The COVID-19 pandemic has witnessed the emergence of diverse variants of SARS-CoV-2, with spike proteins playing a pivotal role in mutation due to their extracellular projection and exposure to immune system pressures. Clinical manifestations of COVID-19 have shown significant variation, ranging from severe symptoms requiring ICU admission or resulting in fatality to asymptomatic cases. This study aims to investigate genetic variations in the spike protein among two distinct groups of SARS-CoV-2 sequences: asymptomatic and ICU/deceased patients. The objective is to explore the viral genetic factors associated with these two clinical outcomes. Our analysis reveals that four spike protein mutations (P26S, D253G, K417N, and D614G) may be partially linked to the ICU/deceased outcome. Additionally, the Omicron and Delta variants exhibit the highest proportions of overall asymptomatic and ICU/deceased patients, respectively. Further evaluation of the ratio of asymptomatic cases to ICU/deceased within a singular variant demonstrates that the Beta and Gamma variants elicit the greatest proportion of asymptomatic and ICU/deceased cases, respectively. In conclusion, our findings suggest a possible association between four spike protein mutations and the outcome of ICU admission or death. The Gamma variants demonstrate greater lethality, while the Delta variants are associated with higher mortality rates.

COVID-19 大流行见证了 SARS-CoV-2 多种变体的出现，其中刺突蛋白由于其细胞外投射和暴露于免疫系统压力而在突变中发挥着关键作用。COVID-19 的临床表现表现出显着差异，从需要入住 ICU 或导致死亡的严重症状到无症状病例。本研究旨在调查两组不同的 SARS-CoV-2 序列中刺突蛋白的遗传变异：无症状患者和 ICU/已故患者。目的是探索与这两种临床结果相关的病毒遗传因素。我们的分析表明，四种刺突蛋白突变（P26S、D253G、K417N 和 D614G）可能与 ICU/死亡结果部分相关。此外，Omicron 和 Delta 变体分别在总体无症状患者和 ICU/死亡患者中所占比例最高。对单一变体中无症状病例与 ICU/死亡病例的比率的进一步评估表明，Beta 和 Gamma 变体分别引起无症状病例和 ICU/死亡病例的最大比例。总之，我们的研究结果表明四种刺突蛋白突变与 ICU 入住或死亡结果之间可能存在关联。Gamma 变体表现出更大的杀伤力，而 Delta 变体则与更高的死亡率相关。