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

Data 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. To evaluate whether COVID-19 vaccination is associated with preventing ICU admission for COVID-19 pneumonia and to compare baseline characte...

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Published in:JAMA network open 2022-10, Vol.5 (10), p.e2238871-e2238871
Main Authors: Grasselli, Giacomo, Zanella, Alberto, Carlesso, Eleonora, Florio, Gaetano, Canakoglu, Arif, Bellani, Giacomo, Bottino, Nicola, Cabrini, Luca, Castelli, Gian Paolo, Catena, Emanuele, Cecconi, Maurizio, Cereda, Danilo, Chiumello, Davide, Forastieri, Andrea, Foti, Giuseppe, Gemma, Marco, Giudici, Riccardo, Grazioli, Lorenzo, Lombardo, Andrea, Lorini, Ferdinando Luca, Madotto, Fabiana, Mantovani, Alberto, Mistraletti, Giovanni, Mojoli, Francesco, Mongodi, Silvia, Monti, Gianpaola, Muttini, Stefano, Piva, Simone, Protti, Alessandro, Rasulo, Frank, Scandroglio, Anna Mara, Severgnini, Paolo, Storti, Enrico, Fumagalli, Roberto, Pesenti, Antonio
Format: Article
Language:English
Subjects:
Adult
BNT162 Vaccine
Cohort analysis
Cohort Studies
Coronaviruses
COVID-19 - epidemiology
COVID-19 - prevention & control
COVID-19 Vaccines
Critical Care Medicine
Critical Illness - therapy
Female
Humans
Immunization
Intensive care
Intensive Care Units
Male
Middle Aged
Mortality
mRNA Vaccines
Online Only
Original Investigation
Oxygen
Pneumonia
Pneumonia - epidemiology
Respiratory failure
Retrospective Studies
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
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Summary:Data 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. To 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. This 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. COVID-19 vaccination status (no vaccination, mRNA vaccine, adenoviral vector vaccine). The 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. Among 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 
ISSN:2574-3805
2574-3805
DOI:10.1001/jamanetworkopen.2022.38871