Τίτλος:
Association between Vaccination Status and Mortality among Intubated Patients with COVID-19-Related Acute Respiratory Distress Syndrome
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Importance: Although vaccination substantially reduces the risk of severe COVID-19, it is yet unknown whether vaccinated patients who develop COVID-19 and require invasive mechanical ventilation have lower mortality than controls. Objective: To examine the association between COVID-19 vaccination status and mortality among critically ill patients who require invasive mechanical ventilation owing to acute respiratory distress syndrome (ARDS) related to COVID-19. Design, Setting, and Participants: This multicenter cohort study was performed between June 7, 2021, and February 1, 2022, among 265 consecutive adult patients with COVID-19 in academic intensive care units who underwent invasive mechanical ventilation owing to ARDS. Exposures: Patients in the full vaccination group had completed the primary COVID-19 vaccination series more than 14 days but less than 5 months prior to intubation. This time threshold was chosen because guidelines from the US Centers for Disease Control and Prevention recommend a booster dose beyond that time. The remaining patients (ie, those who were unvaccinated, partially vaccinated, or fully vaccinated <14 days or >5 months before intubation) comprised the control group. Main Outcomes and Measures: The primary outcome was time from intubation to all-cause intensive care unit mortality. A Cox proportional hazards regression model including vaccination status, age, comorbid conditions, and baseline Sequential Organ Failure Assessment score on the day of intubation was used. Results: A total of 265 intubated patients (170 men [64.2%]; median age, 66.0 years [IQR, 58.0-76.0 years]; 26 [9.8%] in the full vaccination group) were included in the study. A total of 20 patients (76.9%) in the full vaccination group received the BNT162b2 vaccine, and the remaining 6 (23.1%) received the ChAdOx1 nCoV-19 vaccine. Patients in the full vaccination group were older (median age, 72.5 years [IQR, 62.8-80.0 years] vs 66.0 years [IQR, 57.0-75.0 years]) and more likely to have comorbid conditions (24 of 26 [92.3%] vs 160 of 239 [66.9%]), including malignant neoplasm (6 of 26 [23.1%] vs 18 of 239 [7.5%]), than those in the control group. Full vaccination status was significantly associated with lower mortality compared with controls (16 of 26 patients [61.5%] died in the full vaccination group vs 163 of 239 [68.2%] in the control group; hazard ratio, 0.55 [95% CI, 0.32-0.94]; P =.03). Conclusions and Relevance: In this cohort study, full vaccination status was associated with lower mortality compared with controls, which suggests that vaccination might be beneficial even among patients who were intubated owing to COVID-19-related ARDS. These results may inform discussions with families about prognosis.. © 2023 Wolters Kluwer Medknow Publications. All rights reserved.
Συγγραφείς:
Siempos, I.I.
Grapsa, E.
Adamos, G.
Andrianopoulos, I.
Tsolaki, V.
Giannakoulis, V.G.
Karavidas, N.
Giannopoulou, V.
Sarri, K.
Mizi, E.
Gavrielatou, E.
Papathanakos, G.
Mantzarlis, K.D.
Mastora, Z.
Magira, E.
Koulouras, V.
Kotanidou, A.
Siempos, I.I.
Περιοδικό:
JAMA NETWORK OPEN
Εκδότης:
American Medical Association
Λέξεις-κλειδιά:
tozinameran; vaxzevria, adult; adult respiratory distress syndrome; age; aged; Article; cohort analysis; controlled study; coronavirus disease 2019; critically ill patient; disease control; female; human; intensive care unit; invasive ventilation; major clinical study; male; mortality; multicenter study; observational study; outcome assessment; practice guideline; prospective study; retrospective study; Sequential Organ Failure Assessment Score; vaccination; clinical trial; complication; epidemiology; respiratory distress syndrome; United States; vaccination, Adult; Aged; BNT162 Vaccine; ChAdOx1 nCoV-19; Cohort Studies; COVID-19; COVID-19 Vaccines; Humans; Male; Respiratory Distress Syndrome; SARS-CoV-2; United States; Vaccination
DOI:
10.1001/jamanetworkopen.2022.35219
