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Omicron-1 COVID-19 is less invasive in the general population than previous viral variants. However, clinical course and outcome of hospitalised patients with SARS-CoV-2 pneumonia during the shift of the predominance from Delta to Omicron variants are not fully explored. During January 2022 consecutively hospitalised patients with SARS-CoV-2 pneumonia were analysed. SARS-CoV-2 variants were identified by a 2-step pre-screening protocol and randomly confirmed by whole genome sequencing analysis. Clinical, laboratory and treatment data split by type of variant were analysed along with logistic regression of factors associated to mortality. 150 patients [mean age (SD) 67.2(15.8) years, male 54%] were analysed. Compared to Delta ( n  = 46), Omicron-1 patients ( n  = 104) were older [mean age (SD): 69.5(15.4) vs 61.9(15.8) years,  p  = 0.007], with more comorbidities (89.4% vs 65.2%,  p  = 0.001), less obesity (BMI &gt;30Kg/m 2  in 24% vs 43.5%,  p  = 0.034) but higher vaccination rates for COVID-19 (52.9% vs 8.7%,  p  &lt; 0.001). Severe pneumonia (48.7%), pulmonary embolism (4.7%), need for invasive mechanical ventilation (8%), administration of dexamethasone (76%) and 60-day mortality (22.6%) did not significantly differ. Severe SARS-CoV-2 pneumonia independently predicted mortality [OR 8.297 (CI95% 2.080–33.095),  p  = 0.003]. Remdesivir administration ( n  = 135) was protective from death both in unadjusted and adjusted models [OR 0.157 (CI95% 0.026-0.945),  p  = 0.043. In a COVID-19 department the severity of pneumonia that did not differ between Omicron-1 and Delta variants predicted mortality whilst remdesivir remained protective in all analyses. Death rates did not differ between SARS-CoV-2 variants. Vigilance and consistency with prevention and treatment guidelines for COVID-19 is mandatory regardless of the predominant SARS-CoV-2 variant

Real life treatment experience and outcome of consecutively hospitalised patients with SARS-CoV-2 pneumonia by Omicron-1 vs Delta variants