Development of a risk score to identify patients at high risk for a severe course of COVID-19

Jacob, Josephine; Tesch, Falko; Wende, Danny; Batram, Manuel; Loser, Friedrich; Weidinger, Oliver; Roessler, Martin; Seifert, Martin; Risch, Lisa; Nagel, Oliver; König, Christina; Jucknewitz, Roland; Treskova-Schwarzbach, Marina; Hertle, Dagmar; Scholz, Stefan; Stern, Stefan; Ballesteros, Pedro; Baßler, Stefan; Bertele, Barbara; Repschläger, Uwe; Richter, Nico; Riederer, Cordula; Sobik, Franziska; Schramm, Anja; Schulte, Claudia; Walker, Jochen; Schmitt, Jochen

doi:10.1007/s10389-023-01884-7

Cited by 3 publications

(1 citation statement)

References 19 publications

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“…Immune senescence and underlying comorbidities make older adults generally more susceptible to COVID-19 and associated severe outcomes. Several studies have identified older age as a primary risk factor for severe illness with COVID-19 (6,7,8), with one study demonstrating similar performance between a risk score that was based on age alone versus a validated risk score incorporating the effects of multiple underlying comorbidities (POINTED score) (9). Importantly, the WHO has identified older adults (commonly defined by age cutoffs of 50 to 60 years, depending on the country) as a high-priority group for COVID-19 vaccination (10), and many countries have prioritized vaccination of the older population (9).…”

Section: Introductionmentioning

confidence: 99%

Comparative Effectiveness of mRNA-1273 and BNT162b2 COVID-19 Vaccines Among Older Adults: Systematic Literature Review and Meta-Analysis Using the GRADE Framework

Kavikondala,

Haeussler,

Wang

et al. 2023

Preprint

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BackgroundThe mRNA vaccines mRNA-1273 and BNT162b2 demonstrated high efficacy against SARS-CoV-2 infection in phase 3 clinical trials, including among older adults. To inform COVID-19 vaccine selection, this systematic literature review (SLR) and meta-analysis assessed the comparative effectiveness of mRNA-1273 versus BNT162b2 in older adults.MethodsWe systematically searched for relevant studies reporting COVID-19 outcomes with mRNA vaccines in older adults aged ≥50 years by first cross-checking relevant published SLRs. Based on the cutoff date from a previous similar SLR, we then searched the WHO COVID-19 Research Database for relevant articles published between April 9, 2022 and June 2, 2023. Outcomes of interest were SARS-CoV-2 infection, symptomatic SARS-CoV-2 infection, severe SARS-CoV-2 infection, COVID-19‒related hospitalization, and COVID-19‒related death following ≥2 vaccine doses. Random-effects meta-analysis models were used to pool risk ratios (RRs) across studies. Heterogeneity was evaluated using chi-squared testing. Evidence certainty was assessed per GRADE framework.Results24 non-randomized real-world studies reporting clinical outcomes with mRNA vaccines in individuals aged ≥50 years were included in the meta-analysis. Vaccination with mRNA-1273 was associated with significantly lower risk of SARS-CoV-2 infection (RR 0.72 [95% confidence interval (CI) 0.64‒0.80]), symptomatic SARS-CoV-2 infection (RR 0.72 [95% CI 0.62‒0.83]), severe SARS-CoV-2 infection (RR 0.67 [95% CI 0.57‒0.78]), COVID-19‒related hospitalization (RR 0.65 [95% CI 0.53‒0.79]) and COVID-19‒related death (RR 0.80 [95% CI 0.64‒0.99]) compared with BNT162b2. There was considerable heterogeneity between studies for all outcomes (I2>75%) except death (I2=0%). Multiple subgroup and sensitivity analyses excluding specific studies generally demonstrated consistent results. Certainty of evidence across outcomes was rated as low (type 3) or very low (type 4), reflecting the lack of randomized-controlled trial data.ConclusionMeta-analysis of 24 observational studies demonstrated significantly lower risk of asymptomatic, symptomatic, and severe infections; hospitalizations; and deaths with the mRNA-1273 versus BNT162b2 vaccine in older adults aged ≥50 years.SUMMARY POINTSThe COVID-19 pandemic has disproportionately affected older adults, as this population is generally more susceptible to infection and severe outcomes due to immune senescence and underlying comorbidities.The 2 available mRNA vaccines mRNA-1273 and BNT162b2 demonstrated high efficacy against SARS-CoV-2 infection in phase 3 clinical trials, including among older adults.To inform COVID-19 vaccine selection, this systematic literature review and meta-analysis assessed the comparative effectiveness of mRNA-1273 versus BNT162b2 among older adults in real-world settings.Vaccination with homologous primary or booster mRNA-1273 was associated with significantly lower risk of infection (including asymptomatic, symptomatic, and severe infections), hospitalization, and death due to COVID-19 than vaccination with BNT162b2 in older adults aged ≥50 years.

