Clinical outcomes of the severe acute respiratory syndrome coronavirus 2 Omicron and Delta variant: systematic review and meta-analysis of 33 studies covering 6 037 144 coronavirus disease 2019–positive patients

Hu, Feihong; Jia, Yijie; Zhao, Dan‐Yan; Fu, Xuelei; Zhang, Wanqing; Wen, Tian; Hu, Shiqi; Wang, Hua; Ge, Mengwei; Du, Wei; Shen, Weixiao; Zhu, Bin; Chen, Honglin

doi:10.1016/j.cmi.2023.03.017

Cited by 48 publications

(34 citation statements)

References 65 publications

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“…Based on our data, the first wave of the pandemic appears to have affected a more diverse range of comorbidities -mostly cardiovascular-related pathologies and dementia. At the beginning of the Omicron wave, 33 there was an increase in the number of T A B L E 2 Summary table of predictors of adverse evolution, and their relevance, by periods of the study.…”

Section: Discussionmentioning

confidence: 99%

Relevance of comorbidities for main outcomes during different periods of the COVID‐19 pandemic

Quintana‐Lopez,

Rodríguez,

Portuondo

et al. 2024

Influenza Resp Viruses

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BackgroundThroughout the evolution of the COVID‐19 pandemic, the severity of the disease has varied. The aim of this study was to determine how patients' comorbidities affected and were related to, different outcomes during this time.MethodsRetrospective cohort study of all patients testing positive for SARS‐CoV‐2 infection between March 1, 2020, and January 9, 2022. We extracted sociodemographic, basal comorbidities, prescribed treatments, COVID‐19 vaccination data, and outcomes such as death and admission to hospital and intensive care unit (ICU) during the different periods of the pandemic. We used logistic regression to quantify the effect of each covariate in each outcome variable and a random forest algorithm to select the most relevant comorbidities.ResultsPredictors of death included having dementia, heart failure, kidney disease, or cancer, while arterial hypertension, diabetes, ischemic heart, cerebrovascular, peripheral vascular diseases, and leukemia were also relevant. Heart failure, dementia, kidney disease, diabetes, and cancer were predictors of adverse evolution (death or ICU admission) with arterial hypertension, ischemic heart, cerebrovascular, peripheral vascular diseases, and leukemia also relevant. Arterial hypertension, heart failure, diabetes, kidney, ischemic heart diseases, and cancer were predictors of hospitalization, while dyslipidemia and respiratory, cerebrovascular, and peripheral vascular diseases were also relevant.ConclusionsPreexisting comorbidities such as dementia, cardiovascular and renal diseases, and cancers were those most related to adverse outcomes. Of particular note were the discrepancies between predictors of adverse outcomes and predictors of hospitalization and the fact that patients with dementia had a lower probability of being admitted in the first wave.

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Section: Discussionmentioning

confidence: 99%

Relevance of comorbidities for main outcomes during different periods of the COVID‐19 pandemic

Quintana‐Lopez,

Rodríguez,

Portuondo

et al. 2024

Influenza Resp Viruses

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“…On the other hand, the fact that all monocyte parameters were less affected in whole blood challenged with the recombinant spike protein of the Omicron variant seemingly reflect the clinical evidence that the clinical spectrum of disease after infection with the sub-lineages belonging to the Omicron family is substantially milder compared to that caused by the previous strains. Several epidemiological studies, recently meta-analyzed by Hu et al (33 studies, including over 6 million patients with COVID-19) [37] have convincingly shown that Omicron infection was associated with a 2.9-fold lower risk of hospitalization, 3.6-fold lower risk of ICU admission and a cumulatively 3.0-fold lower risk of death compared to the Delta variant in the general population. Esper and colleagues correlated COVID-19 disease severity and outcomes throughout the periods of major variants dominance [38], reporting that the clinical burden (as defined in terms of hospitalization, ICU admission and mortality) was similar between the Alpha and Delta waves, but in both cases was higher than that seen after the emergence of the Omicron variant.…”

Section: Discussionmentioning

confidence: 99%

Effects of Different Types of Recombinant SARS-CoV-2 Spike Protein on Circulating Monocytes Structure

