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Inflammatory Biomarkers Differ Among Hospitalized Veterans Infected with Alpha, Delta, And Omicron COVID-19 Variants
18 Pages Posted: 14 Nov 2022
More...Abstract
Background: Pathogenesis of illness from SARS-CoV-2 infection reflects a complex interplay between the virus and host immune responses. We hypothesized that infections due to the Omicron cause less inflammation and cytokine response compared to Delta and Alpha as measured by laboratory inflammatory biomarkers.
Methods: This is a retrospective cohort study of veterans who tested positive for SARS-CoV-2 and were hospitalized at the Veterans Health Administration. We defined three groups of patients based on the periods when variants were dominant: Alpha, Delta, and Omicron. We extracted the first laboratory results during hospitalization, and the in-hospital mortality. We reported the odds ratio (aOR) of outcomes adjusted by age, gender, sex, race, body mass index, comorbidity index, and frailty status. We stratified the results based on the vaccination status.
Findings: Of 400,147 Veterans tested for COVID-19, 30,340 Veterans met the criteria: Alpha, 15,519 (51.2%); Delta, 7,452 (24.6%); Omicron, 7,369 (24.3%). The odds of abnormal C-Reactive Protein in Delta (aOR, 1.74, 95%CI:1.55-1.97) and Alpha (aOR,1.38, 95%CI:1.23-1.55) were significantly higher compared to Omicron. The same significant trend was observed for Ferritin, Alanine aminotransferase, Aspartate aminotransferase, Lactate dehydrogenase, and Albumin. The in-hospital mortality during the Alpha (aOR, 3.45, 95%CI:3.18-3.75) and Delta (aOR,3.00, 95%CI:2.77-3.25) were higher compared to Omicron. The results remained significant after stratifying the outcomes based on the vaccination status.
Interpretation: Veterans infected with Omicron showed milder inflammatory responses and lower mortality compared to other variants. Understanding the inflammatory responses of each patient across the different variants could be used to enhance acute patients’ management.
Funding Information: The analysis was supported by seed funding from Baylor College of Medicine, Houston, Texas, United States, the Center for Innovations in Quality, Effectiveness and Safety (CIN 13–413), Michael E. DeBakey VA Medical Center, Houston, TX, United states and a national institute of health (NIH), National Heart, Lung, and Blood Institute (NHLBI) K25 funding (#:1K25HL152006-01), VA Clinical Science Research & Development (IK2 CX001981), and Artificial Intelligence/Machine Learning Consortium to Advance Health Equity and Researcher Diversity (AIM-AHEAD) funding (OD032581-01S1).
Declaration of Interests: The funding sources had no role in study design, methods, data collection and analysis, interpretation, and submission of the results. All authors declare no competing interests.
Ethics Approval Statement: We used the veteran health administration (VHA) Corporate Data Warehouse (CDW)9 and VHA COVID-19 shared data resources.10 The Research & Development Committee of the Michael E. DeBakey VA Medical Center and Baylor College of Medicine Institutional Review Board (IRB# H47595) approved our study.
Keywords: inflammatory markers, SARS-CoV-2 variants, alpha, Delta, Omicron
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