-1·95])，而Alpha变异型患者为1448(4.2%)。大多数患者未接种疫苗(两组均为32 078[74.0%])。接种了Delta变异体的患者与阿尔法变异体(入院调整后的HR分别为1·94[95%CI 0·47-8·05]和住院或急救1·58[0·69-3·61])的HR与未接种的患者的HR(2·32[1·29-4·16]和1·43[1·04-1·97]；p=0·82)相似，但接种亚组的精确度较低。这项大型的全国性研究发现，与阿尔法变种相比，感染Delta变种的新冠肺炎患者入院或参加急救的风险更高。结果表明，在未接种疫苗的人群中爆发的Delta变种可能会比阿尔法变种给卫生保健服务带来更大的负担。医学研究理事会；英国研究和创新；卫生和社会保健部；以及国家卫生研究所。
The SARS-CoV-2 delta (B.1.617.2) variant was first detected in England in March, 2021. It has since rapidly become the predominant lineage, owing to high transmissibility. It is suspected that the delta variant is associated with more severe disease than the previously dominant alpha (B.1.1.7) variant. We aimed to characterise the severity of the delta variant compared with the alpha variant by determining the relative risk of hospital attendance outcomes. This cohort study was done among all patients with COVID-19 in England between March 29 and May 23, 2021, who were identified as being infected with either the alpha or delta SARS-CoV-2 variant through whole-genome sequencing. Individual-level data on these patients were linked to routine health-care datasets on vaccination, emergency care attendance, hospital admission, and mortality (data from Public Health England's Second Generation Surveillance System and COVID-19-associated deaths dataset; the National Immunisation Management System; and NHS Digital Secondary Uses Services and Emergency Care Data Set). The risk for hospital admission and emergency care attendance were compared between patients with sequencing-confirmed delta and alpha variants for the whole cohort and by vaccination status subgroups. Stratified Cox regression was used to adjust for age, sex, ethnicity, deprivation, recent international travel, area of residence, calendar week, and vaccination status. Individual-level data on 43 338 COVID-19-positive patients (8682 with the delta variant, 34 656 with the alpha variant; median age 31 years [IQR 17–43]) were included in our analysis. 196 (2·3%) patients with the delta variant versus 764 (2·2%) patients with the alpha variant were admitted to hospital within 14 days after the specimen was taken (adjusted hazard ratio [HR] 2·26 [95% CI 1·32–3·89]). 498 (5·7%) patients with the delta variant versus 1448 (4·2%) patients with the alpha variant were admitted to hospital or attended emergency care within 14 days (adjusted HR 1·45 [1·08–1·95]). Most patients were unvaccinated (32 078 [74·0%] across both groups). The HRs for vaccinated patients with the delta variant versus the alpha variant (adjusted HR for hospital admission 1·94 [95% CI 0·47–8·05] and for hospital admission or emergency care attendance 1·58 [0·69–3·61]) were similar to the HRs for unvaccinated patients (2·32 [1·29–4·16] and 1·43 [1·04–1·97]; p=0·82 for both) but the precision for the vaccinated subgroup was low. This large national study found a higher hospital admission or emergency care attendance risk for patients with COVID-19 infected with the delta variant compared with the alpha variant. Results suggest that outbreaks of the delta variant in unvaccinated populations might lead to a greater burden on health-care services than the alpha variant. Medical Research Council; UK Research and Innovation; Department of Health and Social Care; and National Institute for Health Research.