Risk prediction of covid-19 related death and hospital admission in adults after covid-19 vaccination: national prospective cohort study

Abstract

Objectives To derive and validate risk prediction algorithms to estimate the risk of covid-19 related mortality and hospital admission in UK adults after one or two doses of covid-19 vaccination. Design Prospective, population based cohort study using the QResearch database linked to data on covid-19 vaccination, SARS-CoV-2 results, hospital admissions, systemic anticancer treatment, radiotherapy, and the national death and cancer registries. Settings Adults aged 19-100 years with one or two doses of covid-19 vaccination between 8 December 2020 and 15 June 2021. Main outcome measures Primary outcome was covid-19 related death. Secondary outcome was covid-19 related hospital admission. Outcomes were assessed from 14 days after each vaccination dose. Models were fitted in the derivation cohort to derive risk equations using a range of predictor variables. Performance was evaluated in a separate validation cohort of general practices. Results Of 6 952 440 vaccinated patients in the derivation cohort, 5 150 310 (74.1%) had two vaccine doses. Of 2031 covid-19 deaths and 1929 covid-19 hospital admissions, 81 deaths (4.0%) and 71 admissions (3.7%) occurred 14 days or more after the second vaccine dose. The risk algorithms included age, sex, ethnic origin, deprivation, body mass index, a range of comorbidities, and SARS-CoV-2 infection rate. Incidence of covid-19 mortality increased with age and deprivation, male sex, and Indian and Pakistani ethnic origin. Cause specific hazard ratios were highest for patients with Down’s syndrome (12.7-fold increase), kidney transplantation (8.1-fold), sickle cell disease (7.7-fold), care home residency (4.1-fold), chemotherapy (4.3-fold), HIV/AIDS (3.3-fold), liver cirrhosis (3.0-fold), neurological conditions (2.6-fold), recent bone marrow transplantation or a solid organ transplantation ever (2.5-fold), dementia (2.2-fold), and Parkinson’s disease (2.2-fold). Other conditions with increased risk (ranging from 1.2-fold to 2.0-fold increases) included chronic kidney disease, blood cancer, epilepsy, chronic obstructive pulmonary disease, coronary heart disease, stroke, atrial fibrillation, heart failure, thromboembolism, peripheral vascular disease, and type 2 diabetes. A similar pattern of associations was seen for covid-19 related hospital admissions. No evidence indicated that associations differed after the second dose, although absolute risks were reduced. The risk algorithm explained 74.1% (95% confidence interval 71.1% to 77.0%) of the variation in time to covid-19 death in the validation cohort. Discrimination was high, with a D statistic of 3.46 (95% confidence interval 3.19 to 3.73) and C statistic of 92.5. Performance was similar after each vaccine dose. In the top 5% of patients with the highest predicted covid-19 mortality risk, sensitivity for identifying covid-19 deaths within 70 days was 78.7%. Conclusion This population based risk algorithm performed well showing high levels of discrimination for identifying those patients at highest risk of covid-19 related death and hospital admission after vaccination.

COVID‐19 vaccine hesitancy in renal transplant recipients

“…Renal transplant patients are known to have poor responses after vaccination. The risk of breakthrough infection exists following the vaccination, and hazard ratio for COVID‐19 mortality after vaccination was 8.1‐fold higher in renal transplant recipients compared to general population [ 2 ]. However, we are still waiting for data on COVID‐19 morbidity in vaccinated patients.…”

Covid-19: How is vaccination affecting hospital admissions and deaths?

“…In a paper published by The BMJ ,7 researchers from the University of Oxford reported on their updated QCovid tool, which identifies vaccinated people who are at greatest risk of severe covid-19 leading to hospital admission or death from 14 days after their second dose. It highlighted an elevated risk among people who are immunosuppressed as a result of chemotherapy, a recent bone marrow or solid organ transplantation, or HIV and AIDS; people with neurological disorders, including dementia and Parkinson’s; care home residents; and people with chronic disorders, including Down’s syndrome.…”

Evidence-Based Recommendations on the Use of Anti-SARS-CoV-2 Monoclonal Antibodies (Casirivimab + Imdevimab, and Sotrovimab) for Adults in Ontario

“…12,13,22,23 The largest study of casirivimab + imdevimab in outpatients (by Weinreich et al) relies heavily on risk factors to capture eligible patients; the trial's list of risk factors is very broad, and not all risk factors impact patient outcomes equally. 5 The following proposed risk framework for AmAb use in outpatients is based on current published international and Canadian data around highest risk prognostic factors for mortality as an outcome of COVID-19: [24][25][26][27][28][29][30][31][32][33] Drug Supply Very Restricted The CPG WG acknowledges the limitations of the above risk framework, given the many factors that impact baseline risk with COVID-19 (some of which likely act synergistically), the challenges of establishing the presence of important baseline risk factors (including frailty, and the chance of 1-year survival prior to SARS-CoV-2 infection), and the uncertainty over whether AmAbs have different effects in different clinical subgroups.…”