Association of COVID-19 Vaccinations With Intensive Care Unit Admissions and Outcome of Critically Ill Patients With COVID-19 Pneumonia in Lombardy, Italy

Abstract

ImportanceData on the association of COVID-19 vaccination with intensive care unit (ICU) admission and outcomes of patients with SARS-CoV-2–related pneumonia are scarce.ObjectiveTo evaluate whether COVID-19 vaccination is associated with preventing ICU admission for COVID-19 pneumonia and to compare baseline characteristics and outcomes of vaccinated and unvaccinated patients admitted to an ICU.Design, Setting, and ParticipantsThis retrospective cohort study on regional data sets reports: (1) daily number of administered vaccines and (2) data of all consecutive patients admitted to an ICU in Lombardy, Italy, from August 1 to December 15, 2021 (Delta variant predominant). Vaccinated patients received either mRNA vaccines (BNT162b2 or mRNA-1273) or adenoviral vector vaccines (ChAdOx1-S or Ad26.COV2). Incident rate ratios (IRRs) were computed from August 1, 2021, to January 31, 2022; ICU and baseline characteristics and outcomes of vaccinated and unvaccinated patients admitted to an ICU were analyzed from August 1 to December 15, 2021.ExposuresCOVID-19 vaccination status (no vaccination, mRNA vaccine, adenoviral vector vaccine).Main Outcomes and MeasuresThe incidence IRR of ICU admission was evaluated, comparing vaccinated people with unvaccinated, adjusted for age and sex. The baseline characteristics at ICU admission of vaccinated and unvaccinated patients were investigated. The association between vaccination status at ICU admission and mortality at ICU and hospital discharge were also studied, adjusting for possible confounders.ResultsAmong the 10 107 674 inhabitants of Lombardy, Italy, at the time of this study, the median [IQR] age was 48 [28-64] years and 5 154 914 (51.0%) were female. Of the 7 863 417 individuals who were vaccinated (median [IQR] age: 53 [33-68] years; 4 010 343 [51.4%] female), 6 251 417 (79.5%) received an mRNA vaccine, 550 439 (7.0%) received an adenoviral vector vaccine, and 1 061 561 (13.5%) received a mix of vaccines and 4 497 875 (57.2%) were boosted. Compared with unvaccinated people, IRR of individuals who received an mRNA vaccine within 120 days from the last dose was 0.03 (95% CI, 0.03-0.04; P < .001), whereas IRR of individuals who received an adenoviral vector vaccine after 120 days was 0.21 (95% CI, 0.19-0.24; P < .001). There were 553 patients admitted to an ICU for COVID-19 pneumonia during the study period: 139 patients (25.1%) were vaccinated and 414 (74.9%) were unvaccinated. Compared with unvaccinated patients, vaccinated patients were older (median [IQR]: 72 [66-76] vs 60 [51-69] years; P < .001), primarily male individuals (110 patients [79.1%] vs 252 patients [60.9%]; P < .001), with more comorbidities (median [IQR]: 2 [1-3] vs 0 [0-1] comorbidities; P < .001) and had higher ratio of arterial partial pressure of oxygen (Pao2) and fraction of inspiratory oxygen (FiO2) at ICU admission (median [IQR]: 138 [100-180] vs 120 [90-158] mm Hg; P = .007). Factors associated with ICU and hospital mortality were higher age, premorbid heart disease, lower Pao2/FiO2 at ICU admission, and female sex (this factor only for ICU mortality). ICU and hospital mortality were similar between vaccinated and unvaccinated patients.Conclusions and RelevanceIn this cohort study, mRNA and adenoviral vector vaccines were associated with significantly lower risk of ICU admission for COVID-19 pneumonia. ICU and hospital mortality were not associated with vaccinated status. These findings suggest a substantial reduction of the risk of developing COVID-19–related severe acute respiratory failure requiring ICU admission among vaccinated people.

Comparing scientific abstracts generated by ChatGPT to original abstracts using an artificial intelligence output detector, plagiarism detector, and blinded human reviewers

“…“Association of COVID-19 Vaccinations With Intensive Care Unit Admissions and Outcome of Critically Ill Patients With COVID-19 Pneumonia in Lombardy, Italy” in the style of JAMA; original paper 28…”

SARS-CoV-2 breakthrough infections in vaccinated individuals requiring ventilatory support for severe acute respiratory failure

“…Although other techniques are available to deal with confounding factors, the granularity of the identified risk factors and the inclusion of the non-linear behavior of some of these factors allowed our logistic regression model to correct the observed risk of death [6]. The robustness of these methods may explain the difference in vaccination efficacy to reduce the risk of death also in ICU patients with outbreak infection observed in the present study but not reported in previous studies [3][4][5] in vaccinated than unvaccinated patients.…”

“…SARS-CoV-2 infections are expected in ~ 10% of the vaccinated population (breakthrough infection) [ 1 ]. Although early data showed that progression to critical illness was less likely among vaccinated than unvaccinated patients [ 2 ], recent data show that mortality in patients requiring admission to the intensive care unit (ICU) did not differ [ 3 ], or was higher [ 4 , 5 ] in vaccinated than unvaccinated patients.…”

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CoV-2 infections are expected in ~ 10% of the vaccinated population (breakthrough infection) [1]. Although early data showed that progression to critical illness was less likely among vaccinated than unvaccinated patients [2], recent data show that mortality in patients requiring admission to the intensive care unit (ICU) did not differ [3], or was higher [4,5] in vaccinated than unvaccinated patients.This study sets up to test the hypothesis that when age, comorbidities, and pathophysiological conditions are considered, vaccines are effective to prevent deaths in patients requiring ICU admission for breakthrough infection.This prospective multicenter observational study enrolled patients from 27 ICUs in Italy (June 1st, 2021-June 31st, 2022). Entry criteria were age ≥ 18 and respiratory failure associated to coronavirus disease 2019 (COVID-19) with a P/F < 300.

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Characteristics and outcomes of unvaccinated and vaccinated COVID-19 patients with acute respiratory failure treated with CPAP in a medical intermediate care unit

“…In an original retrospective investigation Grasselli et al reported that vaccines based on mRNA technology or adenoviral vectors significantly decreased the risk of ICU admission while, analysing data of vaccinated and unvaccinated patients admitted to ICUs in Lombardy (Italy) from August to December 2021 no significant association was detected with ICU and hospital mortality despite unvaccinated patients were younger and with fewer comorbidities [6] .…”