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

Figures & data

Table 1. Baseline characteristics of participants infected with Omicron.

N	847
Age, Median (IQR)	62 (41–73)
≤70 yrs	690 (69.66)
>70 yrs	257 (30.34)
Male, N (%)	392 (46.28)
Vaccination, N (%) *	607
Unvaccinated	319 (52.55)
Partially vaccinated	20 (3.29)
Fully vaccinated	130 (21.42)
Booster	138 (22.73)
Comorbidities, N (%)
Heart conditions	257 (30.34)
Metabolic disease	157 (18.54)
CKD stage 4–5	156 (18.42)
Isolated hypertension	145 (17.12)
Cancer	106 (12.51)
Cerebral vascular disease	62 (7.32)
Lung disease	62 (7.32)
Neurodegenerative disease	36 (4.25)
Acute conditions	40 (4.72)
Bone fracture	16 (1.89)
Autoimmune diseases	6 (0.71)
Comorbidities, N (%)
0	293 (34.59)
1	219 (25.86)
2	204 (24.09)
≥3	131 (15.47)
Long-term bedridden, N (%)	161 (19.01)
Treatment, N (%)
Oxygen inhalation	210 (24.79)
High flow or BIPAP	4 (0.47)
Mechanical ventilations	11 (1.3)
Hemodialysis	136 (16.06)
Glucocorticoid	106 (12.51)
Outcome
Severe/Critical cases, N (%)	93 (10.98)
Viral shedding time, median (IQR)	13 (10–16)

* 607 participants reported received doses of COVID-19 vaccine.

Abbreviation: CKD: Chronic Kidney Disease; yrs: years old.

Figure 1. Kaplan–Meier Curve for COVID-19 Nucleic Acid Viral Shedding Time. A. Viral shedding time among participants more or less than 70 years old; B. Viral shedding time between participants with and without chronic kidney disease stage 4–5; C. Viral shedding time between participants with and without heart conditions; D. Viral shedding time between participants not fully vaccinated and fully vaccinated or booster.

Table 2. Multivariate Cox regression of factors associated with COVID-19 nucleic acid viral shedding time.

	Univariate		Multivariate*
	HR (95%CI)	P-value	Adjusted HR (95%CI)	P Value
Female	1.17 (1–1.37)	0.049	1.07 (0.89–1.29)	0.453
Age ≤ 70 yrs	Ref	Ref	Ref	Ref
Age > 70 yrs	0.63 (0.53–0.75)	<0.001	0.78 (0.61–0.99)	0.037
Comorbidities
CKD stage 4–5	0.44 (0.36–0.54)	<0.001	0.61 (0.46–0.8)	<0.001
Metabolic disease	0.66 (0.53–0.81)	<0.001	0.81 (0.64–1.04)	0.098
Heart conditions	0.61 (0.51–0.73)	<0.001	0.76 (0.6–0.97)	0.030
Isolated hypertension	0.77 (0.62–0.95)	0.013	0.81 (0.61–1.06)	0.125
Cerebral vascular disease	0.93 (0.68–1.27)	0.656	–	–
Lung disease	0.75 (0.54–1.04)	0.083	–	–
Cancer	0.85 (0.66–1.1)	0.218	–	–
Acute conditions	0.79 (0.56–1.11)	0.178
Neurodegenerative disease	1.09 (0.73–1.64)	0.669	–	–
Bone fracture	0.66 (0.37–1.17)	0.152	–	–
Autoimmune diseases	0.62 (0.26–1.5)	0.292	–	–
Long-term bedridden	0.62 (0.51–0.76)	<0.001	0.9 (0.68–1.19)	0.452
COVID-19 vaccination
Not fully vaccinated	Ref	Ref	Ref	Ref
Fully vaccinated or booster	1.98 (1.66–2.37)	<0.001	1.4 (1.14–1.72)	0.001
Severe/Critical cases	0.56 (0.42–0.74)	<0.001	0.97 (0.67–1.39)	0.852

*554 participants were enrolled for multivariate regression after removing missing values.

Note: Factors with adjusted HR <1.00 and P-value < 0.05 were considered as risk factors for viral shedding while factors with adjusted HR >1.00 and P-value < 0.05 were considered as protective factors. Smaller or bigger adjusted HR indicates stronger risk or protection, respectively.

Abbreviation: HR: Hazard Ratio; 95%CI: 95% confidence interval; CKD: Chronic Kidney Disease; yrs: years old;

Table 3. Multivariate logistics regression of factors associated with severity progression.

