接种过疫苗的患者中严重的 SARS-CoV-2 肺炎：一项多中心队列研究。
Severe SARS-Cov2 pneumonia in vaccinated patients: a multicenter cohort study.
机构信息
Département de Médecine Interne et Immunologie Cinique, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France.
Sorbonne Université, Paris, France.
出版信息
Sci Rep. 2023 Feb 2;13(1):1902. doi: 10.1038/s41598-023-29131-9.
Vaccination reduces risk of infection, hospitalization, and death due to SARS-Cov2. Vaccinated patients may however experience severe SARS-Cov2 disease. The objective was to describe clinical features of vaccinated patients requiring intensive care unit (ICU) admission due to SARS-Cov2 infection and compare them to a published cohort of unvaccinated patients. We performed a multicenter cohort study of patients with severe SARS-Cov2 disease admitted to 15 ICUs in France between January and September 2021. 100 consecutive vaccinated patients (68 (68%) men, median age 64 [57-71]) were included. Immunosuppression was reported in 38 (38%) patients. Among available serologies at ICU admission, 64% exhibited an optimal antibody level. Median SOFA score at ICU admission was 4 [4-6.3] and median PaO2/FiO2 ratio was 84 [69-128] mmHg. A total of 79 (79%) and 18 (18%) patients received high flow nasal oxygen and non-invasive mechanical ventilation, respectively. Invasive mechanical ventilation (IMV) was initiated in 48 (48%) with a median duration of 11 [5-19] days. During a median ICU length-of-stay of 8 [4-20] days, 31 (31%) patients died. Age (OR per 5-years increment 1.38 CI95% [1.02-1.85], p = 0.035), and SOFA at ICU admission (OR 1.40 CI95% [1.14-1.72] per point, p = 0.002) were independently associated with mortality. When compared to a cohort of 1316 unvaccinated patients (72% men, median age 63 [53-71]), vaccinated patients exhibited less frequently diabetes (16 [16%] vs. 351 [27%], p = 0.029) but were more frequently immunosuppressed (38 [38%] vs. 109 (8.3%), p < 0.0001), had more frequently chronic kidney disease (24 [24%] vs. 89 (6.8%), p < 0.0001), chronic heart failure (16 [16%] vs. 58 [4.4%], p < 0.0001), and chronic liver disease (3 [3%] vs. 8 [0.6%], p = 0.037) compared to unvaccinated patients. Despite similar severity, vaccinated patients required less frequently IMV at ICU day 1 and during ICU stay (23 [23%] vs. 785 [59.7%], p < 0.0001, and 48 [48%] vs. 930 [70.7%], p < 0.0001, respectively). There was no difference concerning ICU mortality (31 [31%] vs. 379 [28.8%], p = 0.64). Severe SARS-Cov2 infection after vaccination occurs mainly in patients with immunosuppression, chronic kidney, heart or liver failure. Age and disease severity are independently associated with mortality.
疫苗接种可降低因 SARS-CoV2 感染而住院和死亡的风险。然而，接种疫苗的患者可能会经历严重的 SARS-CoV2 疾病。本研究旨在描述因 SARS-CoV2 感染而需要入住重症监护病房（ICU）的接种患者的临床特征，并将其与未接种患者的已发表队列进行比较。我们对 2021 年 1 月至 9 月期间在法国 15 家 ICU 收治的严重 SARS-CoV2 疾病患者进行了一项多中心队列研究。纳入了 100 例连续的接种患者（68 例[68%]为男性，中位年龄 64[57-71]岁）。38 例（38%）患者有免疫抑制史。在 ICU 入院时可获得的血清学检测中，64%的患者抗体水平最佳。入 ICU 时 SOFA 评分中位数为 4[4-6.3]，PaO2/FiO2 比值中位数为 84[69-128]mmHg。79 例（79%）和 18 例（18%）患者分别接受高流量鼻氧疗和无创机械通气。48 例（48%）患者开始有创机械通气（IMV），中位持续时间为 11[5-19]天。在中位 ICU 住院时间为 8[4-20]天期间，31 例（31%）患者死亡。年龄（每增加 5 岁，OR[95%CI]为 1.38[1.02-1.85]，p=0.035）和 ICU 入院时的 SOFA（每增加 1 分，OR[95%CI]为 1.40[1.14-1.72]，p=0.002）与死亡率独立相关。与 1316 例未接种患者（72%为男性，中位年龄 63[53-71]岁）相比，接种患者糖尿病（16[16%] vs. 351[27%]，p=0.029）和慢性肾脏疾病（24[24%] vs. 89[6.8%]，p<0.0001）的发病率较低，但免疫抑制（38[38%] vs. 109[8.3%]，p<0.0001）、慢性心力衰竭（16[16%] vs. 58[4.4%]，p<0.0001）和慢性肝脏疾病（3[3%] vs. 8[0.6%]，p=0.037）的发病率较高。尽管严重程度相似，但接种患者在 ICU 第 1 天和 ICU 住院期间需要较少的 IMV（23[23%] vs. 785[59.7%]，p<0.0001和 48[48%] vs. 930[70.7%]，p<0.0001）。两组 ICU 死亡率无差异（31[31%] vs. 379[28.8%]，p=0.64）。接种后严重 SARS-CoV2 感染主要发生在免疫抑制、慢性肾脏、心脏或肝脏衰竭的患者中。年龄和疾病严重程度与死亡率独立相关。
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