Comparison of SARS-CoV-2 Variants of Concern Alpha (B.1.1.7) Vs. Beta (B.1.351) in Critically Ill Patients: A Multicenter Cohort Study

Overview

Journal Front Med (Lausanne)

Specialty General Medicine

Date 2022 Apr 1

PMID 35360736

Authors

Guillaume Louis

Thibaut Belveyre

Christophe Goetz

Sebastien Gibot

Paul Dunand

Marie Conrad

Rostane Gaci

Sebastien Gette

Nadia Ouamara

Pascale Perez

Cyril Cadoz

Yoann Picard

Nouchan Mellati

Affiliations

Soon will be listed here.

Abstract

Objectives: The clinical outcomes of the Beta (B.1.351) variant of concern (VOC) of the SARS-CoV-2 virus remain poorly understood. In early 2021, northeastern France experienced an outbreak of Beta that was not observed elsewhere. This outbreak slightly preceded and then overlapped with a second outbreak of the better understood VOC Alpha (B.1.1.7) in the region. This situation allowed us to contemporaneously compare Alpha and Beta in terms of the characteristics, management, and outcomes of critically ill patients.

Methods: A multicenter prospective cohort study was conducted on all consecutive adult patients who had laboratory confirmed SARS CoV-2 infection, underwent variant screening, and were admitted to one of four intensive care units (ICU) for acute respiratory failure between January 9th and May 15th, 2021. Primary outcome was 60-day mortality. Differences between Alpha and Beta in terms of other outcomes, patient variables, management, and vaccination characteristics were also explored by univariate analysis. The factors that associated with 60-day death in Alpha- and Beta-infected patients were examined with logistic regression analysis.

Results: In total, 333 patients (median age, 63 years; 68% male) were enrolled. Of these, 174 and 159 had Alpha and Beta, respectively. The two groups did not differ significantly in terms of 60-day mortality (19 vs. 23%), 28-day mortality (17 vs. 20%), need for mechanical ventilation (60 vs. 61%), mechanical ventilation duration (14 vs. 15 days), other management variables, patient demographic variables, comorbidities, or clinical variables on ICU admission. The vast majority of patients were unvaccinated (94%). The remaining 18 patients had received a partial vaccine course and 2 were fully vaccinated. The vaccinated patients were equally likely to have Alpha and Beta.

Conclusions: Beta did not differ from Alpha in terms of patient characteristics, management, or outcomes in critically ill patients.

Trial Registration: ClinicalTrials.gov, identifier: NCT04906850.

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References

Garcia Borrega J, Naendrup J, Heindel K, Hamacher L, Heger E, Di Cristanziano V . Clinical Course and Outcome of Patients with SARS-CoV-2 Alpha Variant Infection Compared to Patients with SARS-CoV-2 Wild-Type Infection Admitted to the ICU. Microorganisms. 2021; 9(9). PMC: 8470850. DOI: 10.3390/microorganisms9091944. View

Dres M, Hajage D, Lebbah S, Kimmoun A, Pham T, Beduneau G . Characteristics, management, and prognosis of elderly patients with COVID-19 admitted in the ICU during the first wave: insights from the COVID-ICU study : Prognosis of COVID-19 elderly critically ill patients in the ICU. Ann Intensive Care. 2021; 11(1):77. PMC: 8120254. DOI: 10.1186/s13613-021-00861-1. View

Levey A, Eckardt K, Tsukamoto Y, Levin A, Coresh J, Rossert J . Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2005; 67(6):2089-100. DOI: 10.1111/j.1523-1755.2005.00365.x. View

Lin L, Liu Y, Tang X, He D . The Disease Severity and Clinical Outcomes of the SARS-CoV-2 Variants of Concern. Front Public Health. 2021; 9:775224. PMC: 8669511. DOI: 10.3389/fpubh.2021.775224. View

Challen R, Brooks-Pollock E, Read J, Dyson L, Tsaneva-Atanasova K, Danon L . Risk of mortality in patients infected with SARS-CoV-2 variant of concern 202012/1: matched cohort study. BMJ. 2021; 372:n579. PMC: 7941603. DOI: 10.1136/bmj.n579. View

. Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med. 2020; 47(1):60-73. PMC: 7674575. DOI: 10.1007/s00134-020-06294-x. View

