1
|
Sim JK, Lee HS, Yang J, Gwack J, Kim BI, Cha JO, Min KH, Lee YS. Comparative Analysis of Clinical Outcomes Using Propensity Score Matching: Coronavirus Disease 2019 vs. Seasonal Influenza in Korea. J Korean Med Sci 2024; 39:e128. [PMID: 38622937 PMCID: PMC11018986 DOI: 10.3346/jkms.2024.39.e128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/18/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The advent of the omicron variant and the formulation of diverse therapeutic strategies marked a new epoch in the realm of coronavirus disease 2019 (COVID-19). Studies have compared the clinical outcomes between COVID-19 and seasonal influenza, but such studies were conducted during the early stages of the pandemic when effective treatment strategies had not yet been developed, which limits the generalizability of the findings. Therefore, an updated evaluation of the comparative analysis of clinical outcomes between COVID-19 and seasonal influenza is requisite. METHODS This study used data from the severe acute respiratory infection surveillance system of South Korea. We extracted data for influenza patients who were infected between 2018 and 2019 and COVID-19 patients who were infected in 2021 (pre-omicron period) and 2022 (omicron period). Comparisons of outcomes were conducted among the pre-omicron, omicron, and influenza cohorts utilizing propensity score matching. The adjusted covariates in the propensity score matching included age, sex, smoking, and comorbidities. RESULTS The study incorporated 1,227 patients in the pre-omicron cohort, 1,948 patients in the omicron cohort, and 920 patients in the influenza cohort. Following propensity score matching, 491 patients were included in each respective group. Clinical presentations exhibited similarities between the pre-omicron and omicron cohorts; however, COVID-19 patients demonstrated a higher prevalence of dyspnea and pulmonary infiltrates compared to their influenza counterparts. Both COVID-19 groups exhibited higher in-hospital mortality and longer hospital length of stay than the influenza group. The omicron group showed no significant improvement in clinical outcomes compared to the pre-omicron group. CONCLUSION The omicron group did not demonstrate better clinical outcomes than the pre-omicron group, and exhibited significant disease severity compared to the influenza group. Considering the likely persistence of COVID-19 infections, it is imperative to sustain comprehensive studies and ongoing policy support for the virus to enhance the prognosis for individuals affected by COVID-19.
Collapse
Affiliation(s)
- Jae Kyeom Sim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Juyeon Yang
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Gwack
- Division of Infectious Disease Control, Bureau of Infectious Disease Policy, Korea Disease Control and Prevention Agency (KDCA), Cheongju, Korea
| | - Bryan Inho Kim
- Division of Infectious Disease Control, Bureau of Infectious Disease Policy, Korea Disease Control and Prevention Agency (KDCA), Cheongju, Korea
| | - Jeong-Ok Cha
- Division of Infectious Disease Control, Bureau of Infectious Disease Policy, Korea Disease Control and Prevention Agency (KDCA), Cheongju, Korea
| | - Kyung Hoon Min
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Young Seok Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea.
| |
Collapse
|
2
|
Grant RL, Sauser J, Atkinson A, D’Incau S, Buetti N, Zanella MC, Harbarth S, Marschall J, Catho G. Comparison of clinical outcomes over time of inpatients with healthcare-associated or community-acquired coronavirus disease 2019 (COVID-19): A multicenter, prospective cohort study. Infect Control Hosp Epidemiol 2024; 45:75-81. [PMID: 37529850 PMCID: PMC10782206 DOI: 10.1017/ice.2023.143] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE To compare clinical outcomes over time of inpatients with healthcare-associated coronavirus disease 2019 (HA-COVID-19) versus community-acquired COVID-19 (CA-COVID-19). DESIGN We conducted a multicenter, prospective observational cohort study of inpatients with COVID-19. SETTING The study was conducted across 16 acute-care hospitals in Switzerland. PARTICIPANTS AND METHODS We compared HA-COVID-19 cases, defined as patients with a positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) test > 5 days after hospital admission, with hospitalized CA-COVID-19 cases, defined as those who tested positive within 5 days of admission. The composite primary outcome was patient transfer to an intensive care unit (ICU) or an intermediate care unit (IMCU) and/or all-cause in-hospital mortality. We used cause-specific Cox regression and Fine-Gray regression to model the time to the composite clinical outcome, adjusting for confounders and accounting for the competing event of discharge from hospital. We compared our results to those from a conventional approach using an adjusted logistic regression model where time-varying effects and competitive risk were ignored. RESULTS Between February 19, 2020, and December 31, 2020, we included 1,337 HA-COVID-19 cases and 9,068 CA-COVID-19 cases. HA-COVID-19 patients were significantly older: median, 80 (interquartile range [IQR], 71-87) versus median 70 (IQR, 57-80) (P < .001). A greater proportion of HA-COVID-19 patients had a Charlson comorbidity index ≥ 5 (79% vs 55%; P < .001) than did CA-COVID-19 patients. In time-varying analyses, between day 0 and 8, HA-COVID-19 cases had a decreased risk of death or ICU or IMCU transfer compared to CA-COVID-19 cases (cause-specific hazard ratio [csHR], 0.43; 95% confidence interval [CI], 0.33-0.56). In contrast, from day 8 to 30, HA-COVID-19 cases had an increased risk of death or ICU or IMCU transfer (csHR, 1.49; 95% CI, 1.20-1.85), with no significant effect on the rate of discharge (csHR, 0.83; 95% CI, 0.61-1.14). In the conventional logistic regression model, HA-COVID-19 was protective against transfer to an ICU or IMCU and/or all-cause in-hospital mortality (adjusted odds ratio [aOR], 0.79, 95% CI, 0.67-0.93). CONCLUSIONS The risk of adverse clinical outcomes for HA-COVID-19 cases increased substantially over time in hospital and exceeded that for CA-COVID-19. Using approaches that do not account for time-varying effects or competing events may not fully capture the true risk of HA-COVID-19 compared to CA-COVID-19.
