Association of disease severity and death outcome with vaccination status of admitted COVID-19 patients in delta period of SARS-COV-2 in mixed variety of vaccine background

Javaria Aslam; Muhammad Rauf Ul Hassan; Qindeel Fatima; Hala Bashir Hashmi; Mohammad Y Alshahrani; Ali G Alkhathami; Irrum Aneela

doi:10.1016/j.sjbs.2022.103329

Association of disease severity and death outcome with vaccination status of admitted COVID-19 patients in delta period of SARS-COV-2 in mixed variety of vaccine background

Saudi J Biol Sci. 2022 Jul;29(7):103329. doi: 10.1016/j.sjbs.2022.103329. Epub 2022 May 31.

Authors

Javaria Aslam¹, Muhammad Rauf Ul Hassan², Qindeel Fatima¹, Hala Bashir Hashmi³, Mohammad Y Alshahrani⁴, Ali G Alkhathami⁴, Irrum Aneela⁵

Affiliations

¹ Department of Medicine, Quaid-e-Azam Medical College, Sadiq Abbasi Hospital, Bahawalpur 63100, Pakistan.
² Department of Pulmonology, Quaid-e-Azam Medical College, Bahawalpur 63100, Pakistan.
³ Department of Community Medicine, Quaid-e-Azam Medical College, Bahawalpur 63100, Pakistan.
⁴ Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, P.O. Box 61413, Abha 9088, Saudi Arabia.
⁵ Stroke Specialty Unit, Fairfield General Hospital, Rochdale Old Rd, Bury BL9 7TD, United Kingdom.

Abstract

To understand the effectual role of COVID-19 vaccination, we must analyze its effectiveness in dampening the disease severity and death outcome in patients who acquire infection and require hospitalization. The goal of this study was to see if there was an association between disease progression in admitted COVID-19 patients and their prior vaccination exposure. A prospective cohort study based on 1640 admitted COVID-19 patients were carried between June 2021 and October 2021. Depending on vaccination exposure they were divided into vaccinated (exposed) and unvaccinated (unexposed) groups, excluding partially vaccinated patients. Disease severity was assessed at admission on severity index scale. Disease progression to mortality or need of mechanical ventilation and survival were taken as outcome. Absolute difference with 95%CI and Risk Ratio were calculated using cross tabulation, Chi square test and multivariable logistic regression analysis. Among 1514 total analyzed cohort (median age, 53 years [IQR, 17,106]; 43.7% from 46 to 65 years of age group, 56.2% males,33.4% with no comorbid factor for disease progression) 369(24.4%) were vaccinated breakthrough cases and 1145(75.6%) were unvaccinated controls. 556(36.7%) progressed to death or mechanical ventilation, 958(63.3%) patients survived and were discharged home. Disease progression to death or mechanical ventilation was significantly associated with decreased likelihood of vaccination (24.9% among vaccinated breakthrough vs 40.5% unvaccinated controls, [Absolute difference -15.6% 95%CI (-10.2% to -20.6%); RR 0.615 95%CI (0.509, 0.744); p <.001]). This association was stronger for old age population and for increase time span between second dose of vaccine and onset of symptoms. There was no statistically significant difference among different types of vaccination and occurrence of outcome when compared to unvaccinated controls (RR 0.607(0.482, 0.763); 0.673(0.339, 1.33) and 0.623(0.441, 0.881) for Inactivated virus vaccine, mRNA and Adenovirus vector-based vaccine respectively. The patients who were fully vaccinated against SARS-COV-2 die or shift to mechanical ventilation less frequently than unvaccinated COVID-19 admitted patients.

Keywords: Admitted Patients; COVID-19; Disease Severity; Vaccination.