Identification of CKD, bedridden history and cancer as higher-risk comorbidities and their impact on prognosis of hospitalized Omicron patients: a multi-centre cohort study

Xiaohua Chen; Hongyu Wang; Jingwen Ai; Leer Shen; Ke Lin; Guanmin Yuan; Xiaohua Sheng; Xia Jin; Zhifeng Deng; Jie Xu; Guanzhu Lu; Shunjie Chen; Jianpeng Cai; Yi Zhang; Haocheng Zhang; Sen Wang; Wenhong Zhang; Cunyi Fan

doi:10.1080/22221751.2022.2122581

Identification of CKD, bedridden history and cancer as higher-risk comorbidities and their impact on prognosis of hospitalized Omicron patients: a multi-centre cohort study

Emerg Microbes Infect. 2022 Dec;11(1):2501-2509. doi: 10.1080/22221751.2022.2122581.

Authors

Xiaohua Chen¹, Hongyu Wang², Jingwen Ai², Leer Shen¹, Ke Lin², Guanmin Yuan², Xiaohua Sheng³, Xia Jin⁴, Zhifeng Deng⁵, Jie Xu⁶, Guanzhu Lu⁶, Shunjie Chen⁷, Jianpeng Cai², Yi Zhang², Haocheng Zhang², Sen Wang², Wenhong Zhang^{2

8

9}, Cunyi Fan^{10

11}

Affiliations

¹ Department of Infectious Diseases, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.
² Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
³ Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.
⁴ Shanghai Jiao Tong University Affiliated Sixth People's Hospital (Lingang District), Shanghai, People's Republic of China.
⁵ Department of Neurosurgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.
⁶ Shanghai Jiao Tong University Affiliated Ninth People's Hospital, Shanghai, People's Republic of China.
⁷ Shanghai Fouth People's Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China.
⁸ Huashen Institute of Microbes and Infections, Shanghai, People's Republic of China.
⁹ National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
¹⁰ Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.
¹¹ Shanghai Engineering Research Center for Orthopaedic Material Innovation and Tissue Regeneration, Langu Science and Technology Park, Shanghai, People's Republic of China.

Abstract

To further describe the effect of the "fragile population" and their "higher-risk" comorbidities on prognosis among hospitalized Omicron patients, this observational cohort study enrolled hospitalized patients confirmed with SARS-CoV-2 during the 2022 Omicron wave in Shanghai, China. The primary outcome was progression to severe or critical cases. The secondary outcome was viral shedding time from the first positive SARS-CoV-2 detection. A total of 847 participants were enrolled, most of whom featured as advanced age (>70 years old: 30.34%), not fully vaccinated (55.84%), combined with at least 1 comorbidity (65.41%). Multivariate cox regression suggested age >70 years old (aHR[95%CI] 0.78[0.61-0.99]), chronic kidney disease (CKD) stage 4-5 (aHR[95%CI] 0.61[0.46-0.80]), heart conditions (aHR[95%CI] 0.76[0.60-0.97]) would elongate viral shedding time and fully/booster vaccination (aHR[95%CI] 1.4 [1.14-1.72]) would shorten this duration. Multivariate logistic regression suggested CKD stage 4-5 (aHR[95%CI] 3.21[1.45-7.27]), cancer (aHR[95%CI] 9.52[4.19-22.61]), and long-term bedridden status (aHR[95%CI] 4.94[2.36-10.44]) were the "higher" risk factor compared with the elderly, heart conditions, metabolic disorders, isolated hypertension, etc. for severity while female (aHR[95%CI] 0.34[0.16-0.68]) and fully/booster Vaccination (aHR[95%CI] 0.35[0.12-0.87]) could provide protection from illness progression. CKD stage 4-5, cancer and long-term bedridden history were "higher-risk" factors among hospitalized Omicron patients for severity progression while full vaccination could provide protection from illness progression.

Keywords: COVID-19; Omicron; SARS-CoV-2; hospialized population; risk factors.

Publication types

Observational Study
Multicenter Study

MeSH terms

Aged
COVID-19* / epidemiology
China
Cohort Studies
Comorbidity
Female
Humans
Neoplasms* / epidemiology
Prognosis
Renal Insufficiency, Chronic* / epidemiology
SARS-CoV-2

Grants and funding

This study was funded by a project supported by Three-year Action Plan to Promote Clinical Skills and Clinical Innovation Capabilities in Municipal Hospitals, Shanghai Shenkang Hospital Development Center [No. SHDC2020CR2039B], Shanghai ShenKang Hospital Development Center, Clinical Research Plan of SHDC [No. SHDC2020CR6019], Biomedical Technology Support Special Project of Shanghai 2020 “Science and Technology Innovation Action Plan” [No. 20S31900300], Biomedical Technology Support Special Project of Shanghai 2021 “Science and Technology Innovation Action Plan” [No. 21S31902300], Clinical Research Center (CRC) of Shanghai University of Medicine and Health Sciences [No.20MC2020001], Shanghai Municipal Science and Technology Major Project [HS2021SHZX001], the Shanghai Science and Technology Committee [20dz2260100, 20Z11901100, 20dz2210403], Key Discipline Construction Plan from Shanghai Municipal Health Commission [GWV-10.1-XK01, GWV-3.1, GWV-2], National key R&D Program of China [No. 2021YFC2400805].