Clinical symptoms and severity of elderly COVID-19 patients infected with different SARS-CoV-2 variants
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摘要:
目的 比较新冠病毒德尔塔变异株、奥密克戎变异株BA.1和BA.2在老年感染者中临床表现和严重程度差异。 方法 收集2022年河南省4次大规模新冠肺炎本土疫情中 ≥ 60岁老年感染者的社会人口学信息和发病资料,采用χ2、Fisher精确概率法比较不同变异株感染者发病差异,使用多因素logistic回归分析新冠肺炎重型或危重型的影响因素。 结果 共纳入老年新冠病毒感染者234例,其中德尔塔变异株感染者118例,奥密克戎变异株感染者116例(BA.1 36例、BA.2 80例);56.8 %的感染者为女性,47.6 %有基础性疾病,88.0 %接种了新冠病毒疫苗;德尔塔变异株感染者出现临床症状的比例高于奥密克戎变异株(34.7 % vs. 19.0 %,χ2 = 7.404,P = 0.007),临床表现均以咳嗽、咽痛、咽干等上呼吸道症状和发热、乏力等全身症状为主;德尔塔变异株感染者发展成重型或危重型的比例高于奥密克戎变异株感染者(12.7 % vs. 1.7 %,P = 0.002),多因素logistic回归分析结果显示,感染德尔塔变异株(OR = 5.7,95 % CI = 1.1~31.2),≥ 80岁年龄组(OR = 8.4,95 % CI = 2.0~34.4),存在运动障碍(OR = 5.3,95 % CI = 1.5~18.3)和糖尿病(OR = 5.7,95 % CI = 1.1~31.3)是 ≥ 60岁老年感染者发展成新冠肺炎重型或危重型的危险因素。 结论 ≥ 60岁老年人群感染不同新冠病毒变异株,在临床症状、重型或危重型发生风险上存在差异,感染德尔塔变异株、高龄和患有基础性疾病是发展成重型或危重型的危险因素。 Abstract:Objective To analyze differences in clinical symptoms and severity of elderly coronvirus disease 2019 (COVID-19) patients infected with Delta, Omicron BA.1 and Omicron BA.2 variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods From China′s Infectious Disease Information System, provincial center for disease control and prevention, and local designated hospitals, we collected socio-demographic and clinical information on 60 years and older COVID-19 patients reported in the four large-scale COVID-19 epidemics in Henan province during 2022 and the SARS-CoV-2 variants for the patients′ infections were identified based on gene sequencing in combination with epidemi-ological investigation. Chi-square and Fisher′s precision probability test were used to compare the differences in the incidence of patients infected with different variants and multivariate logistic regression was adopted analyze the influencing factors of disease severity. Results The total number of elderly cases for the four local COVID-19 epidemics was 234, including 118, 36, and 80 cases infected with SARS-CoV-2 Delta, Omicron BA.1, and Omicron BA.2 variant. Of all the cases, 56.8% were female; 47.6% suffered from underlying diseases; and 88.0% had COVID-19 vaccination. The main clinical manifestations for all the cases were fever, fatigue and upper respiratory symptoms such as cough, sore and dry throat. The symptomatic proportion in the cases with