Impact of Vaccines on Mortality in Patients Treated in The Intensive Care Unit Due To COVID-19: A Multicenter Study

Öz

Introduction: The importance of vaccines is increasing day by day because the COVID-19 pandemic has been going on for about two years and there is no effective antiviral treatment. The purpose of this study was to compare the impact of vaccination status on the mortality of patients monitored in the intensive care unit with the diagnosis of COVID-19. Methods: Three hundred and forty-four patients treated in intensive care due to COVID-19 in three hospitals in Gaziantep were included in the study. Demographic characteristics and pre-COVID-19 vaccination status of all patients were recorded, and the diagnosis of COVID-19 was made with nasopharyngeal polymerase chain reaction (PCR) test and Thorax Computed Tomography (CT). Results: Of the patients, 172 (50%) were male, 172 (50%) were female, 152 (44%) were unvaccinated and 192 (55%) were vaccinated. The number of male patients (n=106) (55.2%) in the vaccinated group was significantly higher than female patients (n=86) (44.8%) (p<0.05). Although the vaccination rate was higher in patients over 65 years of age, intubation status, mortality rate, number of hospitalisation days, urea and creatinine values were significantly higher and haemoglobin and white blood cell values were lower in younger and middle age groups (p<0.05). The age and intubation rate of patients who died due to Covid 19 were significantly higher than those who were discharged (p<0.001). The vaccination rate of young patients (28.3%) was significantly lower than that of middle-aged (47.3%) and over-65 (65.9%) patients (p<0.05). Among all vaccinated individuals, death was encountered in 57 (76.0%) of CoronaVac vaccinated and 18 (24.0%) of BioNTech vaccinated patients; the difference was statistically higher (p<0.05). The mortality rate of vaccinated patients over 65 years old was 61 (60.4%), while the mortality rate of unvaccinated patients was 40 (39.6%) and the difference was not statistically significant (p>0.05). Conclusion: The majority of the patients monitored in the intensive care unit with the diagnosis of COVID-19 were vaccinated, and over the age of 65, and the mortality was high. However, vaccination, hospitalization in the intensive care unit, and mortality rates were low in the younger age group. In patients over 65 years of age, the mortality-reducing effect of the vaccine is low. Advanced age and comorbidity reduce the efficacy of the vaccine. In all patients, the BioNTech vaccine reduces the death rate more than the CoronaVac vaccine.

Anahtar Kelimeler

• Covid-19 vaccines
• Intensive Care Unit
• Efficacy
• Mortality

Kaynakça

1. 1.Cheng H, Peng Z, Luo W, et al. Efficacy and safetyof COVID-19 vaccines in phase III trials: a meta-analysis. Vaccines. 2021; 9; 1-14.
2. 2.https://www.titck.gov.tr/haber/1423
3. 3. https://www.trthaber.com/haber/gundem/BioNTech-asisi¬uygulanmaya-baslandi-569556.html
4. 4.https://covid-19asi.saglik.gov.tr/
5. 5.https://covid-19.saglik.gov.tr/
6. 6.Vicini S, Panvini N, Bellini D, et al. Radiographersand COVID-19 pneumonia: Diagnostic performanceusing CO-RADS. Radiography. 2021; 27; 1078-84.
7. 7. Whittaker R, Kristofferson AB, Salamanca BV, et al. Length of hospital stay and risk of intensive careadmission and in-hospital death among COVID-19patients in Norway: a register-based cohort studycomparing patients fully vaccinated with an mRNAvaccine to unvaccinated patients. ClinicalMicrobiology and Infection. 2022; 28; 871-8.
8. 8.Sevinc SA, Metin S, Basi N, et al. Effectiveness ofinactivated SARS-CoV-2 vaccine (CoronaVac) onintensive care unit survival. Epidemiology &Infection. 2022; 150; e35.

9. 9.Whittaker R, Kristofferson AB, Salamanca B V, etal. Length of hospital stay and risk of intensive careadmission and in-hospital death among COVID-19 patients in Norway: a register-based cohort study comparing patients fully vaccinated with an mRNA vaccine to unvaccinated patients. Clinical Microbiology and Infection. 2022; 28; 871-8.
10. 10.Starrfelt J, Danielsen AS, Buanes E, et al. Age andproduct dependent vaccine effectiveness againstSARS-CoV-2 infection and hospitalisation amongadults in Norway: a national cohort study, July–November 2021. BMC medicine. 2022; 20; 1-11.
11. 11.Lim WS, Liang CK, Assantachai P, et al. COVID-19and older people in Asia: Asian Working Group forSarcopenia calls to actions. Geriatrics & gerontologyinternational. 2020; 20; 547–58.
12. 12.Niu S, Tian S, Lou J, et al. Clinical characteristicsof older patients infected with COVID-19: Adescriptive study. Archives of gerontology andgeriatrics. 2020; 89; 104058.
13. 13.Tenforde MW, Self WH, Adams K, et al.Association between mRNA vaccination and COVID-19 hospitalization and disease severity. Jama. 2021;326; 2043-54.
14. 14.Bahl A, Johnson S, Maine G, et al. Vaccinationreduces need for emergency care in breakthroughCOVID-19 infections: A multicenter cohort study.The Lancet Regional Health-Americas2021; 4;100065.
15. 15.Rotshild V, Hirsh-Raccah B, Miskin I, et al.Comparing the clinical efficacy of COVID-19vaccines: a systematic review and network meta-analysis. Scientific reports. 2021; 11; 22777.
16. 16.Tregoning JS, Flight KE, Higham SL, et al.Progress of the COVID-19 vaccine effort: viruses,vaccines and variants versus efficacy, effectivenessand escape. Nature reviews immunology.2021; 21;626-36.
17. 17.Koc F, Göktas EF, Firat P, et al. Risk factors forintensive care unit need in patients with COVID-19:An analysis of 368 cases. Dicle Tıp Dergisi. 2022; 49;287-96.
18. 18.Cheng H, Peng Z, Luo W, et al. Efficacy and safetyof COVID-19 vaccines in phase III trials: a meta-analysis. Vaccines. 20221; 9; 582.