Claudia Stella, Cecilia Berardi, Annalisa Chiarito, Veronica Gennenzi, Stefania Postorino, Donatella Settanni, Melania Cesarano, Rikardo Xhemalaj, Eloisa Sofia Tanzarella, Salvatore Lucio Cutuli, Domenico Luca Grieco, Giorgio Conti, Massimo Antonelli, Gennaro De Pascale
{"title":"意大利COVID-19 ICU中心收治的接种疫苗患者的临床特征和28天死亡率预测因子","authors":"Claudia Stella, Cecilia Berardi, Annalisa Chiarito, Veronica Gennenzi, Stefania Postorino, Donatella Settanni, Melania Cesarano, Rikardo Xhemalaj, Eloisa Sofia Tanzarella, Salvatore Lucio Cutuli, Domenico Luca Grieco, Giorgio Conti, Massimo Antonelli, Gennaro De Pascale","doi":"10.1186/s44158-023-00130-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>COVID-19 vaccination has been proved to be effective in preventing hospitalization and illness progression, even though data on mortality of vaccinated patients in the intensive care unit (ICU) are conflicting. The aim of this study was to investigate the characteristics of vaccinated patients admitted to ICU according to their immunization cycle and to outline the risk factors for 28-day mortality. This observational study included adult patients admitted to ICU for acute respiratory failure (ARF) due to SARS-CoV-2 and who had received at least one dose of vaccine.</p><p><strong>Results: </strong>Fully vaccination was defined as a complete primary cycle from < 120 days or a booster dose from > 14 days. All the other patients were named partially vaccinated. One-hundred sixty patients (91 fully and 69 partially vaccinated) resulted eligible, showing a 28-day mortality rate of 51.9%. Compared to partially vaccinated, fully vaccinated were younger (69 [60-77.5] vs. 74 [66-79] years, p 0.029), more frequently immunocompromised (39.56% vs. 14.39%, p 0.003), and affected by at least one comorbidity (90.11% vs 78.26%, p 0.045), mainly chronic kidney disease (CKD) (36.26% vs 20.29%, p 0.035). At multivariable analysis, independent predictors of 28-day mortality were as follows: older age [OR 1.05 (CI 95% 1.01-1.08), p 0.005], history of chronic obstructive pulmonary disease (COPD) [OR 3.05 (CI 95% 1.28-7.30), p 0.012], immunosuppression [OR 3.70 (CI 95% 1.63-8.40), p 0.002], and admission respiratory and hemodynamic status [PaO<sub>2</sub>/FiO<sub>2</sub> and septic shock: OR 0.99 (CI 95% 0.98-0.99), p 0.009 and 2.74 (CI 95% 1.16-6.48), p 0.022, respectively].</p><p><strong>Conclusions: </strong>Despite a full vaccination cycle, severe COVID-19 may occur in patients with relevant comorbidities, especially immunosuppression and CKD. Regardless the immunization status, predisposing conditions (i.e., older age, COPD, and immunosuppression) and a severe clinical presentation were predictors of 28-day mortality.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"3 1","pages":"47"},"PeriodicalIF":0.0000,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10644635/pdf/","citationCount":"0","resultStr":"{\"title\":\"Clinical features and 28-day mortality predictors of vaccinated patients admitted to a COVID-19 ICU hub in Italy.\",\"authors\":\"Claudia Stella, Cecilia Berardi, Annalisa Chiarito, Veronica Gennenzi, Stefania Postorino, Donatella Settanni, Melania Cesarano, Rikardo Xhemalaj, Eloisa Sofia Tanzarella, Salvatore Lucio Cutuli, Domenico Luca Grieco, Giorgio Conti, Massimo Antonelli, Gennaro De Pascale\",\"doi\":\"10.1186/s44158-023-00130-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>COVID-19 vaccination has been proved to be effective in preventing hospitalization and illness progression, even though data on mortality of vaccinated patients in the intensive care unit (ICU) are conflicting. The aim of this study was to investigate the characteristics of vaccinated patients admitted to ICU according to their immunization cycle and to outline the risk factors for 28-day mortality. This observational study included adult patients admitted to ICU for acute respiratory failure (ARF) due to SARS-CoV-2 and who had received at least one dose of vaccine.