比較臺灣前四波新冠肺炎流行期間病人的臨床表現及預後

Clinical Characteristics and Outcomes of Patients Hospitalized with COVID-19 during the First Four Waves of Epidemics in Taiwan

目的：台灣經歷四波新冠肺炎大流行以四種不同病毒株為主。本次的研究目的在於探討這四波新冠肺炎流行期間因新冠肺炎住院病人的臨床表現及預後是否有所差異？方法：研究的對象為2020年3月1日至2022年4月30日因新冠肺炎逆轉錄聚合酶連鎖陽性反應而入住衛生福利部臺中醫院的病人。中重度新冠肺炎病人的定義為血氧濃度小於94%而需要氧氣治療的病人或那些需要入住重症加護病房的病人。結果：共有436位病人(220位男生及216位女生)，平均年齡為34.8±17歲。2021年4月至7月主要感染α病毒株的病人比起其他流行期間感染其他病毒株為主的病人有比較多的症狀(p<0.001)，比較多的比率需要氧氣治療(p<0.001)，以及比較多的比率肺纖維化(p<0.001)。經過校正其他因子後，發現2021年4月至7月主要感染α病毒株及年齡是轉變成中重度新冠肺炎病人的獨立危險因子。結論：2021年4月至7月主要感染α病毒株的病人比起比起其他流行期間感染其他病毒株為主的病人有比較多的症狀以及轉變成中重度新冠肺炎的風險。

Objectives. In Taiwan, there have been four waves of Coronavirus Disease 2019 (COVID-19) epidemics characterized by different SARS-CoV-2 virus domains. This study aimed to explore potential variations in the clinical outcomes among patients hospitalized with COVID-19 during four epidemic waves in central Taiwan.
Methods. This study enrolled patients diagnosed by a positive reverse-transcription polymerase chain reaction for SARS-CoV-2 who were admitted to Taichung Hospital, Ministry of Health and Welfare, from March 1, 2020 to April 30, 2022. Patients with moderate-to-severe COVID-19 were defined as those with SpO2<94% in room air, those who required oxygen supplementation, or those admitted to the intensive care unit.
Results. Total 436 patients (220 men and 216 women) were enrolled. The mean age was 34.8±17 years. Patients with the COVID-19 alpha variant domain from April to July 2021 exhibited more symptoms than those infected with other SARS-CoV-2 strains domain during other epidemic periods (p<0.001). Patients infected with the alpha variant domain exhibited a higher requirement for oxygen supplementation compared to patients infected with other SARS-CoV-2 strains domain (p<0.001). Pulmonary fibrosis was most frequently observed in patients infected with the alpha variant domain compared to those infected with other SARS-CoV-2 strains (p<0.001). After adjusting for covariates, the alpha variant domain and older age constituted independent risk factors for developing moderate-to-severe COVID-19.
Conclusion. Patients with the alpha variant domain exhibited more clinical symptoms and worse disease severity than those with the ancestral type and other variants of COVID-19.