Comparison of Clinical Characteristics and Viral Shedding Duration Among SARS-CoV-2 Variants in COVID-19 Patients With ARDS: A Retrospective Cohort Study

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Abstract Background Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in significant global morbidity and mortality since 2020 and can cause respiratory failure resembling acute respiratory distress syndrome (ARDS). Studies indicate that different viral variants exhibit distinct clinical characteristics. This study aims to compare the clinical outcomes, viral shedding durations, and associated risk factors among ARDS patients infected with the different COVID-19 variants. Methods This retrospective, single-center cohort study was conducted at a 3000-beds tertiary hospital in Taiwan. Patients with confirmed SARS-CoV-2 infection and ARDS were enrolled from 2021 to 2022. Demographic data, laboratory results, and clinical outcomes for patients with Alpha and Omicron variants were gathered and analyzed. Results Among 191 SARS-CoV-2 patients with ARDS (44 Alpha and 147 Omicron), 82 patients (41 per variant) were included in the final analysis after propensity score matching. The Omicron group showed significantly higher severity upon admission than the Alpha group (SOFA score: 10 vs. 7, p<0.001); APACHE II score: 26 vs. 14, p<0.001). The viral shedding duration was shorter in Omicron patients (median time 11 days for Omicron vs. 17 days for Alpha, p=0.003). Cox regression analysis indicated that the Omicron variant was independently associated with a shorter viral shedding duration, even after adjusting for vaccination status, age, cancer and SOFA score (HR 0.178, 95% CI 0.039-0.805, p=0.025). Conclusion COVID-19 patients with ARDS infected with the Omicron variant exhibited more severe disease but experienced shorter viral shedding durations compared to those with the Alpha variant. Keywords: SARS-CoV-2, COVID-19 variant, Adult respiratory distress syndrome (ARDS), viral shedding

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