	Univariate		Multivariate*
	OR (95%CI)	P-value	Adjusted OR (95%CI)	P-value
Female	0.31 (0.19–0.49)	<0.001	0.34 (0.16–0.68)	0.003
Age ≤ 70 yrs	Ref	Ref	Ref	Ref
Age > 70 yrs	3.57 (2.3–5.58)	<0.001	1.8 (0.91–3.59)	0.093
Comorbidities
CKD stage 4–5	3.72 (2.35–5.87)	<0.001	3.21 (1.45–7.27)	0.004
Metabolic disease	2.29 (1.39–3.7)	<0.001	1.35 (0.67–2.64)	0.395
Heart conditions	3.23 (2.09–5.03)	<0.001	1.53 (0.73–3.2)	0.256
Neurodegenerative disease	3.37 (1.5–7.04)	0.002	1.79 (0.43–6.82)	0.403
Cerebral vascular disease	3.87 (2.09–6.95)	<0.001	0.96 (0.35–2.64)	0.943
Lung disease	2.61 (1.33–4.83)	0.003	2.46 (0.91–6.38)	0.067
Acute conditions	3.35 (1.55–6.79)	0.001	1.91 (0.67–5.16)	0.210
Cancer	4.82 (2.93–7.84)	<0.001	9.52 (4.19–22.61)	<0.00
Isolated hypertension	1.18 (0.66–2.03)	0.557	–	–
Bone fracture	2.48 (0.56–7.94)	0.164	–	–
Autoimmune diseases	NA	NA	–	–
Long-term bedridden	7.51 (4.76–11.91)	<0.001	4.94 (2.36–10.44)	<0.001
COVID-19 vaccination
Not fully vaccinated	Ref	Ref	Ref	Ref
Fully vaccinated or booster	0.11 (0.04–0.25)	<0.001	0.35 (0.12–0.87)	0.034

*607 participants were enrolled for multivariate regression after removing missing values.

Note: Factors with adjusted OR <1.00 and P-value < 0.05 were considered as protective factors against illness progression while factors with adjusted OR >1.00 and P-value < 0.05 were considered as risk factors. Smaller or bigger adjusted HR indicates stronger protection or risk, respectively.

Abbreviation: OR: Odds Ratio; 95%CI: 95% confidence interval; CKD: Chronic Kidney Disease; yrs: years old;

Table 4. Characteristics of participants with high-risk comorbidities for severity progression.

	A	B	A vs B	C	A vs C	D	A vs D
	Control	CKD Stage 4–5	P-value	Cancer	P-value	Long-term bedridden	P-value
N	286	156		106		161
Age, Median (IQR)	39 (32.25–55)	68 (58–76.25)	<0.001	66 (58–72.75)	<0.001	76 (64–86)	<0.001
≤70 yrs	260 (90.91)	89 (57.05)		70 (66.04)		61 (37.89)
>70 yrs	26 (9.09)	67 (42.95)		36 (33.96)		100 (62.11)
Male, N (%)	104 (36.36)	85 (54.49)	<0.001	63 (59.43)	<0.001	89 (55.28)	<0.001
Vaccination, N (%) *			<0.001		<0.001		<0.001
Unvaccinated	51 (23.29)	108 (95.58)		59 (72.84)		93 (80.87)
Partially vaccinated	13 (5.94)	0 (0)		2 (2.47)		3 (2.61)
Fully vaccinated	73 (33.33)	4 (3.54)		16 (19.75)		10 (8.7)
Booster	82 (37.44)	1 (0.88)		4 (4.94)		9 (7.83)
Comorbidities, N (%)
CKD Stage 4–5	0 (0)	156 (100)		6 (5.66)		50 (31.06)
Cancer	0 (0)	6 (3.85)		106 (100)		32 (19.88)
Heart conditions	0 (0)	92 (58.97)		24 (22.64)		93 (57.76)
Metabolic disease	0 (0)	42 (26.92)		23 (21.7)		50 (31.06)
Isolated hypertension	0 (0)	44 (28.21)		27 (25.47)		31 (19.25)
Cerebral vascular disease	0 (0)	15 (9.62)		6 (5.66)		62 (38.51)
Neurodegenerative disease	0 (0)	2 (1.28)		4 (3.77)		19 (11.8)
Lung disease	0 (0)	9 (5.77)		7 (6.6)		17 (10.56)
Acute conditions	0 (0)	12 (7.69)		8 (7.55)		21 (13.04)
Autoimmune disease	0 (0)	1 (0.64)		0 (0)		2 (1.24)
Bone facture	0 (0)	2 (1.28)		4 (3.77)		16 (9.94)
Long-term bedridden, N (%)	0 (0)	50 (32.05)		32 (30.19)		161 (100)
Comorbidities, N (%)
0	286 (100)	0 (0)		1 (0.94)		5 (3.11)
1	0 (0)	16 (10.26)		37 (34.91)		25 (15.53)
2	0 (0)	79 (50.64)		33 (31.13)		58 (36.02)
≥3	0 (0)	61 (39.1)		35 (33.02)		73 (45.34)
Outcome
Severe/Critical COVID-19, N (%)	0 (0)	38 (24.36)	<0.001	32 (30.19)	<0.001	52 (32.3)	<0.001
Viral Shedding Time median (IQR)	11 (8.5–13.5)	17 (15.5–21)	<0.001	14 (12.5–17)	0.007	16.5 (11.25–20)	<0.001

*219, 113, 81, 115 in the group A, B, C, D, respectively, reported received COVID-19 vaccine doses.

Abbreviation: CKD: Chronic Kidney Disease; yrs: years old;

Figure 2. Dynamic laboratory examination monitoring in patients with high-risk comorbidities.