Clinical characteristics and outcomes of critically ill patients with one, two and three doses of vaccination against COVID‐19 in Australia

Abstract

Background Vaccination has been shown to be highly effective in preventing death and severe disease from severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Currently few studies have directly compared vaccinated and unvaccinated patients with severe COVID‐19 in the intensive care unit (ICU). Aims Our aim was to compare the clinical characteristics and outcomes of vaccine recipients and unvaccinated patients with SARS‐CoV‐2 infection admitted to the ICU in a nationwide setting. Materials and Methods Data were extracted from the Short PeRiod IncideNce sTudy of Severe Acute Respiratory Infection Australia, in 57 ICUs during Delta and Omicron predominant periods of the COVID‐19 pandemic. The primary outcome was in‐hospital mortality. Secondary outcomes included duration of mechanical ventilation, ICU length of stay, hospital length of stay, and ICU mortality. Results 2,970 patients were admitted to ICU across participating sites from 26 June 2021 to 8 February 2022. 1,134 (38.2%) patients were vaccine recipients, and 1,836 (61.8%) patients were unvaccinated. Vaccine recipients were older, more comorbid, and less likely to require organ support. Unadjusted in‐hospital mortality was greater in the vaccinated cohort. After adjusting for age, gender and comorbid status, no statistically significant association between in‐hospital or ICU mortality, and vaccination status, was apparent. Conclusion We found COVID‐19 infection can cause severe disease and death in vaccine recipients, though comorbid status and older age were significant contributors to mortality. Organ support requirements and the number of deaths were highest in the unvaccinated cohort. This article is protected by copyright. All rights reserved.

Severe SARS-Cov2 pneumonia in vaccinated patients: a multicenter cohort study

“…High flow nasal oxygen and non-invasive mechanical ventilation were implemented in 79 (79%) and 18 (18%) patients, respectively. Mechanical ventilation was initiated in 48 (48%) with a median duration of 11 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] days. Acute kidney injury was diagnosed in 25 (25%) patients and 11 (11%) required renal replacement therapy.…”

“…Outcomes. During a median ICU length-of-stay of 8 [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] days, 34 (34%) patients exhibited a respiratory superinfection, and 31 (31%) patients died (Table 2). Main causes of death were refractory ARDS in 16 (52%) patients, multi-organ failure in 11 (35%) patients, limitation of life support because of an expected poor outcome in 3 (10%) patients, and septic shock secondary to ventilator-acquired pneumonia in one (3%) patient.…”

“…As we report patients admitted to ICU, patients with more comorbidities might have been denied from ICU admission because of an expected poor outcome. One other study and one other letter have pointed out that critically-ill vaccinated patients were older, more comorbid, without a higher ICU-mortality 9 , 10 .…”

“…As we www.nature.com/scientificreports/ report patients admitted to ICU, patients with more comorbidities might have been denied from ICU admission because of an expected poor outcome. One other study and one other letter have pointed out that critically-ill vaccinated patients were older, more comorbid, without a higher ICU-mortality 9,10 . Vaccination has proven effective in preventing symptomatic SARS-Cov2 infection, hospitalization, and severe disease.…”

<strong></strong>Forgotten “Primum Non Nocere” and Increased Mortality after Covid-19 Vaccination <strong> </strong>

“…Well-designed human studies to address the question of a combined impact of coronavirus infection and subsequent Covid-19 vaccination are lacking. However, a recent study by Otto and colleagues concluded that Covid-19 infection can cause severe disease and death in vaccine recipients, particularly in older adults and those with comorbidities [5]. Given the fact that SARS-CoV-2 viral variants are highly transmissible and have already infected the majority of the populations in westernized countries, such concerns regarding the combined impact of natural infection and subsequent vaccinations could have serious public health implications, particularly in light of ongoing Covid-19 booster campaigns worldwide.…”