Association Between Vaccination Status and Mortality Among Intubated Patients With COVID-19–Related Acute Respiratory Distress Syndrome

• Published in: JAMA network open 2022-10, Vol.5 (10), p.e2235219-e2235219
• Main Authors: Grapsa, Eirini, Adamos, Georgios, Andrianopoulos, Ioannis, Tsolaki, Vasiliki, Giannakoulis, Vassilis G., Karavidas, Nikitas, Giannopoulou, Vassiliki, Sarri, Katerina, Mizi, Eleftheria, Gavrielatou, Evdokia, Papathanakos, Georgios, Mantzarlis, Konstantinos D., Mastora, Zafeiria, Magira, Eleni, Koulouras, Vasilios, Kotanidou, Anastasia, Siempos, Ilias I.
• Format: Article
• Language: English
• Subjects: Cohort analysis; Comorbidity; Coronaviruses; COVID-19 vaccines; Critical Care Medicine; Immunization; Intensive care; Intubation; Mortality; Online Only; Original Investigation; Respiratory distress syndrome; Ventilators
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2022.35219

Importance 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. Objective 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. Design, Setting, and Participants 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. Exposures 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 5 months before intubation) comprised the control group. Main Outcomes and Measures 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 (170 men [64.2%]; median age, 66.0 years [IQR, 58.0-76.0 years]; 26 [9.8%] in the full vaccination group) 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 (median age, 72.5 years [IQR, 62.8-80.0 years] vs 66.0 years [IQR, 57.0-75.0 years]) and more likely to have comorbid conditions (24 of 26 [92.3%] vs 160 of 239 [66.9%]), including malignant neoplasm (6 of 26 [23.1%] vs 18 of 239 [7.5%]), than those in the control group. Full vaccination status was significantly associated with lower mortality compared with controls (16 of 26 patients [61.5%] died in the full vaccination group vs 163 of 239 [68.2%] in the control group; hazard ratio, 0.55 [95% CI, 0.32-0.94];P = .03). Conclusions and Relevance In this cohort study, full vaccination status w