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Section: Introductionmentioning

confidence: 99%

Comparative Effectiveness of mRNA-1273 and BNT162b2 COVID-19 Vaccines Among Older Adults: Systematic Literature Review and Meta-Analysis Using the GRADE Framework

Kavikondala,

Haeussler,

Wang

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

Comparative Effectiveness of mRNA-1273 and BNT162b2 COVID-19 Vaccines Among Older Adults: Systematic Literature Review and Meta-Analysis Using the GRADE Framework

Kavikondala,

Haeussler,

Wang

et al. 2024

Infect Dis Ther

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Introduction The mRNA vaccines mRNA-1273 and BNT162b2 demonstrated high efficacy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in phase 3 clinical trials, including among older adults. To inform coronavirus disease 2019 (COVID-19) vaccine selection, this systematic literature review (SLR) and meta-analysis assessed the comparative effectiveness of mRNA-1273 versus BNT162b2 in older adults. Methods We systematically searched for relevant studies reporting COVID-19 outcomes with mRNA vaccines in older adults aged ≥ 50 years by first cross-checking relevant published SLRs. Based on the cutoff date from a previous similar SLR, we then searched the WHO COVID-19 Research Database for relevant articles published between April 9, 2022, and June 2, 2023. Outcomes of interest were SARS-CoV-2 infection, symptomatic SARS-CoV-2 infection, severe SARS-CoV-2 infection, COVID-19–related hospitalization, and COVID-19–related death following ≥ 2 vaccine doses. Random effects meta-analysis models were used to pool risk ratios (RRs) across studies. Heterogeneity was evaluated using chi-square testing. Evidence certainty was assessed per GRADE framework. Results Twenty-four non-randomized real-world studies reporting clinical outcomes with mRNA vaccines in individuals aged ≥ 50 years were included in the meta-analysis. Vaccination with mRNA-1273 was associated with significantly lower risk of SARS-CoV-2 infection (RR 0.72 [95% confidence interval (CI) 0.64‒0.80]), symptomatic SARS-CoV-2 infection (RR 0.72 [95% CI 0.62‒0.83]), severe SARS-CoV-2 infection (RR 0.67 [95% CI 0.57‒0.78]), and COVID-19–related hospitalization (RR 0.65 [95% CI 0.53‒0.79]) but not COVID-19–related death (RR 0.80 [95% CI 0.64‒1.00]) compared with BNT162b2. There was considerable heterogeneity between studies for all outcomes ( I 2 > 75%) except death ( I 2 = 0%). Multiple subgroup and sensitivity analyses excluding specific studies generally demonstrated consistent results. Certainty of evidence across outcomes was rated as low (type 3) or very low (type 4), reflecting the lack of randomized controlled trial data. Conclusion Meta-analysis of 24 observational studies demonstrated significantly lower risk of asymptomatic, symptomatic, and severe infections and hospitalizations with the mRNA-1273 versus BNT162b2 vaccine in older adults aged ≥ 50 years. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-024-00936-z.

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Prediction models for COVID-19 disease outcomes

Tang,

Gao,

Prasai

et al. 2024

Emerging Microbes & Infections

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SARS-CoV-2 has caused over 6.9 million deaths and continues to produce lasting health consequences. COVID-19 manifests broadly from no symptoms to death. In a retrospective cross-sectional study, we developed personalized risk assessment models that predict clinical outcomes for individuals with COVID-19 and inform targeted interventions. We sequenced viruses from SARS-CoV-2-positive nasopharyngeal swab samples between July 2020 and July 2022 from 4450 individuals in Missouri and retrieved associated disease courses, clinical history, and urban-rural classification. We integrated this data to develop machine learning-based predictive models to predict hospitalization, ICU admission, and long COVID. The mean age was 38.3 years (standard deviation = 21.4) with 55.2% ( N = 2453) females and 44.8% ( N = 1994) males (not reported, N = 4). Our analyses revealed a comprehensive set of predictors for each outcome, encompassing human, environment, and virus genome-wide genetic markers. Immunosuppression, cardiovascular disease, older age, cardiac, gastrointestinal, and constitutional symptoms, rural residence, and specific amino acid substitutions were associated with hospitalization. ICU admission was associated with acute respiratory distress syndrome, ventilation, bacterial co-infection, rural residence, and non-wild type SARS-CoV-2 variants. Finally, long COVID was associated with hospital admission, ventilation, and female sex. Overall, we developed risk assessment models that offer the capability to identify patients with COVID-19 necessitating enhanced monitoring or early interventions. Of importance, we demonstrate the value of including key elements of virus, host, and environmental factors to predict patient outcomes, serving as a valuable platform in the field of personalized medicine with the potential for adaptation to other infectious diseases.

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Development of a risk score to identify patients at high risk for a severe course of COVID-19

Cited by 3 publications

References 19 publications

Comparative Effectiveness of mRNA-1273 and BNT162b2 COVID-19 Vaccines Among Older Adults: Systematic Literature Review and Meta-Analysis Using the GRADE Framework

Comparative Effectiveness of mRNA-1273 and BNT162b2 COVID-19 Vaccines Among Older Adults: Systematic Literature Review and Meta-Analysis Using the GRADE Framework

Comparative Effectiveness of mRNA-1273 and BNT162b2 COVID-19 Vaccines Among Older Adults: Systematic Literature Review and Meta-Analysis Using the GRADE Framework

Prediction models for COVID-19 disease outcomes

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