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Outcomes of non-hospitalized patients with COVID-19 versus seasonal influenza during the fall-winter 2022–2023 period

Hsu et al., BMC Infectious Diseases, doi:10.1186/s12879-025-10833-6, Mar 2025
TriNetX retrospective 18,060 non-hospitalized patients showing lower risk of emergency department visits, hospitalization, and mortality in COVID-19 patients compared to influenza patients, with both groups treated with antivirals.
Hsu et al., 31 Mar 2025, retrospective, multiple countries, peer-reviewed, 8 authors, study period 1 October, 2022 - 31 January, 2023. Contact: dtmed141@gmail.com.
Outcomes of non-hospitalized patients with COVID-19 versus seasonal influenza during the fall-winter 2022–2023 period
Wan-Hsuan Hsu, Bo-Wen Shiau, Ya-Wen Tsai, Jheng-Yan Wu, Ting-Hui Liu, Po-Yu Huang, Min-Hsiang Chuang, Chih-Cheng Lai
BMC Infectious Diseases, doi:10.1186/s12879-025-10833-6
Background The comparability of outcomes for non-hospitalized COVID-19 outpatients during the Omicron wave to outpatients with influenza remains uncertain. This study aims to compare the outcomes of non-hospitalized outpatients with COVID-19 and seasonal influenza during the fall-winter of 2022-2023. Methods This is a retrospective cohort study using TriNetX, a collaborative clinical research platform. Nonhospitalized outpatients with COVID-19 and seasonal influenza between 01 October 2022 and 31 January 2023 were selected from TriNetX. Propensity score matching (PSM) was used to compare patients receiving corresponding outpatient antiviral treatments. Hazard ratios (HRs) with 95% confidence intervals (CIs) for the primary outcome-a composite of all-cause emergency department (ED) visits, hospitalizations, or mortality during the 30-day follow-up period-were calculated and compared. Results After PSM, two well-balanced groups of 9,030 patients each were identified. Non-hospitalized COVID-19 patients had a lower risk of primary composites outcomes including all-cause ED visits, hospitalization, or mortality (5.9% vs. 9.2%, HR, 0.661[95% CI, 0.593-0.737]) compared to the influenza group. In addition, the COVID-19 group demonstrated a reduced risk of all-cause ED visits (4.4% vs. 6.6%, HR 0.683[0.601-0.776]), hospitalization (1.7% vs. 2.9%, HR 0.605[0.495-0.739]) and mortality (0.1% vs. 0.2%, HR 0.176[0.052-0.597]), respectively. Conclusions This study indicates a lower risk of all-cause ED visits, hospitalization, and mortality in the nonhospitalized COVID-19 patients compared to the seasonal influenza group, supporting the current public health strategy of adjusting COVID-19 management based on approaches used for seasonal influenza.
Abbreviations Supplementary Information The online version contains supplementary material available at h t t p s : / / d o i . o r g / 1 0 . 1 1 8 6 / s 1 2 8 7 9 -0 2 5 -1 0 8 3 3 -6. Supplementary Material 1 Author contributions WHH and CCL conceptualized the project. The study design was collaboratively developed by all contributing authors. Data collection was undertaken by BWS, YWT, JYW, THL, PYH, and MHC while data analysis and interpretation were a collective effort of all authors. WHH and CCL drafted the manuscript and all authors contributed to the critical revision of the manuscript, ensuring its intellectual rigor. The final manuscript received unanimous approval from all authors, who also jointly accepted the responsibility for the decision to submit it for publication. Declarations Ethics approval and consent to participate The requirement for written informed consent was waived owing to the utilization of deidentified aggregate data. The study adhered to the Declaration of Helsinki and was approved by the Institutional Review Board of Chi Mei Medical Center (approval number 11202-002). Consent for publication Not required. Competing interests All authors declared that there was no conflict of interest. Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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DOI record: { "DOI": "10.1186/s12879-025-10833-6", "ISSN": [ "1471-2334" ], "URL": "http://dx.doi.org/10.1186/s12879-025-10833-6", "alternative-id": [ "10833" ], "article-number": "442", "assertion": [ { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Received", "name": "received", "order": 1, "value": "17 September 2024" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Accepted", "name": "accepted", "order": 2, "value": "19 March 2025" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "First Online", "name": "first_online", "order": 3, "value": "31 March 2025" }, { "group": { "label": "Declarations", "name": "EthicsHeading" }, "name": "Ethics", "order": 1 }, { "group": { "label": "Ethics approval and consent to participate", "name": "EthicsHeading" }, "name": "Ethics", "order": 2, "value": "The requirement for written informed consent was waived owing to the utilization of deidentified aggregate data. 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