意大利一家新冠重症监护病房中心收治的接种疫苗患者的临床特征及28天死亡率预测因素
Clinical features and 28-day mortality predictors of vaccinated patients admitted to a COVID-19 ICU hub in Italy.
作者信息
Stella Claudia, Berardi Cecilia, Chiarito Annalisa, Gennenzi Veronica, Postorino Stefania, Settanni Donatella, Cesarano Melania, Xhemalaj Rikardo, Tanzarella Eloisa Sofia, Cutuli Salvatore Lucio, Grieco Domenico Luca, Conti Giorgio, Antonelli Massimo, De Pascale Gennaro
机构信息
Dipartimento Di Scienze Biotecnologiche Di Base, Cliniche Intensivologiche E Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.
Dipartimento Di Scienze Dell'Emergenza, Anestesiologiche E Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
出版信息
J Anesth Analg Crit Care. 2023 Nov 13;3(1):47. doi: 10.1186/s44158-023-00130-6.
BACKGROUND
COVID-19 vaccination has been proved to be effective in preventing hospitalization and illness progression, even though data on mortality of vaccinated patients in the intensive care unit (ICU) are conflicting. The aim of this study was to investigate the characteristics of vaccinated patients admitted to ICU according to their immunization cycle and to outline the risk factors for 28-day mortality. This observational study included adult patients admitted to ICU for acute respiratory failure (ARF) due to SARS-CoV-2 and who had received at least one dose of vaccine.
RESULTS
Fully vaccination was defined as a complete primary cycle from < 120 days or a booster dose from > 14 days. All the other patients were named partially vaccinated. One-hundred sixty patients (91 fully and 69 partially vaccinated) resulted eligible, showing a 28-day mortality rate of 51.9%. Compared to partially vaccinated, fully vaccinated were younger (69 [60-77.5] vs. 74 [66-79] years, p 0.029), more frequently immunocompromised (39.56% vs. 14.39%, p 0.003), and affected by at least one comorbidity (90.11% vs 78.26%, p 0.045), mainly chronic kidney disease (CKD) (36.26% vs 20.29%, p 0.035). At multivariable analysis, independent predictors of 28-day mortality were as follows: older age [OR 1.05 (CI 95% 1.01-1.08), p 0.005], history of chronic obstructive pulmonary disease (COPD) [OR 3.05 (CI 95% 1.28-7.30), p 0.012], immunosuppression [OR 3.70 (CI 95% 1.63-8.40), p 0.002], and admission respiratory and hemodynamic status [PaO/FiO and septic shock: OR 0.99 (CI 95% 0.98-0.99), p 0.009 and 2.74 (CI 95% 1.16-6.48), p 0.022, respectively].
CONCLUSIONS
Despite a full vaccination cycle, severe COVID-19 may occur in patients with relevant comorbidities, especially immunosuppression and CKD. Regardless the immunization status, predisposing conditions (i.e., older age, COPD, and immunosuppression) and a severe clinical presentation were predictors of 28-day mortality.
背景
尽管重症监护病房（ICU）中接种疫苗患者的死亡率数据存在矛盾，但2019冠状病毒病（COVID-19）疫苗接种已被证明在预防住院和疾病进展方面有效。本研究的目的是根据免疫周期调查入住ICU的接种疫苗患者的特征，并概述28天死亡率的危险因素。这项观察性研究纳入了因严重急性呼吸综合征冠状病毒2（SARS-CoV-2）导致急性呼吸衰竭（ARF）而入住ICU且已接种至少一剂疫苗的成年患者。
结果
全程接种定义为在<120天内完成完整的初始接种周期或在>14天后接种加强针。所有其他患者被称为部分接种。160例患者（91例全程接种和69例部分接种）符合条件，28天死亡率为51.9%。与部分接种患者相比，全程接种患者更年轻（69[60 - 77.5]岁 vs. 74[66 - 79]岁，p = 0.029），免疫功能低下的频率更高（39.56% vs. 14.39%，p = 0.003），且至少患有一种合并症的比例更高（90.11% vs 78.26%，p = 0.045），主要是慢性肾脏病（CKD）（36.26% vs 20.29%，p = 0.035）。在多变量分析中，28天死亡率的独立预测因素如下：年龄较大[比值比（OR）1.05（95%置信区间[CI]1.01 - 1.08），p = 0.005]、慢性阻塞性肺疾病（COPD）病史[OR 3.05（95%CI 1.28 - 7.30），p = 0.012]、免疫抑制[OR 3.70（95%CI 1.63 - 8.40），p = 0.002]以及入院时的呼吸和血流动力学状态[动脉血氧分压/吸入氧分数值（PaO₂/FiO₂）和感染性休克：OR 0.99（95%CI 0.98 - 0.99），p = 0.009和2.74（95%CI 1.16 - 6.48），p = 0.022，分别]。
结论
尽管完成了全程疫苗接种，但有相关合并症的患者，尤其是免疫抑制和CKD患者，仍可能发生重症COVID-19。无论免疫状态如何，易感因素（即年龄较大、COPD和免疫抑制）以及严重的临床表现是28天死亡率的预测因素。
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