COVID-19 Vaccination Status Among Adults Admitted to Intensive Care Units in Veneto, Italy

Lorenzoni, Giulia; Rosi, Paolo; Rosa, Silvia De; Ranieri, V. Marco; Navalesi, Paolo; Gregori, Darío; Baratto, Fabio; Fullin, Giorgio; Poole, Daniele; Peta, Mario; Toffoletto, Fabio

doi:10.1001/jamanetworkopen.2022.13553

Cited by 16 publications

(28 citation statements)

References 8 publications

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“…Our analyses, similar to previously published data, [19][20][21] show that the risk of ICU admission for COVID-19 pneumonia in vaccinated individuals was 15% of the risk of unvaccinated individuals, meaning that being unvaccinated resulted in almost 7-times higher risk of being admitted to an ICU.…”

Section: Discussionsupporting

confidence: 89%

“…6,[21][22][23][24][26][27][28][29][30] Even 4 months after vaccine administration, vaccinated individuals still had a 4.5-times lower risk of ICU admission compared with unvaccinated individuals. Furthermore, mRNA vaccines maintained a greater and more prolonged effectiveness in preventing ICU admission compared with AdV.During the vaccination campaign, Lombardy experienced 2 pandemic waves.…”

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confidence: 99%

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

et al. 2022

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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 &lt; .001), whereas IRR of individuals who received an adenoviral vector vaccine after 120 days was 0.21 (95% CI, 0.19-0.24; P &lt; .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 &lt; .001), primarily male individuals (110 patients [79.1%] vs 252 patients [60.9%]; P &lt; .001), with more comorbidities (median [IQR]: 2 [1-3] vs 0 [0-1] comorbidities; P &lt; .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.

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Section: Discussionsupporting

confidence: 89%

mentioning

confidence: 99%

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

et al. 2022

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“…A recent cohort study conducted in a northern region of Italy reported a 18% rate of vaccinated patients admitted to the ICU, with a median time from vaccination to ICU admission of 5 to 6 months ( 14 ). Another multicenter observational study, conducted in Spain from January to September 2021, reported that only 7% of patients admitted to the ICU for severe COVID-19 was vaccinated ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

“…These findings are different by our results. Firstly, the study by Lorenzoni et al ( 14 ) was conducted from May to December 2021, when only the 57.5% of the total population in Italy received at least one dose of anti-SARS-CoV-2 vaccine ( 28 ). Similarly, the Spanish study was conducted in the same period and the 69% of Spanish inhabitants were vaccinated ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, the effect of the first cycle with anti-SARS-CoV-2 vaccine wanes over a period of months, deeming necessary a “booster” dose ( 8 , 11 , 12 ), particularly in immunosuppressed patients ( 13 ). Indeed, a cohort study conducted in a northern region of Italy has reported that 18% of patients admitted in the ICU received the complete first vaccination cycle since a median time of 5 to 6 months, while 8% were partially vaccinated and waiting for the second dose ( 14 ). However, in patients with advanced age or comorbidities, critical COVID-19 has been reported despite recent vaccination ( 15 , 16 ).…”

Section: Introductionmentioning

confidence: 99%

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Characteristics of unvaccinated and vaccinated critically ill COVID-19 patients in calabria region (Italy): A retrospective study

Bruni

Longhini²,

Macheda³

et al. 2022

Front. Med.

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IntroductionAfter the rapid surge of a novel coronavirus (SARS-CoV-2) in 2020 anti-SARS-CoV-2 vaccines have been developed to prevent the development of critical forms of COVID-19 leading to Intensive Care Unit (ICU) admission. The possibility of ICU admission after the first-cycle vaccination has been already reported; however, no data have been published regarding vaccinated patients with a “booster” dose. This retrospective study describes the characteristics of critically ill patients after the implementation of the regional “booster” dose vaccination program in a southern region of Italy.Materials and methodsWe screened all medical records of critically ill COVID-19 patients in the period between January to April 2022. We collected the demographic characteristics, the presence of comorbidities, the vaccination status, the clinical course (arterial blood gases and type of respiratory support) and outcomes (rate of tracheostomy, ICU length of stay and mortality).ResultsA total of 272 patients were admitted to ICUs during the study period. 161 patients were unvaccinated, whereas 111 were vaccinated with the complete first-cycle or “booster” dose. The type of respiratory support was similar between groups. Vaccinated patients were characterized by a better oxygenation throughout the whole ICU length of stay. Fourteen unvaccinated and 3 vaccinated patients required tracheostomy (p = 0.045). ICU length of stay was 12.2 (± 7.3) days in unvaccinated patients and 10.4 (± 6.7) days in vaccinated patients (p = 0.036). ICU mortalities were 38.5 and 24.3% in unvaccinated and vaccinated patients, respectively (p = 0.014).ConclusionVaccinated patients have better clinical course and outcomes as compared to the unvaccinated population.

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Effectiveness of different vaccine platforms in reducing mortality and length of ICU stay in severe and critical cases of COVID‐19 in the Omicron variant era: A national cohort study in Iran

Jamaati

Karimi

Ghorbani

et al. 2023

Journal of Medical Virology

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Various severe acute respiratory syndrome coronavirus 2 vaccines with different platforms have been administered worldwide; however, their effectiveness in critical cases of COVID‐19 has remained a concern. In this national cohort study, 24 016 intensive care unit (ICU) coronavirus disease‐2019 (COVID‐19) admissions were included from January to April 2022. The mortality and length of ICU stay were compared between the vaccinated and unvaccinated patients. A total of 9428 (39.25%) patients were unvaccinated, and 14 588 (60.75%) patients had received at least one dose of the vaccine. Compared with the unvaccinated, the first, second, and third doses of vaccine resulted in 8%, 20%, and 33% lower risk of ICU mortality in the adjusted model, with risk ratio (RR): 0.92, 95% confidence interval (CI): 0.84–1.001, RR: 0.80, 95% CI: 0.77–0.83, and RR: 0.67, 95% CI: 0.64–0.71, respectively. The mean survival time was significantly shorter in the unvaccinated versus the fully vaccinated patients (hazard ratio [HR]: 0.84, 95% CI: 0.80–0.88); p < 0.001). All vaccine platforms successfully decreased the hazard of ICU death compared with the unvaccinated group. The duration of ICU stay was significantly shorter in the fully vaccinated than in unvaccinated group (MD, −0.62, 95% CI: −0.82 to −0.42; p < 0.001). Since COVID‐19 vaccination in all doses and platforms has been able to reduce the risk of mortality and length of ICU‐stay, universal vaccination is recommended based on vaccine availability.

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COVID-19 Vaccination Status Among Adults Admitted to Intensive Care Units in Veneto, Italy

Abstract: This cohort study examines admissions to intensive care units for COVID-19–associated acute respiratory distress syndrome by COVID-19 vaccination status among adults in the Veneto region of Italy from May to December 2021.

Cited by 16 publications

References 8 publications

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

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

Characteristics of unvaccinated and vaccinated critically ill COVID-19 patients in calabria region (Italy): A retrospective study

Effectiveness of different vaccine platforms in reducing mortality and length of ICU stay in severe and critical cases of COVID‐19 in the Omicron variant era: A national cohort study in Iran

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