Collapse
Affiliation(s)
- Rebecca L. Grant
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Julien Sauser
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Andrew Atkinson
- Department of Infectious Diseases, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Stéphanie D’Incau
- Department of Infectious Diseases, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Division of Infectious Diseases, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Niccolò Buetti
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marie-Céline Zanella
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Division of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
| | - Gaud Catho
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
| | | |
Collapse
|
3
|
Bilgin H, Başarı T, Pazar N, Küçüker I, Can-Sarınoğlu R. Comparison of 28-Day Mortality Between Hospital- and Community-Acquired Influenza Patients. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2023; 5:231-238. [PMID: 38633557 PMCID: PMC10985807 DOI: 10.36519/idcm.2023.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/08/2023] [Indexed: 04/19/2024]
Abstract
Objective This study aimed to compare 28-day mortality between patients have hospital-acquired influenza (HAI) and those have community-acquired influenza (CAI) during the 2017-2019 influenza seasons in a tertiary care center in İstanbul, Türkiye. Materials and Methods This retrospective cohort included all hospitalized patients who had confirmed influenza infection and were over 17 years old. HAI was defined as a case of influenza that tested negative in a PCR test or had no signs of influenza on admission but with a positive test result at any point after 72 hours of admission. CAI was defined as a case of influenza diagnosed within 72 hours of admission or before admission. The primary outcome was 28-day mortality after diagnosis. Biological sex, admission to the intensive care unit (ICU), presence of chronic obstructive pulmonary disease, cardiovascular and immunosuppressive comorbidities, influenza subtype, and other variables identified with univariate analyses (p<0.25) were entered into logistic regression analysis. Results During the study period, 92 (46%) of 201 hospitalized patients who tested positive for influenza were identified as HAI, and the rest (109) were identified as CAI. Univariate analysis showed no differences between survivors and non-survivors in patient characteristics, except non-survivors were more likely to have an ICU admission. The multivariable logistic regression analysis results showed that HAI was associated with 5.6-fold increased odds of mortality (95% confidence interval [CI]=1.6-19.3; p=0.006), after adjustment for age, gender, comorbidity, and ICU admission. Conclusion The results of this study revealed that patients who had HAI were more likely to die within 28 days compared to those who had CAI after controlling for key confounders. The high rate of HAI underscores the critical importance of robust infection control measures for hospital-acquired viral infections. Additional research and targeted interventions are necessary to improve the HAI prognosis.
