d'Arminio Monforte Antonella, Tavelli Alessandro, De Benedittis Sara, Bai Francesca, Tincati Camilla, Gazzola Lidia, Viganò Ottavia, Allegrini Marina, Mondatore Debora, Tesoro Daniele, Barbanotti Diletta, Mulé Giovanni, Castoldi Roberto, De Bona Anna, Bini Teresa, Chiumello Davide, Centanni Stefano, Passarella Sabrina, Orfeo Nicola, Marchetti Giulia, Cozzi-Lepri Alessandro
Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy.
Intensive Care Unit ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy.
Vaccines (Basel). 2022 Apr 1;10(4):550. doi: 10.3390/vaccines10040550.
Whether vaccination confers a protective effect against progression after hospital admission for COVID-19 remains to be elucidated. Observational study including all the patients admitted to San Paolo Hospital in Milan for COVID-19 in 2021. Previous vaccination was categorized as: none, one dose, full vaccination (two or three doses >14 days before symptoms onset). Data were collected at hospital admission, including demographic and clinical variables, age-unadjusted Charlson Comorbidity index (CCI). The highest intensity of ventilation during hospitalization was registered. The endpoints were in-hospital death (primary) and mechanical ventilation/death (secondary). Survival analysis was conducted by means of Kaplan-Meier curves and Cox regression models. Effect measure modification by age was formally tested. We included 956 patients: 151 (16%) fully vaccinated (18 also third dose), 62 (7%) one dose vaccinated, 743 (78%) unvaccinated. People fully vaccinated were older and suffering from more comorbidities than unvaccinated. By 28 days, the risk of death was of 35.9% (95%CI: 30.1−41.7) in unvaccinated, 41.5% (24.5−58.5) in one dose and 28.4% (18.2−38.5) in fully vaccinated (p = 0.63). After controlling for age, ethnicity, CCI and month of admission, fully vaccinated participants showed a risk reduction of 50% for both in-hospital death, AHR 0.50 (95%CI: 0.30−0.84) and for mechanical ventilation or death, AHR 0.49 (95%CI: 0.35−0.69) compared to unvaccinated, regardless of age (interaction p > 0.56). Fully vaccinated individuals in whom vaccine failed to keep them out of hospital, appeared to be protected against critical disease or death when compared to non-vaccinated. These data support universal COVID-19 vaccination.
接种疫苗是否能对新冠病毒感染住院后的病情进展起到保护作用仍有待阐明。本观察性研究纳入了2021年在米兰圣保禄医院因新冠病毒感染住院的所有患者。既往接种情况分为：未接种、接种一剂、全程接种（症状出现前14天以上接种两剂或三剂）。在入院时收集数据，包括人口统计学和临床变量、未校正年龄的查尔森合并症指数（CCI）。记录住院期间最高通气强度。观察终点为院内死亡（主要终点）和机械通气/死亡（次要终点）。采用Kaplan-Meier曲线和Cox回归模型进行生存分析。对年龄的效应测量修正进行了正式检验。我们纳入了956例患者：151例（16%）全程接种（其中18例接种了第三剂），62例（7%）接种了一剂，743例（78%）未接种。与未接种者相比，全程接种者年龄更大，合并症更多。到第28天时，未接种者的死亡风险为35.9%（95%置信区间：30.1−41.7），接种一剂者为41.5%（24.5−58.5），全程接种者为28.4%（18.2−38.5）（p = 0.63）。在控制年龄、种族、CCI和入院月份后，与未接种者相比，全程接种者的院内死亡风险降低了50%，风险比（AHR）为0.50（95%置信区间：0.30−0.84），机械通气或死亡风险比为0.49（95%置信区间：0.35−0.69），且不受年龄影响（交互作用p > 0.56）。与未接种者相比，那些尽管接种了疫苗仍住院的全程接种者似乎对重症疾病或死亡具有保护作用。这些数据支持普遍接种新冠疫苗。