Jassat W, Mudara C, Ozougwu L, Tempia S, Blumberg L, Davies M . Difference in mortality among individuals admitted to hospital with COVID-19 during the first and second waves in South Africa: a cohort study. Lancet Glob Health. 2021; 9(9):e1216-e1225. PMC: 8270522. DOI: 10.1016/S2214-109X(21)00289-8. View

Papazian L, Aubron C, Brochard L, Chiche J, Combes A, Dreyfuss D . Formal guidelines: management of acute respiratory distress syndrome. Ann Intensive Care. 2019; 9(1):69. PMC: 6565761. DOI: 10.1186/s13613-019-0540-9. View

Staub T, Arendt V, Lasso de la Vega E, Braquet P, Michaux C, Kohnen M . Case series of four re-infections with a SARS-CoV-2 B.1.351 variant, Luxembourg, February 2021. Euro Surveill. 2021; 26(18). PMC: 8103728. DOI: 10.2807/1560-7917.ES.2021.26.18.2100423. View

10.

Abdool Karim S, Abdool Karim Q . Omicron SARS-CoV-2 variant: a new chapter in the COVID-19 pandemic. Lancet. 2021; 398(10317):2126-2128. PMC: 8640673. DOI: 10.1016/S0140-6736(21)02758-6. View

11.

Horby P, Lim W, Emberson J, Mafham M, Bell J, Linsell L . Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2020; 384(8):693-704. PMC: 7383595. DOI: 10.1056/NEJMoa2021436. View

12.

Teyssou E, Soulie C, Visseaux B, Lambert-Niclot S, Ferre V, Marot S . The 501Y.V2 SARS-CoV-2 variant has an intermediate viral load between the 501Y.V1 and the historical variants in nasopharyngeal samples from newly diagnosed COVID-19 patients. J Infect. 2021; 83(1):119-145. PMC: 8080495. DOI: 10.1016/j.jinf.2021.04.023. View

13.

Cele S, Gazy I, Jackson L, Hwa S, Tegally H, Lustig G . Escape of SARS-CoV-2 501Y.V2 from neutralization by convalescent plasma. Nature. 2021; 593(7857):142-146. PMC: 9867906. DOI: 10.1038/s41586-021-03471-w. View

14.

Abu-Raddad L, Chemaitelly H, Butt A . Effectiveness of the BNT162b2 Covid-19 Vaccine against the B.1.1.7 and B.1.351 Variants. N Engl J Med. 2021; 385(2):187-189. PMC: 8117967. DOI: 10.1056/NEJMc2104974. View

15.

Tregoning J, Flight K, Higham S, Wang Z, Pierce B . Progress of the COVID-19 vaccine effort: viruses, vaccines and variants versus efficacy, effectiveness and escape. Nat Rev Immunol. 2021; 21(10):626-636. PMC: 8351583. DOI: 10.1038/s41577-021-00592-1. View

16.

Klein S, Mayerhofer T, Fries D, Hernandez C, Joannidis M . Elevated HbA1c remains a predominant finding in severe COVID-19 and may be associated with increased mortality in patients requiring mechanical ventilation. Crit Care. 2021; 25(1):300. PMC: 8375457. DOI: 10.1186/s13054-021-03730-2. View

17.

Cevik M, Grubaugh N, Iwasaki A, Openshaw P . COVID-19 vaccines: Keeping pace with SARS-CoV-2 variants. Cell. 2021; 184(20):5077-5081. PMC: 8445744. DOI: 10.1016/j.cell.2021.09.010. View

18.

. Linked transmission chains of imported SARS-CoV-2 variant B.1.351 across mainland France, January 2021. Euro Surveill. 2021; 26(13). PMC: 8017907. DOI: 10.2807/1560-7917.ES.2021.26.13.2100333. View

19.

Bravata D, Perkins A, Myers L, Arling G, Zhang Y, Zillich A . Association of Intensive Care Unit Patient Load and Demand With Mortality Rates in US Department of Veterans Affairs Hospitals During the COVID-19 Pandemic. JAMA Netw Open. 2021; 4(1):e2034266. PMC: 7816100. DOI: 10.1001/jamanetworkopen.2020.34266. View

20.

Eriksson C, Stoner R, Eden K, Newgard C, Guise J . The Association Between Hospital Capacity Strain and Inpatient Outcomes in Highly Developed Countries: A Systematic Review. J Gen Intern Med. 2016; 32(6):686-696. PMC: 5442002. DOI: 10.1007/s11606-016-3936-3. View