Collapse
Affiliation(s)
- Hüseyin Bilgin
- Department of Infectious Diseases and Clinical Microbiology,
Marmara University School of Medicine, İstanbul, Türkiye
| | - Tuğçe Başarı
- Department of Infectious Diseases and Clinical Microbiology,
Marmara University School of Medicine, İstanbul, Türkiye
| | - Nazlı Pazar
- Department of Infectious Diseases and Clinical Microbiology,
Marmara University School of Medicine, İstanbul, Türkiye
| | - Işıl Küçüker
- Infection Prevention and Control Unit, Marmara University
Hospital, İstanbul, Türkiye
| | - Rabia Can-Sarınoğlu
- Department of Medical Microbiology, Bahceşehir University School
of Medicine, İstanbul, Türkiye
| |
Collapse
|
4
|
Setayeshgar S, Wilton J, Sbihi H, Zandy M, Janjua N, Choi A, Smolina K. Comparison of influenza and COVID-19 hospitalisations in British Columbia, Canada: a population-based study. BMJ Open Respir Res 2023; 10:10/1/e001567. [PMID: 36731922 PMCID: PMC9895913 DOI: 10.1136/bmjresp-2022-001567] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/23/2023] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION We compared the population rate of COVID-19 and influenza hospitalisations by age, COVID-19 vaccine status and pandemic phase, which was lacking in other studies. METHOD We conducted a population-based study using hospital data from the province of British Columbia (population 5.3 million) in Canada with universal healthcare coverage. We created two cohorts of COVID-19 hospitalisations based on date of admission: annual cohort (March 2020 to February 2021) and peak cohort (Omicron era; first 10 weeks of 2022). For comparison, we created influenza annual and peak cohorts using three historical periods years to capture varying severity and circulating strains: 2009/2010, 2015/2016 and 2016/2017. We estimated hospitalisation rates per 100 000 population. RESULTS COVID-19 and influenza hospitalisation rates by age group were 'J' shaped. The population rate of COVID-19 hospital admissions in the annual cohort (mostly unvaccinated; public health restrictions in place) was significantly higher than influenza among individuals aged 30-69 years, and comparable to the severe influenza year (2016/2017) among 70+. In the peak COVID-19 cohort (mostly vaccinated; few restrictions in place), the hospitalisation rate was comparable with influenza 2016/2017 in all age groups, although rates among the unvaccinated population were still higher than influenza among 18+. Among people aged 5-17 years, COVID-19 hospitalisation rates were lower than/comparable to influenza years in both cohorts. The COVID-19 hospitalisation rate among 0-4 years old, during Omicron, was higher than influenza 2015/2016 and 2016/2017 and lower than 2009/2010 pandemic. CONCLUSIONS During first Omicron wave, COVID-19 hospitalisation rates were significantly higher than historical influenza hospitalisation rates for unvaccinated adults but were comparable to influenza for vaccinated adults. For children, in the context of high infection levels, hospitalisation rates for COVID-19 were lower than 2009/2010 H1N1 influenza and comparable (higher for 0-4) to non-pandemic years, regardless of the vaccine status.
Collapse
Affiliation(s)
- Solmaz Setayeshgar
- Data and Analytic Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - James Wilton
- Data and Analytic Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Hind Sbihi
- Data and Analytic Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada,School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Moe Zandy
- Public Health Surveillance Unit, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Naveed Janjua
- Data and Analytic Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada,School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexandra Choi
- Office of the Chief Medical Health Officer, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Kate Smolina
- Data and Analytic Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada,School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
5
|
Portmann L, de Kraker MEA, Fröhlich G, Thiabaud A, Roelens M, Schreiber PW, Troillet N, Iten A, Widmer A, Harbarth S, Sommerstein R. Hospital Outcomes of Community-Acquired SARS-CoV-2 Omicron Variant Infection Compared With Influenza Infection in Switzerland. JAMA Netw Open 2023; 6:e2255599. [PMID: 36790812 PMCID: PMC9932839 DOI: 10.1001/jamanetworkopen.2022.55599] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
IMPORTANCE With the ongoing COVID-19 pandemic, it is crucial to assess the current burden of disease of community-acquired SARS-CoV-2 Omicron variant in hospitalized patients to tailor appropriate public health policies. Comparisons with better-known seasonal influenza infections may facilitate such decisions. OBJECTIVE To compare the in-hospital outcomes of patients hospitalized with the SARS-CoV-2 Omicron variant with patients with influenza. DESIGN, SETTING, AND PARTICIPANTS This cohort study was based on a national COVID-19 and influenza registry. Hospitalized patients aged 18 years and older with community-acquired SARS-CoV-2 Omicron variant infection who were admitted between January 15 and March 15, 2022 (when B.1.1.529 Omicron predominance was >95%), and hospitalized patients with influenza A or B infection from January 1, 2018, to March 15, 2022, where included. Patients without a study outcome by August 30, 2022, were censored. The study was conducted at 15 hospitals in Switzerland. EXPOSURES Community-acquired SARS-CoV-2 Omicron variant vs community-acquired seasonal influenza A or B. MAIN OUTCOMES AND MEASURES Primary and secondary outcomes were defined as in-hospital mortality and admission to the intensive care unit (ICU) for patients with the SARS-CoV-2 Omicron variant or influenza. Cox regression (cause-specific and Fine-Gray subdistribution hazard models) was used to account for time-dependency and competing events, with inverse probability weighting to adjust for confounders with right-censoring at day 30. RESULTS Of 5212 patients included from 15 hospitals, 3066 (58.8%) had SARS-CoV-2 Omicron variant infection in 14 centers and 2146 patients (41.2%) had influenza A or B in 14 centers. Of patients with the SARS-CoV-2 Omicron variant, 1485 (48.4%) were female, while 1113 patients with influenza (51.9%) were female (P = .02). Patients with the SARS-CoV-2 Omicron variant were younger (median [IQR] age, 71 [53-82] years) than those with influenza (median [IQR] age, 74 [59-83] years; P < .001). Overall, 214 patients with the SARS-CoV-2 Omicron variant (7.0%) died during hospitalization vs 95 patients with influenza (4.4%; P < .001). The final adjusted subdistribution hazard ratio (sdHR) for in-hospital death for SARS-CoV-2 Omicron variant vs influenza was 1.54 (95% CI, 1.18-2.01; P = .002). Overall, 250 patients with the SARS-CoV-2 Omicron variant (8.6%) vs 169 patients with influenza (8.3%) were admitted to the ICU (P = .79). After adjustment, the SARS-CoV-2 Omicron variant was not significantly associated with increased ICU admission vs influenza (sdHR, 1.08; 95% CI, 0.88-1.32; P = .50). CONCLUSIONS AND RELEVANCE The data from this prospective, multicenter cohort study suggest a significantly increased risk of in-hospital mortality for patients with the SARS-CoV-2 Omicron variant vs those with influenza, while ICU admission rates were similar.
