: This cohort study examines admissions to intensive care units for COVID-19–associated acute respiratory distress syndrome by COVID-19 vaccination status among adults in the Veneto region of Italy from May to December 2021

De Rosa S.

Gregori D.

Lorenzoni G.

Navalesi P.

Ranieri V. M.

Rosi P.

English

Archivio istituzionale della ricerca - Alma Mater Studiorum Università di Bologna

Research Letter | Critical Care MedicineCOVID-19 Vaccination Status Among Adults Admitted to Intensive Care Unitsin Veneto, ItalyGiulia Lorenzoni, PhD; Paolo Rosi, MD; Silvia De Rosa, MD; V. Marco Ranieri, MD; Paolo Navalesi, MD; Dario Gregori, PhD; for the COVID-19 VENETO ICU NetworkIntroductionEffectiveness of vaccination to prevent severe COVID-19 requiring admission to the intensive careunit (ICU) has been reported to be approximately 90%.1 However, few data are available regardingduration of vaccination coverage to prevent ICU admission for severe COVID-19 and outcomes inpatients who require ICU admission despite prior vaccination. This study aimed to provide adescriptive analysis of ICU admissions for severe COVID-19 after a vaccination campaign in theVeneto region of Italy that started at the end of December 2020 and prioritized health care workers,older individuals, nursing home residents, and patients with severe comorbidities.MethodsThis cohort study included all consecutive patients aged 18 years or older admitted to the Veneto ICUNetwork2 from May to December 2021 for COVID-19–associated acute respiratory distresssyndrome.3 The Institutional Ethical Committee of Padova University Hospital approved the study;informed consent was waived because of the observational design and retrospective analysis of datafrom an anonymous database. The study followed the STROBE guideline.Vaccination status (vaccinated [2 doses], partially vaccinated [1 dose], or not vaccinated),date of vaccine administration, age, hospital and ICU admission date, and ICU outcome (death ordischarge) were collected for each patient. Data were analyzed using R, version 4.1.0, and 2-sidedP < .05 was significant. A full description of statistical methods is available in the eMethods inSupplement 1.ResultsA total of 748 patients were admitted to ICUs of the Veneto ICU Network during the study period(mean [SD] age, 62 [14] years); 138 (18%) were vaccinated, 58 (8%) were partially vaccinated, and552 (74%) were not vaccinated. Vaccinated patients were more often older than 80 years (29 [21%])compared with partially vaccinated patients (3 [5%]) and nonvaccinated patients (19 [3%]) (P < .001)(Table). Median time from vaccine administration to ICU admission for partially vaccinated patientswas 22.5 days (IQR, 16.0-49.8 days) and for vaccinated patients, 159.0 days (IQR, 112.0-192.0 days).The Figure shows ICU admissions per million inhabitants during the study period. A statisticallysignificant increasing trend was detected for ICU admissions among nonvaccinated patients.Conversely, the trend remained stable for vaccinated patients. Overall, 145 patients died in the ICU:93 nonvaccinated (17%; 95% CI, 14%-20%), 19 partially vaccinated (33%; 95% CI, 21%-46%), and 33vaccinated (24%; 95% CI, 17%-32%) patients.DiscussionThe study data revealed that vaccinated patients received the second dose of vaccine a median of 5months before admission to the ICU, whereas for partially vaccinated patients, the median ICU+ Supplemental contentAuthor affiliations and article information arelisted at the end of this article.Open Access. This is an open access article distributed under the terms of the CC-BY License.JAMA Network Open. 2022;5(5):e2213553. doi:10.1001/jamanetworkopen.2022.13553 (Reprinted) May 24, 2022 1/3Downloaded From: https://jamanetwork.com/ by a Universitá di Bologna User  on 11/14/2023admission time occurred while they awaited the second dose. A statistically significant increase inICU admissions was observed only for nonvaccinated patients. The data suggest that mortality washigher among vaccinated patients than among nonvaccinated patients, and the proportion ofpatients older than 80 years was greater among vaccinated patients than among partially vaccinatedand nonvaccinated patients. The data are consistent with recent work showing that among 1585 ICUpatients, only 7% were vaccinated and hospital mortality was higher among vaccinated individualsthan among nonvaccinated individuals.4This study has limitations. Patients could not be characterized according to clinicalcharacteristics and type of vaccine administered because this information was not available.Furthermore, confounding by indication may be problematic given that the priority schemes used invaccination programs were often determined by health outcomes among nonvaccinated patients.Table. Intensive Care Unit Admissions for COVID-19–Associated Acute Respiratory Distress SyndromeAccording to Vaccination Status, May to December 2021Patients (N = 748)Vaccinated(n = 138)Partially vaccinated(n = 58)Not vaccinated(n = 552)Age group, No. (%)<50 y 6 (4) 6 (10) 109 (20)50-59 y 19 (14) 9 (16) 155 (28)60-69 y 26 (19) 21 (36) 155 (28)70-79 y 58 (42) 19 (33) 114 (21)≥80 y 29 (21) 3 (5) 19 (3)Time to hospital admission, median (IQR), d 154.0 (110.0-190.0) 16.0 (11.0-32.5) NATime to ICU admission, median (IQR), d 159.0 (112.0-192.0) 22.5 (16.0-49.8) NAICU deaths according to age group, No./totalNo. (%)<50 y 0/33 0/19 5/93 (5)50-59 y 2/33 (6) 3/19 (16) 18/93 (19)60-69 y 6/33 (18) 6/19 (31) 28/93 (30)70-79 y 16/33 (49) 8/19 (42) 39/93 (43)≥80 y 9/33 (27) 2/19 (11) 3/93 (3)Abbreviations: ICU, intensive care unit; NA, notapplicable.Figure. Admissions to Intensive Care Units (ICUs) in the COVID-19 Veneto ICU Network Among Vaccinated,Partially Vaccinated, and Nonvaccinated Patients by Calendar Month, May to December 2021200150100500ICU admissions per million inhabitantsMonth in 2021Sep Oct Nov DecMay Jun Jul AugVaccinatedNot vaccinatedPartially vaccinatedP = .06P = .02P = .16The time series were fitted using local polynomialregression.JAMA Network Open | Critical Care Medicine COVID-19 Vaccination Status Among Adults Admitted to Intensive Care Units in Veneto, ItalyJAMA Network Open. 2022;5(5):e2213553. doi:10.1001/jamanetworkopen.2022.13553 (Reprinted) May 24, 2022 2/3Downloaded From: https://jamanetwork.com/ by a Universitá di Bologna User  on 11/14/2023The study’s findings suggest that vaccination was associated with fewer ICU admissions and that aCOVID-19 booster campaign5 and a fourth dose of mRNA vaccine6 may be warranted, especially forolder patients and individuals with comorbidities.ARTICLE INFORMATIONAccepted for Publication: March 29, 2022.Published: May 24, 2022. doi:10.1001/jamanetworkopen.2022.13553Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 LorenzoniG et al. JAMA Network Open.Corresponding Author: Paolo Navalesi, MD, Department of Medicine, University of Padova, via V. Gallucci 13,35125 Padova, Italy (paolo.navalesi@unipd.it).Author Affiliations: Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic,Vascular Sciences and Public Health, University of Padova, Padova, Italy (Lorenzoni, Gregori); Emergency MedicalServices, Regional Department, AULSS 3, Venice, Italy (Rosi); Department of Anesthesiology and Intensive Care,San Bortolo Hospital, Vicenza, Italy (De Rosa); Alma Mater Studiorum–Università di Bologna, Dipartimento diScienze Mediche e Chirurgiche (DIMEC), IRCCS Policlinico di Sant’Orsola, Anesthesia and Intensive Care Medicine,Bologna, Italy (Ranieri); Department of Medicine, University of Padova, Padova, Italy (Navalesi); Institute ofAnaesthesia and Intensive Care Unit, Padova University Hospital, Padova, Italy (Navalesi).Author Contributions: Dr Navalesi and Prof Gregori had full access to all of the data in the study and takeresponsibility for the integrity of the data and the accuracy of the data analysis.Concept and design: Ranieri, Navalesi, Gregori.Acquisition, analysis, or interpretation of data: Lorenzoni, Rosi, De Rosa, Gregori.Drafting of the manuscript: Lorenzoni, De Rosa.Critical revision of the manuscript for important intellectual content: Rosi, De Rosa, Ranieri, Navalesi, Gregori.Statistical analysis: Lorenzoni, Gregori.Administrative, technical, or material support: Rosi.Supervision: Ranieri, Navalesi, Gregori.Conflict of Interest Disclosures: None reported.Group Information: Members of the COVID-19 VENETO ICU Network are listed in Supplement 2.REFERENCES1. Pilishvili T, Gierke R, Fleming-Dutra KE, et al; Vaccine Effectiveness among Healthcare Personnel Study Team.Effectiveness of mRNA Covid-19 vaccine among US health care personnel. N Engl J Med. 2021;385(25):e90. doi:10.1056/NEJMoa21065992. Pasin L, Sella N, Correale C, et al. Regional COVID-19 network for coordination of SARS-CoV-2 outbreak inVeneto, Italy. J Cardiothorac Vasc Anesth. 2020;34(9):2341-2345. doi:10.1053/j.jvca.2020.05.0053. Ranieri VM, Rubenfeld GD, Thompson BT, et al; ARDS Definition Task Force. Acute respiratory distresssyndrome: the Berlin Definition. JAMA. 2012;307(23):2526-2533.4. Motos A, López-Gavín A, Riera J, et al; CIBERESUCICOVID Project (COV20/00110, ISCIII). Higher frequency ofcomorbidities in fully vaccinated patients admitted to the ICU due to severe COVID-19: a prospective, multicentre,observational study. Eur Respir J. 2022;59(2):2102275. Published online February 10, 2021. doi:10.1183/13993003.02275-20215. Arbel R, Hammerman A, Sergienko R, et al. BNT162b2 vaccine booster and mortality due to Covid-19. N Engl JMed. Published online December 8, 2021. doi:10.1056/NEJMoa21156246. Regev-Yochay G, Gonen T, Gilboa M, et al. Efficacy of a fourth dose of covid-19 mRNA vaccine against Omicron.N Engl J Med. 2022. Published online March 16, 2022. doi:10.1056/NEJMc2202542SUPPLEMENT 1.eMethodsSUPPLEMENT 2.COVID-19 VENETO ICU NetworkJAMA Network Open | Critical Care Medicine COVID-19 Vaccination Status Among Adults Admitted to Intensive Care Units in Veneto, ItalyJAMA Network Open. 2022;5(5):e2213553. doi:10.1001/jamanetworkopen.2022.13553 (Reprinted) May 24, 2022 3/3Downloaded From: https://jamanetwork.com/ by a Universitá di Bologna User  on 11/14/2023

COVID-19 Vaccination Status among Adults Admitted to Intensive Care Units in Veneto, Italy

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COVID-19 Vaccination Status among Adults Admitted to Intensive Care Units in Veneto, Italy

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