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Comparison of Clinical Characteristics and Mortality Outcome in Critical COVID-19 Patients Infected with Alpha and
Hsin-I Cheng1, Ko-Wei Chang1, Bing-Chen Wu1
1Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkuo, Taiwan.
Insights
Critical COVID-19 patients with Alpha variant had lower mortality than Omicron. Charlson Comorbidity Index (CCI) ≥ 3, elevated creatine, and prolonged prothrombin time (PT) independently predicted mortality in severe cases.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Epidemiology
Background:
- Early reports suggested lower mortality for the Omicron variant of coronavirus disease 2019 (COVID-19).
- However, specific mortality rates for critical COVID-19 patients in Taiwan across different SARS-CoV-2 variants remain underexplored.
Purpose of the Study:
- To investigate and compare the mortality rates of critical COVID-19 patients in Taiwan infected with different SARS-CoV-2 variants.
- To identify independent risk factors associated with in-hospital mortality in this patient population.
Main Methods:
- A retrospective cohort study was conducted at Chang Gung Memorial Hospital, Taiwan, from April 2020 to September 2022.
- Enrolled patients were critically ill, confirmed SARS-CoV-2 positive, and required mechanical ventilation (MV).
- Demographic, laboratory, treatment, and clinical outcome data were analyzed, comparing patients during Alpha and Omicron variant predominance periods.
Main Results:
- The study included 110 critical COVID-19 patients requiring intubation and ICU admission.
- The Omicron group (n=64) exhibited higher in-hospital mortality (40.6%) compared to the Alpha group (n=46, 15.2%).
- Independent risk factors for mortality included Charlson Comorbidity Index (CCI) ≥ 3, elevated serum creatine, and prolonged prothrombin time (PT).
Conclusions:
- Critical COVID-19 patients infected during the Omicron predominance period had significantly higher in-hospital mortality than those during the Alpha predominance period.
- Charlson Comorbidity Index (CCI) ≥ 3, elevated serum creatine, and prolonged prothrombin time (PT) are independent predictors of mortality in critical COVID-19.
- These findings highlight the need for intensive monitoring for critical COVID-19 patients with identified risk factors.
Objective:
Early reports have indicated that the Omicron variant of coronavirus disease 2019 (COVID-19) may be associated with low mortality. However, the mortality rate of critical patients in Taiwan with COVID-19 caused by different variants has not been well described.
Methods:
This retrospective cohort study was conducted at the Linkou Branch of Chang Gung Memorial Hospital, Taiwan, from April 2020 to September 2022. Critically ill patients who had confirmed SARS-CoV-2 infection and were on mechanical ventilation (MV) were enrolled. Demographic data, laboratory results, and treatment information were collected and analyzed. In addition, clinical outcomes for different SARS-CoV-2 variants were analyzed.
Results:
This study included 110 critical patients with COVID-19 who required intubation and intensive care unit (ICU) admission. Among these patients, 46 (41.8%) required intensive care during Alpha predominance period and 64 (58.2%) during the Omicron predominance period. The Alpha group had a higher body mass index, had a longer ICU stay, and included more patients with acute respiratory distress syndrome, and the Omicron group included more active smokers, had more comorbidities, had worse initial laboratory data (including higher white blood cell counts, prothrombin time [PT], activated partial prothrombin time, blood urine nitrogen levels, and creatine levels), and had higher in-hospital mortality rates (40.6% vs 15.2%, p = 0.004). The independent risk factors for in-hospital mortality, were Charlson Comorbidity Index (CCI) ≥ 3 and higher PT and creatine levels.
Conclusion:
Our study discovered that CCI ≥ 3, elevated serum creatine levels, and prolonged PT were independently associated with a high mortality rate in patients with critical COVID-19. Patients with those risk factors may require intensive monitoring during their treatment course.
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