ABSTRACT
Background. The SARS-CoV-2 Omicron variant has been rapidly spreading worldwide. We aimed to characterize Omicron severity by assessing in-hospital deaths and intensive care admissions in a large healthcare system in South Florida during an Omicron predominant surge. Methods. Laboratory-confirmed COVID-19 adult patients hospitalized during January 1 -14, 2022 were retrospectively reviewed. Risks of in-hospital mortality and intensive care admission were estimated using logistic regression models. Analyses were stratified by age >= 65 years and vaccination status, and further adjusted for sex, comorbidities, and history of a previous COVID-19 infection. Results. 500 consecutively hospitalized COVID-19 Omicron patients were included. The median age was 69 (IQR, 53-80) years, and 271 (54.2%) were women. The most common comorbidities were hypertension (65.5%), diabetes (32%), and chronic kidney disease (24%). 260 (52%) patients were fully vaccinated (defined as a patient who received 2-dose vaccines), and 32 (6.4%) were previously infected with COVID-19. 252 (50.4%) patients required supplemental oxygen, 54 (10.8%) required intensive care unit (ICU) admission, and 44 (8.8%) patients required mechanical ventilation. At study closeout of March 7, 2022, case fatality rates among patients aged 18 -29 years, 30 -39 years, 40-49 years, 50-59 years, 60-69 years, 70-79 years, and >= 80 years were 0%, 2.2%, 6.4%, 5.3%, 8.0%, 5.7%, and 15.4% respectively ( p < 0.001), with the median time from hospital admission to death being 13 days (IQR, 6.5-20.5) (Figure 1). Patients aged >= 65 years had 2.6 times higher rates for in-hospital mortality (OR, 2.63;95% CI, 1.29-5.33;p =0.007) than those aged < 65 years, but were comparable for ICU admission (OR, 0.85;95% CI, 0.49-1.52;p =0.586). Past vaccination offered no protection against in-hospital mortality (OR, 1.18;95% CI, 0.64-2.19;p =0.599) or ICU admission (OR, 1.16;95% CI, 0.66-2.06;p =0.6) (Figure 2). In multivariable-adjusted models, patients aged >= 65 years had a higher in-hospital mortality than those aged < 65 years (Figure 2). Conclusion. This case series provides characteristics and outcomes of hospitalized adult patients with COVID-19 Omicron variant. Past COVID-19 vaccination did not impact ICU admission rate nor in-hospital mortality.
ABSTRACT
Background. Patients infected with COVID-19 Omicron variant, may be hospitalized for reasons other than COVID-19 pneumonia. We describe the clinical presentations of hospitalized adult patients with COVID-19 Omicron variant in a large healthcare system in South Florida. Methods. Laboratory-confirmed COVID-19 adult patients hospitalized during January 1-14, 2022 were retrospectively reviewed. Clinical presentations were divided into one of three admission groups: COVID-19 pneumonia or respiratory infection (Group 1), severe extrapulmonary manifestations of COVID-19 (Group 2), and completely incidental diagnosis of COVID-19 (Group 3). Risks of in-hospital mortality and intensive care admission were estimated using logistic regression models. Results. Among 500 consecutively hospitalized COVID-19 Omicron patients, the median age was 69 (IQR, 53-80) years, and 271 (54.2%) were women. The most common comorbidities were hypertension (326;65.5%), diabetes (160;32%), and chronic kidney disease (120;24%). 260 (52%) patients were fully vaccinated (defined as a patient who received 2-dose vaccines), and 32 (6.4%) were previously infected with COVID-19. 257(51.4%) patients were classified as Group 1, 82 (16.4%) in Group 2, and 161 (32.2%) in Group 3 (Figure 1). Compared to Group 3, patients in Group 1 and Group 2 had a higher risk for ICU admission, with odds ratios (ORs) of 7.45 (95% CI, 2.62-21.23;p< 0.001) and 4.84 (95% CI, 1.44-16.23;p=0.011), and for in-hospital mortality, with ORs of 27.76 (95% CI, 3.78-204.3;p=0.001) and 12.63 (95% CI, 1.49-106.78;p=0.020), respectively (Figure 2). In multivariable-adjusted models, patients in Group 1 remained at higher risk for ICU admission and in-hospital mortality compared to Group 3, while patients in Group 2 remained at a higher risk for ICU admission, but with no difference in in-hospital mortality compared to Group 3 (Figure 2). Figure 1. Clinical characteristics of consecutively hospitalized patients stratified by clinical presentations at admission. Figure 2. Crude (Upper panel) and multivariable-adjusted (Lower panel) odds ratios for ICU admission and in-hospital mortality from logistic regression models. Group 3 represents patients with a completely incidental diagnosis of COVID-19. The variables included in the final multivariable models were age, gender, history of hypertension, diabetes, chronic obstructive pulmonary disease, chronic kidney disease, coronary artery disease, malignancy, transplantation, HIV, vaccination status, and previous SARS-CoV-2 infection. Conclusion. This case series illustrates the clinical presentations of hospitalized adult patients infected with the COVID-19 Omicron variant. Significant differences in in-hospital mortality and ICU admission exist when comparing patients admitted for a COVID-19 related respiratory infection to those admitted with a completely incidental COVID-19 diagnosis.