Omicron Variant in the Critical Care Units of the Paris Metropolitan Area: The Reality Research Group

Vieillard‐Baron, Antoine; Flicoteaux, R.; Salmona, Maud; Chariot, Appoline; D’Ableiges, Bertrand De Maupeou; Darmon, Michaël; Batteux, Frédéric

doi:10.1164/rccm.202202-0411le

Cited by 22 publications

(25 citation statements)

References 12 publications

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“…Indeed, infection with variant Omicron was shown in recent observational cohort studies to be associated with a reduced risk of hospitalization 1,2,15,16 and death 1,16,17 , as compared to Delta infection. Our study is in keeping with a recent one 5 , indicating that there is no signi cant difference between variants Omicron and Delta in terms of mortality when focusing on the speci c population of patients with severe COVID-19 pneumonia requiring ICU admission, despite the fact that this condition is rarer in patients with Omicron infection.…”

Section: Discussionsupporting

confidence: 90%

“…Although variant Omicron appears to cause a less severe disease than its predecessor variant Delta [1][2][3][4] , with less frequent requirement for intensive care 1 , a substantial number of Omicroninfected patients experienced severe COVID-19 with acute respiratory distress syndrome (ARDS) requiring intensive care support. A recent observational study has suggested that the mortality of critically ill patients infected with variant Omicron was not signi cantly different from that of patients infected with variant Delta 5 . However, little is known on the comorbid factors and clinical conditions associated with the severity of variant Omicron infection.…”

Section: Introductionmentioning

confidence: 96%

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Clinical phenotypes and outcomes associated with SARS-CoV-2 variant Omicron, sublineages BA.1, BA.1.1, BA.2 and impact of mutational patterns in critically ill French patients with COVID-19

Fourati

Prost²,

Audureau

et al. 2022

Preprint

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Infection with SARS-CoV-2 variant Omicron is considered to be less severe than infection with variant Delta, with a rarer occurrence of severe disease requiring intensive care. However, a substantial number of patients infected with variant Omicron still experienced severe COVID-19. Little information is available on comorbid factors, clinical conditions and specific viral mutational patterns associated with the severity of variant Omicron infection. In this multicenter prospective cohort study, patients consecutively admitted for severe COVID-19 in 20 participating intensive care units in France between December 7th 2021 and May 1st 2022 were included. Among 259 patients for whom SARS-CoV-2 variant lineage was determined, we show that the clinical phenotype of patients infected with variant Omicron (n = 148) was different from that in those infected with variant Delta (n = 111). We observed no significant relationship between Delta and Omicron variant lineages/sublineages and 28-day mortality (adjusted odds ratio [95% confidence interval] = 0.68 [0.35–1.32]; p = 0.253). Among Omicron-infected patients, 43.2% were immunocompromised, most of whom had received two doses of vaccine or more (85.9%) but displayed a poor humoral response to vaccination (mean difference in serum anti-spike IgG antibody titers between vaccinated and non-vaccinated immunocompromised patients: 1078 BAU/mL [-319.4; 2475.0]; p = 0.160). The mortality rate of immunocompromised patients infected with variant Omicron was significantly higher than that of non-immunocompromised patients (46.9% vs 26.2%; p = 0.009). In patients infected with variant Omicron, there was no association between specific sublineages (BA.1/BA.1.1 (n = 109) and BA.2 (n = 21)) or any viral genome polymorphisms or mutational profile and the 28-day mortality.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 96%

Clinical phenotypes and outcomes associated with SARS-CoV-2 variant Omicron, sublineages BA.1, BA.1.1, BA.2 and impact of mutational patterns in critically ill French patients with COVID-19

Fourati

Prost²,

Audureau

et al. 2022

Preprint

Self Cite

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“…The incidence of ICU admission seems to decrease with the Omicron variant. This finding was recently confirmed by Vieillard-Baron et al, who discovered that Omicron patients are less likely to be admitted to the ICU compared with Delta ones [ 15 ]. Few studies have been completed in different countries where the Omicron severity and other attributes were compared with the Delta taking into account all hospital sections.…”

Section: Discussionmentioning

confidence: 53%

“…In this study, the higher number of comorbidities and, therefore, higher CCI leads to a trend toward higher mortality (52.94% for Omicron versus 41.9% for Delta) even though it is not statistically significant, probably due to the restricted sample size; this pattern is, on the one hand, in line with data from other studies in the last two years that have shown that pre-existing comorbidities represent independent risk factors associated with COVID-19 in-hospital mortality [ 31 , 32 , 33 , 34 , 35 ]. On the other hand, no difference in the mortality between the two groups was found by Vieillard-Baron et al However, only pneumonia and immunosuppression were considered to be comorbidities [ 15 ]. Therefore, Omicron might raise the mortality rate in ICU compared with Delta only when all comorbidities are considered.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, data on the spectrum of disease severity caused by the Omicron variant and prevalence of comorbidities compared with the Delta variant in patients admitted to the ICU are lacking. Only one recently published study serves this very purpose [ 15 ], as it shows that when patients are admitted to the ICU for pneumonia, the severity of the disease appears to be similar to that of Delta, with no difference in the risk of in-ICU mortality. A different virus variant can cause a more severe form of the disease in a patient with particular comorbidity that exposes that specific patient to a less favourable evolution of the pathology.…”

