In-hospital outcomes of healthcare-associated COVID-19 (Omicron) versus healthcare-associated influenza: a retrospective, nationwide cohort study in Switzerland

Grant et al., Clinical Infectious Diseases, doi:10.1093/cid/ciae558

Nov 2024

Retrospective 3,769 hospitalized patients in Switzerland showing comparable 30-day in-hospital mortality between healthcare-associated COVID-19 (Omicron) and healthcare-associated influenza patients.

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Grant et al., 13 Nov 2024, retrospective, Switzerland, peer-reviewed, 33 authors. Contact: rebecca.grant@hug.ch.

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In-hospital outcomes of healthcare-associated COVID-19 (Omicron) versus healthcare-associated influenza: a retrospective, nationwide cohort study in Switzerland

PhD Rebecca Grant, Marlieke E A De Kraker, Niccolò Buetti, Holly Jackson, Mohamed Abbas, Jonathan Aryeh Sobel, Rami Sommerstein, Marcus Eder, Carlo Balmelli, Nicolas Troillet, Peter W Schreiber, Philipp Jent, Laurence Senn, Domenica Flury, Sarah Tschudin-Sutter, Michael Buettcher, Maria Süveges, Laura Urbini, Olivia Keiser, Ursina Roder, Stephan Harbarth, Marie-Céline Zanella, Christoph Berger, Sara Bernhard-Stirnemann, Alexia Cusini, Ulrich Heininger, Anita Niederer-Loher, Yvonne Nussbaumer-Ochsner, Reto Stocker, Danielle Vuichard-Gysin, Petra Zimmermann, Franziska Zucol

Clinical Infectious Diseases, doi:10.1093/cid/ciae558

Background: As COVID-19 is integrated into existing infectious disease control programs, it is important to understand the comparative clinical impact of COVID-19 and other respiratory diseases. Methods: We conducted a retrospective cohort study of patients with symptomatic healthcareassociated COVID-19 or influenza reported to the nationwide, hospital-based surveillance system in Switzerland. Included patients were adults (≥18 years) hospitalized for ≥3 days in tertiary care and large regional hospitals. Patients had COVID-19 symptoms and a RT-PCR-confirmed SARS-CoV-2 infection ≥3 days after hospital admission between 1 February 2022 and 30 April 2023, or influenza symptoms and a RT-PCR-confirmed influenza A or B infection ≥3 days after hospital admission between 1 November 2018 and 30 April 2023. Primary and secondary outcomes were 30-day in-hospital mortality and admission to intensive care unit (ICU), respectively. Cox regression (Fine-Gray model) was used to account for time-dependency and competing events, with inverse probability weighting to adjust for confound ing. Results: We included 2901 patients with symptomatic healthcare-associated COVID-19 (Omicron) and 868 patients with symptomatic healthcare-associated influenza from nine hospitals. We found a similar case fatality ratio between healthcare-associated COVID-19 (Omicron) (6.2%) and healthcare-associated influenza (6.1%) patients; after adjustment, patients had a comparable subdistribution hazard ratio for 30-day in-hospital mortality (0.91, 95%CI 0.67-1.24). A similar proportion of patients were admitted to ICU (2.4% COVID-19; 2.6% influenza). Conclusions: COVID-19 and influenza continue to cause severe disease among hospitalized patients. Our results suggest that in-hospital mortality risk of healthcare-associated COVID-19 (Omicron) and healthcare-associated influenza are comparable.

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DOI record: { "DOI": "10.1093/cid/ciae558", "ISSN": [ "1058-4838", "1537-6591" ], "URL": "http://dx.doi.org/10.1093/cid/ciae558", "abstract": "Abstract\n \n Background\n As COVID-19 is integrated into existing infectious disease control programs, it is important to understand the comparative clinical impact of COVID-19 and other respiratory diseases.\n \n \n Methods\n We conducted a retrospective cohort study of patients with symptomatic healthcare-associated COVID-19 or influenza reported to the nationwide, hospital-based surveillance system in Switzerland. Included patients were adults (≥18 years) hospitalized for ≥3 days in tertiary care and large regional hospitals. Patients had COVID-19 symptoms and a RT-PCR-confirmed SARS-CoV-2 infection ≥3 days after hospital admission between 1 February 2022 and 30 April 2023, or influenza symptoms and a RT-PCR-confirmed influenza A or B infection ≥3 days after hospital admission between 1 November 2018 and 30 April 2023. Primary and secondary outcomes were 30-day in-hospital mortality and admission to intensive care unit (ICU), respectively. Cox regression (Fine-Gray model) was used to account for time-dependency and competing events, with inverse probability weighting to adjust for confounding.\n \n \n Results\n We included 2901 patients with symptomatic healthcare-associated COVID-19 (Omicron) and 868 patients with symptomatic healthcare-associated influenza from nine hospitals. We found a similar case fatality ratio between healthcare-associated COVID-19 (Omicron) (6.2%) and healthcare-associated influenza (6.1%) patients; after adjustment, patients had a comparable subdistribution hazard ratio for 30-day in-hospital mortality (0.91, 95%CI 0.67-1.24). A similar proportion of patients were admitted to ICU (2.4% COVID-19; 2.6% influenza).\n \n \n Conclusions\n COVID-19 and influenza continue to cause severe disease among hospitalized patients. 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