Clinical phenotypes and outcomes associated with SARS-CoV-2 variant Omicron in critically ill French patients with COVID-19

Prost, Nicolas de; Audureau, Étienne; Heming, Nicholas; Gault, Elyanne; Pham, Tài; Chaghouri, Amal; Montmollin, Nina de; Voiriot, Guillaume; Morand‐Joubert, Laurence; Joseph, Adrien; Chaix, Marie‐Laure; Preau, Sébastien; Favory, Raphaël; Guigon, Aurélie; Luyt, Charles‐Édouard; Burrel, Sonia; Mayaux, Julien; Marot, Stéphane; Roux, Damien; Descamps, Diane; Meireles, Sylvie; Pène, Frédéric; Rozenberg, Flore; Contou, Damien; Henry, Amandine; Gaudry, Stéphane; Brichler, Ségolène; Timsit, Jean‐François; Kimmoun, Antoine; Hartard, Cédric; Jandeaux, Louise-Marie; Fafi‐Kremer, Samira; Gabarre, Paul; Emery, Malo; Garcia-Sanchez, Claudio; Jochmans, Sébastien; Pitsch, A.; Annane, Djillali; Azoulay, Élie; Dessap, Armand Mekontso; Rodriguez, Christophe; Pawlotsky, Jean‐Michel; Fourati, Slim

doi:10.1038/s41467-022-33801-z

Cited by 45 publications

(58 citation statements)

References 26 publications

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“…In a French multicenter prospective cohort study of critically ill patients admitted for severe COVID-19 between December 2021 and May 2022, those infected with Omicron variant were immunocompromised patients in 43% of cases, half of whom had received an organ transplant. This figure was three times higher than Delta-infected patients ( de Prost et al, 2022 ). Their day-28 mortality rate was 47%, significantly higher than that of non-immunocompromised patients (26%).…”

Section: Discussionmentioning

confidence: 58%

Protection from successive Omicron variants with SARS-CoV-2 vaccine and monoclonal antibodies in kidney transplant recipients

et al. 2023

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IntroductionKidney transplant recipients (KTRs) are at high risk of severe COVID-19, even when they are fully vaccinated. Additional booster vaccinations or passive immunization with prophylactic monoclonal antibodies are recommended to increase their protection against severe COVID-19.MethodsHere, we describe the neutralization of SARS-CoV-2 Delta, Omicron BA.1, BA.2, BA.4, and BA.5 variants, firstly by 39 serum samples from vaccinated KTRs exhibiting anti-spike antibody concentrations ≥264 binding antibody units (BAU)/mL and, secondly, by tixagevimab/cilgavimab.ResultsNo neutralization was observed for 18% of the KTRs, while serum from only 46% of patients could neutralize the five variants. Cross-neutralization of the Delta and Omicron variants occurred for 65–87% of sera samples. The anti-spike antibody concentration correlated with neutralization activity for all the variants. The neutralization titers against the Delta variant were higher in vaccinated KTRs who had previously presented with COVID-19, compared to those KTRs who had only been vaccinated. Breakthrough infections occurred in 39% of the KTRs after the study. Tixagevimab/cilgavimab poorly neutralizes Omicron variants, particularly BA.5, and does not neutralize BQ.1, which is currently the most prevalent strain.DiscussionAs a result, sera from seropositive vaccinated KTRs had poor neutralization of the successive Omicron variants. Several Omicron variants are able to escape tixagevimab/cilgavimab.

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Section: Discussionmentioning

confidence: 58%

Protection from successive Omicron variants with SARS-CoV-2 vaccine and monoclonal antibodies in kidney transplant recipients

et al. 2023

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“…Hypertension remains a significant risk factor for COVID-19 severity brought on by different SARS-CoV-2 variants, but only limited studies have investigated the relationship between hypertension and infection with these variants. Although the COVID-19 severity and mortality rate associated with Omicron infections declined significantly compared to the previous variants, a recent study showed those infected with variant Omicron were older and had significantly more frequent comorbidities, including hypertension [293] , which is probably due to the remarkably higher transmissibility and immune evasion ability.…”

Section: The Role Of Counter-regulatory Ras To Link Hypertension and ...mentioning

confidence: 91%

Counter-regulatory renin-angiotensin system in hypertension: Review and update in the era of COVID-19 pandemic

Chen

Peng

Wang

et al. 2023

Biochemical Pharmacology

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“…This method has been previously used for disease phenotyping, such as chronic obstructive pulmonary disease (COPD) ( 11 ) and sepsis ( 12 ). Similarly, several authors have recently used clustering to identify clinical phenotypes in patients with COVID-19 ( 13 – 21 ).…”

Section: Introductionmentioning

confidence: 99%

Interpretable clinical phenotypes among patients hospitalized with COVID-19 using cluster analysis

Yamga

Mullie

Durand

et al. 2023

Front. Digit. Health

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BackgroundMultiple clinical phenotypes have been proposed for coronavirus disease (COVID-19), but few have used multimodal data. Using clinical and imaging data, we aimed to identify distinct clinical phenotypes in patients admitted with COVID-19 and to assess their clinical outcomes. Our secondary objective was to demonstrate the clinical applicability of this method by developing an interpretable model for phenotype assignment.MethodsWe analyzed data from 547 patients hospitalized with COVID-19 at a Canadian academic hospital. We processed the data by applying a factor analysis of mixed data (FAMD) and compared four clustering algorithms: k-means, partitioning around medoids (PAM), and divisive and agglomerative hierarchical clustering. We used imaging data and 34 clinical variables collected within the first 24 h of admission to train our algorithm. We conducted a survival analysis to compare the clinical outcomes across phenotypes. With the data split into training and validation sets (75/25 ratio), we developed a decision-tree-based model to facilitate the interpretation and assignment of the observed phenotypes.ResultsAgglomerative hierarchical clustering was the most robust algorithm. We identified three clinical phenotypes: 79 patients (14%) in Cluster 1, 275 patients (50%) in Cluster 2, and 203 (37%) in Cluster 3. Cluster 2 and Cluster 3 were both characterized by a low-risk respiratory and inflammatory profile but differed in terms of demographics. Compared with Cluster 3, Cluster 2 comprised older patients with more comorbidities. Cluster 1 represented the group with the most severe clinical presentation, as inferred by the highest rate of hypoxemia and the highest radiological burden. Intensive care unit (ICU) admission and mechanical ventilation risks were the highest in Cluster 1. Using only two to four decision rules, the classification and regression tree (CART) phenotype assignment model achieved an AUC of 84% (81.5–86.5%, 95 CI) on the validation set.ConclusionsWe conducted a multidimensional phenotypic analysis of adult inpatients with COVID-19 and identified three distinct phenotypes associated with different clinical outcomes. We also demonstrated the clinical usability of this approach, as phenotypes can be accurately assigned using a simple decision tree. Further research is still needed to properly incorporate these phenotypes in the management of patients with COVID-19.

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Clinical phenotypes and outcomes associated with SARS-CoV-2 variant Omicron in critically ill French patients with COVID-19

Cited by 45 publications

References 26 publications

Protection from successive Omicron variants with SARS-CoV-2 vaccine and monoclonal antibodies in kidney transplant recipients

Protection from successive Omicron variants with SARS-CoV-2 vaccine and monoclonal antibodies in kidney transplant recipients

Counter-regulatory renin-angiotensin system in hypertension: Review and update in the era of COVID-19 pandemic

Interpretable clinical phenotypes among patients hospitalized with COVID-19 using cluster analysis

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