Objectives
To describe breakthrough COVID-19 in patients who needed hospitalization and the factors associated with poor outcomes.
Methods
A retrospective study on complete (diagnosed two weeks after the second dose of the Pfizer/Moderna/AstraZeneca or first dose of the Janssen vaccine was administered) or partial vaccine scheme (CV or PV) patients hospitalized for COVID-19 between December 27, 2020, and October 17, 2021, was conducted. The main outcomes were all-cause mortality and the need for invasive mechanical ventilation (IMV). The baseline factors associated with the outcomes were analyzed by multiple logistic regression, estimating the odds ratios (OR; 95% CI).
Results
One hundred and forty-five patients (101 CV) were included. The CV subgroup was mainly composed of elderly males with high comorbidity (Charlson index ≥3, 72%; immunosuppression, 20%), with bilateral pneumonia in 63.4%; limited therapeutic effort (LTE) was agreed upon for 28% of the patients. In the CV subgroup, endotracheal intubation was required in 10.9%, reaching 15.3% when excluding LTE patients; the global mortality was 22.8% and 41.4% in the subgroup with LTE. Although the PV patients were younger and had fewer comorbidities, the main outcomes did not differ significantly between the CV and PV groups. The predictors of poor outcomes were age ≥ 65 years, confusion, ferritin > 500 mg/L, extensive lung infiltrates, and a Charlson index ≥ 3.
Conclusions
Fully vaccinated patients hospitalized due to breakthrough COVID-19 tend to be elderly, with comorbidities, and have high mortality.
Exploring differences in clinical outcomes based on race and origin among patients hospitalized for COVID-19 is a controversial issue. The ALC COVID-19 Registry includes all confirmed COVID-19 patients admitted to hospital from 3 March 2020 to 17 December 2020. The data were obtained from electronic health records in order to evaluate the differences in the clinical features and outcomes among European and Latin American patients. The follow-ups occurred after 156 days. A propensity score weighting (PSW) logistic regression model was used to estimate the odds ratio (OR, 95% CI) for Latin American origin and outcome associations. Of the 696 patients included, 46.7% were women, with a median age of 65 (IQR 53–67) years, 614 (88.2%) were European, and 82 (11.8%) were Latin American. Latin American patients were younger, with fewer comorbidities, and a higher incidence of extensive pneumonia. After adjusting for residual confounders, Latin American origin was not associated with an increased risk of death (PSW OR 0.85 (0.23–3.14)) or with the need for invasive mechanical ventilation (PSW OR 0.35 (0.12–1.03)). Latin American origin was associated with a shorter hospital stay, but without differences in how long the patient remained on mechanical ventilation. In a public healthcare system, the rates of death or mechanical ventilation in severe COVID-19 cases were found to be comparable between patients of European and Latin American origins.
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