Delta variant infection was significantly higher than that in the cases with Omicron variant infection (34.7% vs. 19.0%, P = 0.007). The proportion of severe or critical conditions was significantly higher in the cases with Delta variant infection than that in the cases with Omicron variant infection (12.7% vs. 1.7%, P = 0.002). The results of multivariate logistic regression analysis revealed following risk factors for the occurrence of severe or critical conditions among the elderly cases: infected with Delta variant (odds ratio [OR] = 5.7, 95% confidence interval [95% CI]: 1.1 – 31.2), aged ≥ 80 years (OR = 8.4, 95% CI = 2.0 – 34.4), suffering from dyskinesia (OR = 5.3, 95% CI: 1.5 – 18.3), and suffering from diabetes (OR = 5.7, 95% CI: 1.1 – 31.3). Conclusion In COVID-19 patients aged 60 years and above, clinical symptoms and the occurrence of server or critical conditions differ by different SARS-CoV-2 variants and the patients with Delta variant infection, at older age, and with underlying diseases are at a higher risk of having severe or critical conditions. -
Key words:
- COVID-19 /
- Omicron variant /
- Delta variant /
- older adults /
- clinical symptom /
- clinical severity
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表 1 ≥ 60岁新冠病毒感染者社会人口学特征分布情况(N = 234)
特征 德尔塔变异株 奥密克戎变异株 总计 合计 BA.1 BA.2 n % n % n % n % n % 性别 男 51 43.2 50 43.1 12 33.3 38 47.5 101 43.2 女 67 56.8 66 56.9 24 66.7 42 52.5 133 56.8 年龄组(岁) 60~69 64 54.2 67 57.8 21 58.3 46 57.5 131 56.0 70~79 24 20.3 38 32.8 13 36.1 25 31.3 62 26.5 ≥ 80 30 25.4 11 9.5 2 5.6 9 11.3 41 17.5 地区 农村 76 64.4 110 94.8 34 94.4 76 95.0 186 79.5 城市 42 35.6 6 5.2 2 5.6 4 5.0 48 20.5 职业 农民 84 71.2 100 86.2 34 94.4 66 82.5 184 78.6 家务及待业 15 12.7 5 4.3 0 0.0 5 6.3 20 8.5 离退休 9 7.6 5 4.3 1 2.8 4 5.0 14 6.0 其他 10 8.5 6 5.2 1 2.8 5 6.3 16 6.8 表 2 ≥ 60岁新冠病毒感染者基础性疾病发生情况(N = 234)
疾病 德尔塔变异株 奥密克戎变异株 总计 合计 BA.1 BA.2 n % n % n % n % n % 有基础性疾病 否 47 39.8 55 47.4 21 58.3 34 42.5 102 43.6 是 58 49.2 56 48.3 15 41.7 41 51.3 114 48.7 不详 13 11.0 5 4.3 0 0 5 6.3 18 7.7 运动障碍 否 102 86.4 100 86.2 31 86.1 69 86.3 202 86.3 是 16 13.6 16 13.8 5 13.9 11 13.8 32 13.7 高血压 否 94 79.7 87 75.0 28 77.8 59 73.8 181 77.4 是 24 20.3 29 25.0 8 22.2 21 26.3 53 22.6 心脑血管疾病 a 否 95 80.5 94 81.0 34 94.4 60 75.0 189 80.8 是 23 19.5 22 19.0 2 5.6 20 25.0 46 19.2 糖尿病 否 112 94.9 103 88.8 33 91.7 70 87.5 215 91.9 是 6 5.1 13 11.2 3 8.3 10 12.5 19 8.1 肺部疾病 否 114 96.6 115 99.1 35 97.2 80 100.0 229 97.9 是 4 3.4 1 0.9 1 2.8 0 0.0 5 2.1 肿瘤 否 116 98.3 113 97.4 34 94.4 79 98.8 229 97.9 是 2 1.7 3 2.6 2 5.6 1 1.2 5 2.1 注:a 奥密克戎变异株BA.1与BA.2比较,P < 0.05。 表 3 ≥ 60岁新冠病毒感染者新冠病毒疫苗接种情况(N = 234)
