Havaldar Amarja Ashok, Selvam Sumithra
Department of Critical Care, St. John's Medical College Hospital, Bangalore, 560034, India.
Department of Biostatistics, St. John's Research Institute, Bangalore, 560034, India.
Ann Intensive Care. 2024 Feb 12;14(1):24. doi: 10.1186/s13613-024-01257-7.
Vaccination helped in reducing mortality and disease severity due to COVID-19. Some patients can develop breakthrough infections. The effect of vaccination in critically ill patients admitted with breakthrough infections is not well studied. We designed a study to estimate the effect of vaccination on ICU mortality in critically ill COVID-19 patients by using propensity score matching.
We included patients from 15th June 2020 to 31st December 2021. Inclusion criteria were unvaccinated and vaccinated COVID-19 patients requiring intensive care unit (ICU) admission. The institutional ethics committee approval was obtained (institutional ethics committee, IEC 08/2023, Clinical trial registry, India CTRI/2023/01/049142). The primary outcome was ICU mortality. The secondary outcomes were the length of ICU stay and duration of mechanical ventilation. We used multivariable logistic regression (MLR) and propensity score matching (PSM) for the statistical analysis.
Total of 667 patients (79.31%) were unvaccinated and 174 (20.68%) vaccinated. The mean age was 57.11 [standard deviation (SD) 15.13], and 70.27% were males. The ICU mortality was 56.60% [95% confidence interval (CI) 53.24-60%]. The results of MLR and PSM method showed that vaccinated patients were less likely to be associated with mortality [adjusted odds ratio (AOR), 95% CI using logistic regression: 0.52 (0.29, 0.94), and by propensity score matching: 0.83 (0.77, 0.91)].
The findings of this study support COVID-19 vaccination as an effective method for reducing case fatality not only in the general population but also in critically ill patients, and it has important public health implications.
接种疫苗有助于降低因新冠病毒病（COVID-19）导致的死亡率和疾病严重程度。一些患者可能会发生突破性感染。疫苗接种对因突破性感染而入院的重症患者的影响尚未得到充分研究。我们设计了一项研究，通过倾向评分匹配来估计疫苗接种对重症COVID-19患者重症监护病房（ICU）死亡率的影响。
我们纳入了2020年6月15日至2021年12月31日期间的患者。纳入标准为需要入住重症监护病房（ICU）的未接种疫苗和已接种疫苗的COVID-19患者。获得了机构伦理委员会的批准（机构伦理委员会，IEC 08/2023，临床试验注册，印度CTRI/2023/01/049142）。主要结局是ICU死亡率。次要结局是ICU住院时间和机械通气时间。我们使用多变量逻辑回归（MLR）和倾向评分匹配（PSM）进行统计分析。
共有667例患者（79.31%）未接种疫苗，174例（20.68%）接种了疫苗。平均年龄为57.11岁[标准差（SD）15.13]，70.27%为男性。ICU死亡率为56.60%[95%置信区间（CI）53.24 - 60%]。MLR和PSM方法的结果显示，接种疫苗的患者死亡关联可能性较小[调整优势比（AOR），使用逻辑回归的95%CI：0.52（0.29，0.94），通过倾向评分匹配：0.83（0.77，0.91）]。
本研究结果支持COVID-19疫苗接种不仅是降低普通人群病死率的有效方法，也是降低重症患者病死率的有效方法，具有重要的公共卫生意义。