Vettori¹,

Dima²,

Henry³

et al. 2023

Preprint

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Background: This study investigated the biological effects on circulating monocytes after challenge with SARS-CoV-2 recombinant spike protein. Methods: Whole blood collected form seven ostensibly healthy healthcare workers was incubated for 15 min with 2 and 20 ng/mL recombinant spike protein of Ancestral, Alpha, Delta and Omicron variants. Samples were analyzed with Sysmex XN and DI-60 analyzers. Results: Cellular complexity (i.e., presence of granules, vacuoles and other cytoplasmic inclusions) increased in all samples challenged with the recombinant spike protein of Ancestral, Alpha and Delta variants, but not in those containing Omicron. The cellular content of nucleic acids was constantly decreased in most samples, achieving statistical significance in those containing 20 ng/mL of Alpha and Delta recombinant spike proteins. The heterogeneity of monocyte volumes significantly increased in all samples, achieving statistical significance in those containing 20 ng/mL of recombinant spike protein of Ancestral, Alpha and Delta variants. The monocyte morphological abnormalities after spike protein challenge included dysmorphia, granulation, intense vacuolization, platelet phagocytosis, development of aberrant nuclei and cytoplasmic extrusions. Conclusions: The SARS-CoV-2 spike protein triggers important monocyte morphological abnormalities, more evident in cells challenged with spike protein of the more clinically severe Alpha and Delta variants.

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“…First, the majority of patients had received a complete vaccine series, which hinders the comparability with the EPIC-HR trial.9 Furthermore, a large amount of data shows the more favorable outcome of infection due to the Omicron variant and subvariants as compared to the ancestral Wuhan strain or preceding VoCs, with rates of hospitalization as low as 1% even in the absence of antiviral treatment. 2,[24][25][26] This relatively benign course makes it difficult to evaluate the effectiveness of new antiviral drugs in terms of requirement of hospital admission or death. Second, since our study lacked control group, any conclusion on the role of NMV/r in the specific population of immunocompromised patients must be taken with caution.…”

Section: Discussionmentioning

confidence: 99%

Nirmatrelvir/ritonavir for the treatment of immunocompromised adult patients with early‐stage symptomatic COVID‐19: A real‐life experience

Caso,

Fernández‐Ruiz,

López‐Medrano

et al. 2023

Journal of Medical Virology

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Regardless of vaccination status, progression to severe coronavirus disease 2019 (COVID‐19) is still a relevant cause of morbidity among immunocompromised patients. Despite the proven efficacy of nirmatrelvir/ritonavir (NMV/r), concerns remain regarding the potential for drug‐to‐drug interactions (DDIs) and the safety in this at‐risk population. We aimed to evaluate the clinical outcomes of immunocompromised patients treated with NMV/r, as well as the occurrence of DDIs and treatment‐emergent adverse events (TEAEs). This retrospective observational study included all the patients with some form of immunosuppression and laboratory‐confirmed COVID‐19 that received NMV/r at our center from April to August 2022. The main outcome was worsening of the clinical status (increase of ≥1 point from baseline in a validated clinical progression scale) by Days +7 and +28 after the initiation of therapy. Safety outcomes included the rates of any TEAE and potentially severe DDIs. We included 110 patients. Main causes of immunosuppression were hematological malignancy (58.2%) (mainly multiple myeloma [22.7%] and non‐Hodgkin lymphoma [13.6%]), active chemotherapy (30.0%) and hematopoietic stem cell transplantation (14.5%). Clinical worsening by Days +7 and +28 was observed in four (3.6%) and five patients (4.5%), respectively. Only one patient had a positive SARS‐CoV‐2 polymerase chain reaction test at Day +28. At least one potentially severe DDI was observed in 56.4% of the patients. The rate of attributable TEAEs was 10.9%, although only two patients (1.8%) required premature discontinuation of NMV/r. Early initiation of NMV/r therapy should be considered in immunocompromised patients with COVID‐19, with particular attention to interacting medications.

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Clinical outcomes of the severe acute respiratory syndrome coronavirus 2 Omicron and Delta variant: systematic review and meta-analysis of 33 studies covering 6 037 144 coronavirus disease 2019–positive patients

Cited by 48 publications

References 65 publications

Relevance of comorbidities for main outcomes during different periods of the COVID‐19 pandemic

Relevance of comorbidities for main outcomes during different periods of the COVID‐19 pandemic

Effects of Different Types of Recombinant SARS-CoV-2 Spike Protein on Circulating Monocytes Structure

Nirmatrelvir/ritonavir for the treatment of immunocompromised adult patients with early‐stage symptomatic COVID‐19: A real‐life experience

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