</p><p><strong>Results: </strong>Fully vaccination was defined as a complete primary cycle from < 120 days or a booster dose from > 14 days. All the other patients were named partially vaccinated. One-hundred sixty patients (91 fully and 69 partially vaccinated) resulted eligible, showing a 28-day mortality rate of 51.9%. Compared to partially vaccinated, fully vaccinated were younger (69 [60-77.5] vs. 74 [66-79] years, p 0.029), more frequently immunocompromised (39.56% vs. 14.39%, p 0.003), and affected by at least one comorbidity (90.11% vs 78.26%, p 0.045), mainly chronic kidney disease (CKD) (36.26% vs 20.29%, p 0.035). At multivariable analysis, independent predictors of 28-day mortality were as follows: older age [OR 1.05 (CI 95% 1.01-1.08), p 0.005], history of chronic obstructive pulmonary disease (COPD) [OR 3.05 (CI 95% 1.28-7.30), p 0.012], immunosuppression [OR 3.70 (CI 95% 1.63-8.40), p 0.002], and admission respiratory and hemodynamic status [PaO<sub>2</sub>/FiO<sub>2</sub> and septic shock: OR 0.99 (CI 95% 0.98-0.99), p 0.009 and 2.74 (CI 95% 1.16-6.48), p 0.022, respectively].</p><p><strong>Conclusions: </strong>Despite a full vaccination cycle, severe COVID-19 may occur in patients with relevant comorbidities, especially immunosuppression and CKD. Regardless the immunization status, predisposing conditions (i.e., older age, COPD, and immunosuppression) and a severe clinical presentation were predictors of 28-day mortality.</p>\",\"PeriodicalId\":73597,\"journal\":{\"name\":\"Journal of Anesthesia, Analgesia and Critical Care (Online)\",\"volume\":\"3 1\",\"pages\":\"47\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-11-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10644635/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Anesthesia, Analgesia and Critical Care (Online)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1186/s44158-023-00130-6\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Anesthesia, Analgesia and Critical Care (Online)","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1186/s44158-023-00130-6","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景:COVID-19疫苗接种已被证明在预防住院和疾病进展方面有效，尽管关于重症监护病房(ICU)接种疫苗的患者死亡率的数据相互矛盾。本研究的目的是根据免疫接种周期调查ICU住院接种疫苗患者的特征，并概述28天死亡率的危险因素。这项观察性研究纳入了因SARS-CoV-2引起的急性呼吸衰竭(ARF)而入住ICU的成年患者，这些患者至少接受了一剂疫苗。结果:完全疫苗接种定义为从14天开始的完整初级周期。所有其他病人都被命名为部分接种疫苗。160名患者(91名完全接种疫苗，69名部分接种疫苗)符合条件，28天死亡率为51.9%。与部分接种疫苗相比，完全接种疫苗的患者更年轻(69[60-77.5]对74[66-79]岁，p 0.029)，更常见的免疫功能低下(39.56%对14.39%，p 0.003)，并且至少有一种合病(90.11%对78.26%，p 0.045)，主要是慢性肾脏疾病(CKD)(36.26%对20.29%，p 0.035)。在多变量分析中，28天死亡率的独立预测因素如下:年龄较大[OR 1.05 (CI 95% 1.01-1.08)， p 0.005]，慢性阻塞性肺疾病(COPD)病史[OR 3.05 (CI 95% 1.28-7.30)， p 0.012]，免疫抑制[OR 3.70 (CI 95% 1.63-8.40)， p 0.002]，入院呼吸和血流动力学状态[PaO2/FiO2和感染性休克:OR 0.99 (CI 95% 0.98-0.99)， p 0.009和2.74 (CI 95% 1.16-6.48)， p 0.022]。结论:尽管有完整的疫苗接种周期，但严重的COVID-19可能发生在相关合并症患者中，特别是免疫抑制和CKD。无论免疫状态如何，易感条件(即年龄较大、COPD和免疫抑制)和严重的临床表现是28天死亡率的预测因素。
Clinical features and 28-day mortality predictors of vaccinated patients admitted to a COVID-19 ICU hub in Italy.
Background: COVID-19 vaccination has been proved to be effective in preventing hospitalization and illness progression, even though data on mortality of vaccinated patients in the intensive care unit (ICU) are conflicting. The aim of this study was to investigate the characteristics of vaccinated patients admitted to ICU according to their immunization cycle and to outline the risk factors for 28-day mortality. This observational study included adult patients admitted to ICU for acute respiratory failure (ARF) due to SARS-CoV-2 and who had received at least one dose of vaccine.
Results: Fully vaccination was defined as a complete primary cycle from < 120 days or a booster dose from > 14 days. All the other patients were named partially vaccinated. One-hundred sixty patients (91 fully and 69 partially vaccinated) resulted eligible, showing a 28-day mortality rate of 51.9%. Compared to partially vaccinated, fully vaccinated were younger (69 [60-77.5] vs. 74 [66-79] years, p 0.029), more frequently immunocompromised (39.56% vs. 14.39%, p 0.003), and affected by at least one comorbidity (90.11% vs 78.26%, p 0.045), mainly chronic kidney disease (CKD) (36.26% vs 20.29%, p 0.035). At multivariable analysis, independent predictors of 28-day mortality were as follows: older age [OR 1.05 (CI 95% 1.01-1.08), p 0.005], history of chronic obstructive pulmonary disease (COPD) [OR 3.05 (CI 95% 1.28-7.30), p 0.012], immunosuppression [OR 3.70 (CI 95% 1.63-8.40), p 0.002], and admission respiratory and hemodynamic status [PaO2/FiO2 and septic shock: OR 0.99 (CI 95% 0.98-0.99), p 0.009 and 2.74 (CI 95% 1.16-6.48), p 0.022, respectively].
Conclusions: Despite a full vaccination cycle, severe COVID-19 may occur in patients with relevant comorbidities, especially immunosuppression and CKD. Regardless the immunization status, predisposing conditions (i.e., older age, COPD, and immunosuppression) and a severe clinical presentation were predictors of 28-day mortality.
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