Collapse
Affiliation(s)
- Lea Portmann
- Department of Health Sciences and Medicine, Clinic St Anna, University of Lucerne, Lucerne, Switzerland
| | - Marlieke E. A. de Kraker
- Geneva University Hospitals and Faculty of Medicine, Infection Control Program and WHO Collaborating Center, Geneva, Switzerland
| | - Georg Fröhlich
- Heart Clinic Lucerne, Lucerne, Switzerland
- Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Amaury Thiabaud
- Institute of Global Health of the University of Geneva, Geneva, Switzerland
| | - Maroussia Roelens
- Institute of Global Health of the University of Geneva, Geneva, Switzerland
| | - Peter W. Schreiber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich and University of Zürich, Zürich, Switzerland
| | - Nicolas Troillet
- Department for Infectious Diseases, Central Institution, Valais Hospital, Sion, Switzerland
- Swissnoso, the National Center for Infection Control, Bern, Switzerland
| | - Anne Iten
- Geneva University Hospitals and Faculty of Medicine, Infection Control Program and WHO Collaborating Center, Geneva, Switzerland
| | - Andreas Widmer
- Swissnoso, the National Center for Infection Control, Bern, Switzerland
- Department for Infectious Diseases, University Hospital Basel, Basel, Switzerland
| | - Stephan Harbarth
- Geneva University Hospitals and Faculty of Medicine, Infection Control Program and WHO Collaborating Center, Geneva, Switzerland
- Swissnoso, the National Center for Infection Control, Bern, Switzerland
| | - Rami Sommerstein
- Department of Health Sciences and Medicine, Clinic St Anna, University of Lucerne, Lucerne, Switzerland
- Swissnoso, the National Center for Infection Control, Bern, Switzerland
- Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
| |
Collapse
|
6
|
Belyakov NA, Boeva EV, Simakina OE, Danilenko DM, Lioznov DA. EPIDEMIOLOGY AND COURSE OF INFECTIOUS DISEASES DURING THE COVID-19 PANDEMIC. REPORT 2: REALIZATION OF INTERFERENCE BETWEEN SARS-COV-2 AND ACUTE RESPIRATORY VIRAL INFECTIONS. RUSSIAN JOURNAL OF INFECTION AND IMMUNITY 2022. [DOI: 10.15789/2220-7619-eac-1960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The analytical review, based on the analysis of literature and own materials, outlines the features of the interaction of a new coronavirus infection (COVID-19) and acute respiratory diseases. Particular attention is paid to the combined course of SARS-CoV-2 and the influenza virus, a comparative characteristic of the severity of the clinical picture. An assessment of the epidemic situation against the background of the COVID-19 pandemic in foreign countries and the Russian Federation made it possible to establish the presence of the phenomenon of SARS-CoV-2 interference with other viral respiratory agents, based on the facts of a sharp suppression of the circulation of influenza viruses, respiratory syncytial virus (RSV) and other pathogens of acute respiratory viral infections (ARVI) during the period of active spread of pandemic coronavirus. The results obtained confirm the need to ensure effective surveillance and additional diagnostic capabilities for monitoring SARS, which can significantly affect the decision-making on appropriate preventive measures and clinical management of relevant diseases.
Collapse
|
7
|
Comparison of Clinical Profiles and Mortality Outcomes Between Influenza and COVID-19 Patients Invasively Ventilated in the ICU: A Retrospective Study From All Paris Public Hospitals From 2016 to 2021. Crit Care Explor 2022; 4:e0737. [PMID: 35923591 PMCID: PMC9324620 DOI: 10.1097/cce.0000000000000737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Studies comparing outcomes of ICU patients admitted for either COVID-19 or seasonal influenza are limited. Our objective was to describe baseline clinical profiles, care procedures, and mortality outcomes by infection status (influenza vs COVID-19) of patients who received invasive mechanical ventilation in the ICU.
Collapse
|