PDF(Pubmed)
Abstract：
The aim of this study was to evaluate differences in the clinical manifestations and outcomes in hospitalized patients with COVID-19 in a single Romanian center during four pandemic waves determined by different SARS-CoV-2 variants of concern (VOCs). A retrospective study on 9049 consecutive hospitalized adult patients was performed between 27 February 2020 and 31 March 2023. The study interval was divided into waves based on national data on SARS-CoV-2 VOCs\' circulation. Multivariate logistic regression models were built, predicting death and complications as functions of comorbidities, therapy, wave, severity form, and vaccination status, and adjusted for ages ≥65 years. Pulmonary (pneumothorax/pneumomediastinum, pulmonary embolism) and extrapulmonary complications (liver injury, acute kidney injury, ischemic/hemorrhagic stroke, myocardial infarction, and gastrointestinal bleeding) were present, more frequently in ICU hospitalized patients and with differences between waves. The highest in-hospital mortality was found in patients presenting pneumothorax/pneumomediastinum. All of the evaluated risk factors were significantly associated with death, except for obesity and the Omicron wave. Our study highlights the changing nature of COVID-19 and acknowledges the impacts of viral mutations on disease outcomes. For all four waves, COVID-19 was a severe disease with a high risk of poor outcomes.
摘要：
这项研究的目的是评估一个罗马尼亚中心的COVID-19住院患者在由不同的SARS-CoV-2关注变体（VOCs）确定的四次大流行波中的临床表现和结局的差异。在2020年2月27日至2023年3月31日期间，对9049名连续住院的成年患者进行了回顾性研究。根据SARS-CoV-2VOCs循环的国家数据，将研究间隔分为波。建立多元Logistic回归模型,预测死亡和并发症作为合并症的功能，治疗,波浪,严重性形式，和疫苗接种状况，并调整年龄≥65岁。肺（气胸/纵隔气胸，肺栓塞）和肺外并发症（肝损伤，急性肾损伤，缺血性/出血性中风，心肌梗塞,和胃肠道出血）存在，在ICU住院患者中更常见，并且波之间存在差异。在出现气胸/纵隔气肿的患者中，院内死亡率最高。所有评估的危险因素都与死亡显著相关，除了肥胖和Omicron波。我们的研究强调了COVID-19的变化性质，并承认病毒突变对疾病结局的影响。对于所有四个波，COVID-19是一种严重的疾病，预后不良的风险很高。
