Increased mortality in community-tested cases of SARS-CoV-2 lineage B.1.1.7
Increased mortality in community-tested cases of SARS-CoV-2 lineage B.1.1.7
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DOI：
10.1101/2021.02.01.21250959
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发表时间：
2021-03-15
期刊：
影响因子：
64.8
通讯作者：
Keogh, Ruth H.
中科院分区：
文献类型：
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作者：
Davies, Nicholas G.;Jarvis, Christopher I.;Keogh, Ruth H.
SARS-CoV-2谱系B.1.1.7是2020年9月在英国首次发现的变种(1)，已传播到全球多个国家。几项研究已经证实，B.1.1.7比以前存在的变种更容易传播，但还没有确定它是否会导致疾病严重程度的变化。在这里，我们分析了一个数据集，该数据集将2020年11月1日至2021年2月14日期间英国2,245,263例SARS-CoV-2阳性社区检测和17,452例与新冠肺炎相关的死亡联系在一起。对于这些测试中的1,146,534例(51%)，可以确定B.1.1.7的存在或不存在，因为这一谱系的突变阻止了对SPEKE(S)基因靶标的聚合酶链式反应(称为SGENE靶标失败(SGTF)(1))。根据4945例已知SGTF状态的死亡病例，我们估计，在调整了年龄、性别、种族、贫困、在疗养院居住、居住地方当局和测试日期后，与SGTF相关的死亡风险比没有SGTF的病例高55%(95%可信区间，39-72%)。这相当于55-69岁男子的绝对死亡风险在社区阳性检测后28天内从0.6%上升到0.9%(95%可信区间，0.8%-1.0%)。纠正SGTF的错误分类和SGTF状态下的错配，我们估计与B.1.1.7相关的死亡风险比以前存在的变体高61%(42-82%)。我们的分析表明，B.1.1.7不仅比以前存在的SARS-CoV-2变种更具传播性，而且还可能导致更严重的疾病。
SARS-CoV-2 lineage B.1.1.7, a variant that was first detected in the UK in September 2020(1), has spread to multiple countries worldwide. Several studies have established that B.1.1.7 is more transmissible than pre-existing variants, but have not identified whether it leads to any change in disease severity. Here we analyse a dataset that links 2,245,263 positive SARS-CoV-2 community tests and 17,452 deaths associated with COVID-19 in England from 1 November 2020 to 14 February 2021. For 1,146,534 (51%) ofthese tests, the presence or absence of B.1.1.7 can be identified because mutations in this lineage prevent PCR amplification ofthe spike (S) gene target (known as Sgene target failure (SGTF)(1)). On the basis of 4,945 deaths with known SGTF status, we estimate that the hazard of death associated with SGTF is 55% (95% confidence interval, 39-72%) higher than in cases without SGTF after adjustment for age, sex, ethnicity, deprivation, residence in a care home, the local authority of residence and test date. This corresponds to the absolute risk of death for a 55-69-year-old man increasing from 0.6% to 0.9% (95% confidence interval, 0.8-1.0%) within 28 days of a positive test in the community. Correcting for misclassification of SGTF and missingness in SGTF status, we estimate that the hazard of death associated with B.1.1.7 is 61% (42-82%) higher than with pre-existing variants. Our analysis suggests that B.1.1.7 is not only more transmissible than pre-existing SARS-CoV-2 variants, but may also cause more severe illness.