Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
J Korean Med Sci. 2022 Aug 15;37(32):e252. doi: 10.3346/jkms.2022.37.e252.
The clinical features of coronavirus disease 2019 (COVID-19) patients in the COVID-19 vaccination era need to be clarified because breakthrough infection after vaccination is not uncommon.
We retrospectively analyzed hospitalized COVID-19 patients during a delta variant-dominant period 6 months after the national COVID-19 vaccination rollout. The clinical characteristics and risk factors for severe progression were assessed and subclassified according to vaccination status.
A total of 438 COVID-19 patients were included; the numbers of patients in the unvaccinated, partially vaccinated and fully vaccinated groups were 188 (42.9%), 117 (26.7%) and 133 (30.4%), respectively. The vaccinated group was older, less symptomatic and had a higher Charlson comorbidity index at presentation. The proportions of patients who experienced severe progression in the unvaccinated and fully vaccinated groups were 20.3% (31/153) and 10.8% (13/120), respectively. Older age, diabetes mellitus, solid cancer, elevated levels of lactate dehydrogenase and chest X-ray abnormalities were associated with severe progression, and the vaccination at least once was the only protective factor for severe progression. Chest X-ray abnormalities at presentation were the only predictor for severe progression among fully vaccinated patients.
In the hospitalized setting, vaccinated and unvaccinated COVID-19 patients showed different clinical features and risk of oxygen demand despite a relatively high proportion of patients in the two groups. Vaccination needs to be assessed as an initial checkpoint, and chest X-ray may be helpful for predicting severe progression in vaccinated patients.
由于接种疫苗后突破性感染并不少见，因此需要明确 2019 年冠状病毒病（COVID-19）患者在 COVID-19 疫苗接种时代的临床特征。
我们回顾性分析了 COVID-19 疫苗接种后 6 个月期间，德尔塔变异株流行期间住院的 COVID-19 患者。根据接种状况评估了临床特征和严重进展的危险因素，并进行了分类。
共纳入 438 例 COVID-19 患者；未接种、部分接种和完全接种组患者分别为 188（42.9%）、117（26.7%）和 133（30.4%）。接种组年龄较大，症状较轻，入院时 Charlson 合并症指数较高。未接种和完全接种组患者发生严重进展的比例分别为 20.3%（31/153）和 10.8%（13/120）。年龄较大、糖尿病、实体瘤、乳酸脱氢酶水平升高和胸部 X 线异常与严重进展相关，至少接种一次是严重进展的唯一保护因素。接种组患者入院时的胸部 X 线异常是严重进展的唯一预测因素。
在住院环境中，尽管两组患者中都有相当高比例的患者，但接种疫苗和未接种疫苗的 COVID-19 患者表现出不同的临床特征和氧气需求风险。需要将疫苗接种评估作为初始检查点，胸部 X 线可能有助于预测接种患者的严重进展。
