背景:哈萨克斯坦于2020年3月宣布了中亚最早的2019年冠状病毒病(COVID-19)病例。尽管实施了遏制感染传播的积极措施,在对区域大流行的临床和流行病学特征的理解方面仍然存在差距。
方法:我们进行了回顾性研究,2020年2月至4月在哈萨克斯坦住院的实验室确诊COVID-19患者的观察性队列研究.我们比较了人口统计,临床,入院时不同COVID-19严重度患者的实验室和放射学数据。Logistic回归用于评估与疾病严重程度和住院死亡相关的因素。对53例患者进行了SARS-CoV-2全基因组分析。
结果:在2020年3月至4月的1072例经实验室确认的COVID-19患者中,中位年龄为36岁(IQR24-50),男性为484例(45%)。一入场,683名(64%)参与者无症状/轻度,341(32%)中度,截至2020年5月5日,报告有47例(4%)重症至危重症COVID-19表现;20例住院死亡(1•87%)。多变量回归表明,与年龄相关的严重疾病的几率增加(比值比1•05,95%CI1•03-1•07,每年增加;p<0•001),合并症的存在(2•34,95%CI1•18-4•85;p=0•017)和白细胞计数升高(WBC,1•13,95%CI1•00-1•27;p=0•044)入院时,而年龄较大(1•09,95%CI1•06-1•13,每年增加;p<0•001)和男性(5•63,95%CI2•06-17•57;p=0•001)与院内死亡几率增加相关。SARS-CoV-2分离株分为七个系统发育谱系,O/B.4.1,S/A.2,S/B.1.1,G/B.1,GH/B.1.255,GH/B.1.3和GR/B.1.1.10;87%的分离株是来自亚洲早期谱系的O和S亚型,而G,GH和GR分离株与来自欧洲和美洲的谱系有关。
结论:年龄较大,合并症,白细胞计数增加,男性是哈萨克斯坦COVID-19疾病严重程度和死亡率的危险因素。SARS-CoV-2的广泛多样性表明,在旅行限制之前,有多种输入和社区水平的放大。
背景:哈萨克斯坦共和国教育和科学部。
BACKGROUND: The earliest coronavirus disease-2019 (COVID-19) cases in Central Asia were announced in March 2020 by Kazakhstan. Despite the implementation of aggressive measures to curb infection spread, gaps remain in the understanding of the clinical and epidemiologic features of the regional pandemic.
METHODS: We did a retrospective, observational cohort
study of patients with laboratory-confirmed COVID-19 hospitalized in Kazakhstan between February and April 2020. We compared demographic, clinical, laboratory and radiological data of patients with different COVID-19 severities on admission. Logistic regression was used to assess factors associated with disease severity and in-hospital death. Whole-genome SARS-CoV-2 analysis was performed in 53 patients.
RESULTS: Of the 1072 patients with laboratory-confirmed COVID-19 in March-April 2020, the median age was 36 years (IQR 24-50) and 484 (45%) were male. On admission, 683 (64%) participants had asymptomatic/mild, 341 (32%) moderate, and 47 (4%) severe-to-critical COVID-19 manifestation; 20 in-hospital deaths (1•87%) were reported by 5 May 2020. Multivariable regression indicated increasing odds of severe disease associated with older age (odds ratio 1•05, 95% CI 1•03-1•07, per year increase; p<0•001), the presence of comorbidities (2•34, 95% CI 1•18-4•85; p=0•017) and elevated white blood cell count (WBC, 1•13, 95% CI 1•00-1•27; p=0•044) on admission, while older age (1•09, 95% CI 1•06-1•13, per year increase; p<0•001) and male sex (5•63, 95% CI 2•06-17•57; p=0•001) were associated with increased odds of in-hospital death. The SARS-CoV-2 isolates grouped into seven phylogenetic lineages, O/B.4.1, S/A.2, S/B.1.1, G/B.1, GH/B.1.255, GH/B.1.3 and GR/B.1.1.10; 87% of the isolates were O and S sub-types descending from early Asian lineages, while the G, GH and GR isolates were related to lineages from Europe and the Americas.
CONCLUSIONS: Older age, comorbidities, increased WBC count, and male sex were risk factors for COVID-19 disease severity and mortality in Kazakhstan. The broad SARS-CoV-2 diversity suggests multiple importations and community-level amplification predating travel restriction.
BACKGROUND: Ministry of Education and Science of the Republic of Kazakhstan.