项目 德尔塔变异株 奥密克戎变异株 总计 合计 BA.1 BA.2 n % n % n % n % n % 接种新冠病毒疫苗 a 否 21 17.8 7 6.0 3 8.3 4 5.0 28 12.0 是 97 82.2 109 94.0 33 91.7 76 95.0 206 88.0 全程接种新冠病毒疫苗 a 否 26 22.0 11 9.5 5 13.9 6 7.5 37 15.8 是 92 78.0 105 90.5 31 86.1 74 92.5 197 84.2 接种新冠病毒疫苗加强针 ab 否 106 89.8 73 62.9 34 94.4 39 48.8 179 76.5 是 12 10.2 43 37.1 2 5.6 41 51.2 55 23.5 最后1剂接种时间在确诊90 d以内 a 否 95 80.5 76 65.5 30 86.3 46 57.5 171 73.1 是 23 19.5 40 34.5 6 16.7 34 42.5 23 26.9 注:a 德尔塔变异株与奥密克戎变异株(合计)比较,P < 0.05;b 奥密克戎变异株BA.1与BA.2比较,P < 0.05。 表 4 ≥ 60岁新冠病毒感染者临床症状表现(N = 234)
项目 德尔塔变异株 奥密克戎变异株 总计 合计 BA.1 BA.2 n % n % n % n % n % 咳嗽 a 25 21.2 9 7.8 3 8.3 6 7.5 34 14.5 发热 15 12.7 8 6.9 1 2.8 7 8.8 23 9.8 咽痛、咽干 13 11.0 7 6.0 2 5.6 5 6.3 20 8.5 乏力 4 3.4 5 4.3 2 5.6 3 3.8 9 3.8 头晕、头痛 b 7 5.9 3 2.6 3 8.3 0 0 10 4.3 恶心、呕吐 0 0.0 2 1.7 1 2.8 1 1.3 2 0.9 鼻塞流涕 4 3.4 1 0.9 0 0 1 1.3 5 2.1 腹泻 4 3.4 0 0.0 0 0 0 0 4 1.7 合计 a 41 34.7 22 19.0 9 25 13 16.9 63 26.9 注:a 德尔塔变异株与奥密克戎变异株(合计)比较,P < 0.05;b 奥密克戎变异株BA.1与BA.2比较,Fisher精确概率P < 0.05。 表 5 患有基础性疾病感染者重型或危重型分布情况(N = 234)
项目 非重型或危重型 重型或危重型 P 值 a n % n % 基础性疾病 0.004 否 100 98.0 2 2.0 是 99 86.8 15 13.2 不详 18 100.0 0 0.0 运动障碍 0.003 否 192 95.0 10 5.0 是 25 78.1 7 21.9 高血压 0.228 否 170 93.9 11 6.1 是 47 88.7 6 11.3 心脑血管疾病 0.026 否 179 94.7 10 5.3 是 38 84.4 7 15.6 糖尿病 0.149 否 201 93.5 14 6.5 是 16 84.2 3 15.8 肺部疾病 0.316 否 213 93.0 16 7.0 是 4 80.0 1 20.0 肿瘤 0.316 否 213 93.0 16 7.0 是 4 80.0 1 20.0 注:a Fisher精确概率法。 表 6 不同新冠疫苗接种情况感染者临床表现严重程度分布(N = 234)
项目 非重型或危重型 重型或危重型 P 值 a n % n % 接种新冠病毒疫苗 0.13 否 24 85.7 4 14.3 是 193 93.7 13 6.3 全程接种新冠病毒疫苗 0.008 否 30 81.1 7 18.9 是 187 94.9 10 5.1 加强接种新冠病毒疫苗 0.015 否 162 90.5 17 9.5 是 55 100 0 0 最后1剂接种时间是否在检测阳性90 d内 0.008 否 154 90.1 17 9.9 是 63 100 0 0 注:a Fisher精确概率法。 表 7 ≥ 60岁新冠病毒感染者临床表现严重程度影响因素分析
自变量 参照组 β $S_{\bar x}$ Wald χ2 值 P 值 OR 值 95 % CI 变异株 德尔塔 奥密克戎合计 1.7 0.9 4.1 0.043 5.7 1.1~31.2 年龄组(岁) 70~79 60~69 0.8 0.8 0.9 0.343 2.2 0.4~11.6 ≥ 80 2.1 0.7 8.7 0.003 8.4 2.0~34.4 运动障碍 是 否 1.7 0.6 6.9 0.009 5.3 1.5~18.3 糖尿病 是 否 1.7 0.9 4.1 0.043 5.7 1.1~31.3 -
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