Section: Introductionmentioning

confidence: 99%

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COVID-19 Variants in Critically Ill Patients: A Comparison of the Delta and Omicron Variant Profiles

Corriero

Ribezzi

Mele

et al. 2022

Infectious Disease Reports

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Background: Coronavirus disease is a pandemic that has disrupted many human lives, threatening people’s physical and mental health. Each pandemic wave struck in different ways, infectiveness-wise and mortality-wise. This investigation focuses on critically ill patients affected by the last two variants, Delta and Omicron, and aims to analyse if any difference exists between the two groups. Methods: intensive care unit (ICU) COVID-19 consecutive admissions between 1 October 2021 and 31 March 2022 were recorded daily, and data concerning the patients’ demographics, variants, main comorbidities, ICU parameters on admission, and the outcome were analysed by a univariate procedure and by a multivariate analysis. Results: 65 patients were enrolled, 31 (47.69%) belonging to the Omicron versus 34 (52.31%) to the Delta group. The mortality rate was 52.94% for the Omicron group versus 41.9% for the Delta group. A univariate analysis showed that the Omicron variant was associated with total comorbidities number, Charlson Comorbidity Index (CCI), pre-existing pulmonary disease, vaccination status, and acute kidney injury (AKI). In stepwise multivariate analysis, the total number of comorbidities was positively associated with the Omicron group, while pulmonary embolism was negatively correlated with the Omicron group. Conclusion: Omicron appears to have lost some of the hallmarks of the Delta variant, such as endothelialitis and more limited cellular tropism when it comes to the patients in the ICU. Further studies are encouraged to explore different therapeutic approaches to treat critical patients with COVID-19.

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Clinical characteristics and mortality prediction of patients admitted to the Hong Kong East Cluster intensive care units in the COVID‐19 fifth wave

Man,

Lam,

et al. 2024

Hong Kong j. emerg. med.

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IntroductionCOVID‐19 has been threatening global public health since 2019. To address the overwhelming caseload, several tools were developed to predict prognosis and aid triage of critically ill patients for intensive care. Currently, there is a lack of local data on the validity of such tools.ObjectiveThe objective of this study is to identify the predictors of intensive care unit (ICU) mortality in COVID‐19 patients in Hong Kong and externally validate the different scoring systems.MethodsA retrospective cohort analysis of patients admitted to the HKEC ICUs from 1 January 2022 to 30 April 2022 was performed. We collected data on patient demographics, vaccination status, laboratory parameters, and clinical outcomes including need for organ support and mortality. Clinical severities were estimated by Sequential Organ Failure Score, 4C Mortality Score, COVID‐Gram score, and Acute Physiology and Chronic Health Evaluation (APACHE) IV score based on the original studies. Comparison between individual scoring systems' performance on hospital mortality was conducted and summarized.ResultsIn these four months, 137 patients with COVID‐19 admitted to ICUs of Ruttonjee Hospital and Pamela Youde Nethersole Eastern Hospital were recruited. 64 patients (46.7%) were admitted for COVID‐19 related respiratory failure, among which mortality was 66.7%. The overall hospital and ICU mortality were 21.9% and 13.1%, respectively. Invasive mechanical ventilation (IMV) (OR 3.221, p 0.034), high flow nasal cannula (HFNC) oxygen therapy (OR 3.107, p 0.039), and higher APACHE IV score (OR 1.043, p < 0.001) were independent predictors of hospital mortality using multivariate analysis. The scoring systems had good performance in mortality prediction in our population. The APACHE IV score (AUROC 0.79, 95% CI 0.698–0.894) and 4C Mortality Score (AUROC 0.751, 95% CI 0.657–0.844) outperformed other scoring systems in predicting hospital mortality.ConclusionIn patients with COVID‐19, the use of IMV or HFNC and APACHE IV score were independent risk factors for hospital mortality. The APACHE IV and the 4C Mortality Score were most useful in our population for predicting ICU and hospital mortality.

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Omicron Variant in the Critical Care Units of the Paris Metropolitan Area: The Reality Research Group

Cited by 22 publications

References 12 publications

Clinical phenotypes and outcomes associated with SARS-CoV-2 variant Omicron, sublineages BA.1, BA.1.1, BA.2 and impact of mutational patterns in critically ill French patients with COVID-19

Clinical phenotypes and outcomes associated with SARS-CoV-2 variant Omicron, sublineages BA.1, BA.1.1, BA.2 and impact of mutational patterns in critically ill French patients with COVID-19

COVID-19 Variants in Critically Ill Patients: A Comparison of the Delta and Omicron Variant Profiles

Clinical characteristics and mortality prediction of patients admitted to the Hong Kong East Cluster intensive care units in the COVID‐19 fifth wave

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