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Clinical phenotypes and outcomes associated with SARS-CoV-2 Omicron sublineage JN.1 in critically ill COVID-19 patients: a prospective, multicenter cohort study in France, November 2022 to January 2024

de Prost N 1 , Audureau E 2 , Guillon A 3 , Handala L 4 , Préau S 5 , Guigon A 6 Show all authors , Uhel F 7 , Le Hingrat Q 8 , Delamaire F 9 , Grolhier C 10 , Tamion F 11 , Moisan A 12 , Darreau C 13 , Thomin J 14 , Contou D 15 , Henry A 16 , Daix T 17 , Hantz S 18 , Saccheri C 19 , Giordanengo V 20 , Pham T 21 , Chaghouri A 22 , Bay P 23 , Pawlotsky JM 2 , Fourati S 2 , SEVARVIR investigators

Affiliations 

  • 1 Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France. [email protected]
  • 2 Université Paris-Est-Créteil (UPEC), Créteil, France
  • 3 Intensive Care Unit, Research Center for Respiratory Diseases (CEPR), INSERM U1100, Tours University Hospital, University of Tours, Tours, France
  • 4 INSERM U1259, Université de Tours, Tours, France
  • 5 U1167 - RID-AGE Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, 59000, Lille, France
  • 6 Service de Virologie, CHU de Lille, 59000, Lille, France
  • 7 DMU ESPRIT, Service de Médecine Intensive Réanimation, Université Paris Cité, APHP, Hôpital Louis Mourier, Colombes, France
  • 8 IAME INSERM UMR 1137, Service de Virologie, Université Paris Cité, Hôpital Bichat-Claude Bernard, Assistance Publique - Hôpitaux de Paris, Paris, France
  • 9 CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
  • 10 Laboratoire de Virologie, CHU Rennes, Rennes, France
  • 11 Service de Médecine Intensive-Réanimation, CHU De Rouen, 76000, Rouen, France
  • 12 INSERM DYNAMICURE UMR 1311 Department of Virology, Univ Rouen Normandie, Université de Caen Normandie, Normandie Univ, CHU Rouen, National Reference Center of HIV, 76000, Rouen, France
  • 13 Service de Réanimation Médico-Chirurgicale, Centre Hospitalier du Mans, Le Mans, France
  • 14 Laboratoire de Microbiologie, Centre Hospitalier du Mans, Le Mans, France
  • 15 Service de Réanimation, Hôpital Victor Dupouy, Argenteuil, France
  • 16 Service de Virologie, Hôpital Victor Dupouy, Argenteuil, France
  • 17 INSERM CIC 1435 and UMR 1092, Réanimation Polyvalente, CHU Limoges, Limoges, France
  • 18 Bacteriology, Virology, Hygiene Department, French National Reference Center for Herpesviruses, CHU Limoges, 87000, Limoges, France
  • 19 Service de Réanimation Médicale, CHU de Nice, Nice, France
  • 20 Laboratoire de Virologie, CHU de Nice, Nice, France
  • 21 Groupe de Recherche Clinique CARMAS, Université Paris-Est-Créteil (UPEC), Créteil, France
  • 22 Laboratoire de Virologie, Hôpital Paul Brousse, Assistance Publique - Hôpitaux de Paris, Villejuif, France
  • 23 Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
Ann Intensive Care, 2024 Jun 28;14(1):101.
PMID: 38940865 DOI: 10.1186/s13613-024-01319-w

Abstract

BACKGROUND: A notable increase in severe cases of COVID-19, with significant hospitalizations due to the emergence and spread of JN.1 was observed worldwide in late 2023 and early 2024. However, no clinical data are available regarding critically-ill JN.1 COVID-19 infected patients.

METHODS: The current study is a substudy of the SEVARVIR prospective multicenter observational cohort study. Patients admitted to any of the 40 participating ICUs between November 17, 2022, and January 22, 2024, were eligible for inclusion in the SEVARVIR cohort study (NCT05162508) if they met the following inclusion criteria: age ≥ 18 years, SARS-CoV-2 infection confirmed by a positive reverse transcriptase-polymerase chain reaction (RT-PCR) in nasopharyngeal swab samples, ICU admission for acute respiratory failure. The primary clinical endpoint of the study was day-28 mortality. Evaluation of the association between day-28 mortality and sublineage group was conducted by performing an exploratory multivariable logistic regression model, after systematically adjusting for predefined prognostic factors previously shown to be important confounders (i.e. obesity, immunosuppression, age and SOFA score) computing odds ratios (OR) along with their corresponding 95% confidence intervals (95% CI).

RESULTS: During the study period (November 2022-January 2024) 56 JN.1- and 126 XBB-infected patients were prospectively enrolled in 40 French intensive care units. JN.1-infected patients were more likely to be obese (35.7% vs 20.8%; p = 0.033) and less frequently immunosuppressed than others (20.4% vs 41.4%; p = 0.010). JN.1-infected patients required invasive mechanical ventilation support in 29.1%, 87.5% of them received dexamethasone, 14.5% tocilizumab and none received monoclonal antibodies. Only one JN-1 infected patient (1.8%) required extracorporeal membrane oxygenation support during ICU stay (vs 0/126 in the XBB group; p = 0.30). Day-28 mortality of JN.1-infected patients was 14.6%, not significantly different from that of XBB-infected patients (22.0%; p = 0.28). In univariable logistic regression analysis and in multivariable analysis adjusting for confounders defined a priori, we found no statistically significant association between JN.1 infection and day-28 mortality (adjusted OR 1.06 95% CI (0.17;1.42); p = 0.19). There was no significant between group difference regarding duration of stay in the ICU (6.0 [3.5;11.0] vs 7.0 [4.0;14.0] days; p = 0.21).

CONCLUSIONS: Critically-ill patients with Omicron JN.1 infection showed a different clinical phenotype than patients infected with the earlier XBB sublineage, including more frequent obesity and less immunosuppression. Compared with XBB, JN.1 infection was not associated with higher day-28 mortality.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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