Full vaccination lowers mortality and requirement of mechanical ventilation among critically ill COVID-19 patients

Although vaccination substantially reduces the risk of severe COVID-19, it is yet unknown whether vaccinated patients who develop COVID-19 and require invasive mechanical ventilation have lower mortality than controls.

A study was conducted to examine the association between COVID-19 vaccination status and mortality among critically ill patients who require invasive mechanical ventilation owing to acute respiratory distress syndrome (ARDS) related to COVID-19.

This multicenter cohort study was performed between June 7, 2021, and February 1, 2022, among 265 consecutive adult patients with COVID-19 in academic intensive care units who underwent invasive mechanical ventilation owing to ARDS.

Patients in the full vaccination group had completed the primary COVID-19 vaccination series more than 14 days but less than 5 months prior to intubation. This time threshold was chosen because guidelines from the US Centers for Disease Control and Prevention recommend a booster dose beyond that time. The remaining patients (ie, those who were unvaccinated, partially vaccinated, or fully vaccinated <14 days or >5 months before intubation) comprised the control group.

The primary outcome was time from intubation to all-cause intensive care unit mortality. A Cox proportional hazards regression model including vaccination status, age, comorbid conditions, and baseline Sequential Organ Failure Assessment score on the day of intubation was used.

Results:

• A total of 265 intubated patients were included in the study.
• A total of 20 patients (76.9%) in the full vaccination group received the BNT162b2 vaccine, and the remaining 6 (23.1%) received the ChAdOx1 nCoV-19 vaccine.
• Patients in the full vaccination group were older and more likely to have comorbid conditions including malignant neoplasm than those in the control group.
• Full vaccination status was significantly associated with lower mortality compared with controls

In this cohort study, full vaccination status was associated with lower mortality compared with controls, which suggests that vaccination might be beneficial even among patients who were intubated owing to COVID-19–related ARDS. These results may inform discussions with families about prognosis.

Reference:

Grapsa E, Adamos G, Andrianopoulos I, et al. Association Between Vaccination Status and Mortality Among Intubated Patients With COVID-19–Related Acute Respiratory Distress Syndrome. JAMA Netw Open. 2022;5(10):e2235219. doi:10.1001/jamanetworkopen.2022.35219

Keywords:

Eirini Grapsa, Georgios Adamos, Ioannis Andrianopoulos, Vasiliki Tsolaki, Vassilis G. Giannakoulis, Nikitas Karavidas, Vassiliki Giannopoulou, Katerina Sarri, Eleftheria Mizi, Evdokia Gavrielatou, Georgios Papathanakos, Konstantinos D. Mantzarlis, Association, Between, Vaccination, Status, Mortality, Among, Intubated, Patients, COVID-19, Acute, Respiratory, Distress, Syndrome, JAMA Netw Open