Clinical Scorecard: Hospitalization and Mortality Rates Associated with COVID-19 in US Veterans Infected with SARS-CoV-2 During the XBB, JN.1, and KP Variant Periods

At a Glance

Key Highlights

• Hospitalization odds declined during JN.1 (OR 0.81) and KP (OR 0.80) variant periods compared with XBB.
• In-hospital mortality rates remained consistently low across all variant-predominant eras.
• Study included 130,263 VA patients with SARS-CoV-2 positive tests from September 2023 to October 2024.

Guideline-Based Recommendations

Diagnosis

• Confirm SARS-CoV-2 infection by positive test.
• Classify variant-predominant era based on CDC variant surveillance data corresponding to test date.

Management

• Hospitalize patients with COVID-19 diagnosis within 3 days of positive test if clinically indicated.
• Consider vaccination status and comorbidities in clinical decision-making.

Monitoring & Follow-up

• Monitor hospitalization and mortality outcomes during variant-predominant periods.
• Track vaccination uptake including adapted vaccines for XBB and KP.2 variants.

Risks

• Older age, higher area deprivation index, and increased healthcare utilization are associated with higher hospitalization and mortality risk.
• Hospitalization risk decreased with JN.1 and KP variants compared to XBB.

Patient & Prescribing Data

Veterans with SARS-CoV-2 infection during XBB, JN.1, and KP variant periods

Vaccination status including adapted vaccines may influence hospitalization risk; detailed treatment data not provided.

Clinical Best Practices

• Use electronic health records to identify and classify patients by variant-predominant era.
• Adjust clinical risk assessments for demographic, comorbidity, and vaccination factors.
• Employ logistic regression and spline analyses to monitor evolving hospitalization and mortality trends.
• Incorporate sensitivity analyses to validate findings across different variant classification methods and exclusion criteria.

References

• CDC COVID Data Tracker - SARS-CoV-2 Variant Proportions Laboratory Surveillance