COVID-19 vaccination is associated with lower mortality and intensive care unit admission among hospitalized patients with COVID-19: A retrospective cohort study

Julian  Madrid; Prerana  Agarwal; Katharina  Müller-Peltzer; Leo  Benning; Mischa  Selig; Philipp  Diehl; Johannes  Kalbhenn; Georg  Trummer; Stefan  Utzolino; Tobias  Wengenmayer; Hans Jörg Busch; Daiana  Stolz; Siegbert  Rieg; Marcus  Panning; Christopher  L. Schlett; Fabian  Bamberg; Esther  Askani

Authors

Julian Madrid Charité - University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany and Pneumology, Angiology, Acute Geriatrics and Intensive Care, Ortenau Klinikum, Lahr, Germany
Prerana Agarwal Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Katharina Müller-Peltzer Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Leo Benning University Emergency Center, Medical Center – University of Freiburg, Faculty of Medicine,University of Freiburg, Freiburg, Germany
Mischa Selig G.E.R.N. Research Center for Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Philipp Diehl Pneumology, Angiology, Acute Geriatrics and Intensive Care, Ortenau Klinikum, Lahr, Germany
Johannes Kalbhenn Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Georg Trummer Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Stefan Utzolino University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Tobias Wengenmayer Interdisciplinary Medical Intensive Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Hans Jörg Busch University Emergency Center, Medical Center – University of Freiburg, Faculty of Medicine,University of Freiburg, Freiburg, Germany
Daiana Stolz Clinic of Respiratory Medicine, Medical Center – University of Freiburg, Faculty of Medicine,University of Freiburg, Freiburg, Germany
Siegbert Rieg Division of Infectious Diseases, Department of Medicine II, Medical Center –University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Marcus Panning Institute of Virology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Christopher L. Schlett Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Fabian Bamberg Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Esther Askani Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany

Keywords:

Computed tomography, COVID-19, hospitalized patients, ICU admission, mortality, SARS-CoV-2, vaccination

Abstract

Background: Vaccination has been central to reducing severe coronavirus disease 2019 (COVID-19). However, the association between prior vaccination and outcomes among patients hospitalized with COVID-19 remains clinically relevant.

Objective: To investigate the association between COVID-19 vaccination status and mortality and intensive care unit (ICU) admission among hospitalized patients with COVID-19.

Methods: This retrospective single-center cohort study included adults hospitalized with reverse transcription polymerase chain reaction -confirmed COVID-19 between July 2021 and February 2022 who had documented vaccination status and underwent at least one chest computed tomography (CT) scan. The exposure of interest was full COVID-19 vaccination. Primary outcomes were mortality and intensive care unit (ICU) admission. Associations were examined using regression models adjusted for age, type 2 diabetes, hypertension, cardiac disease, and pulmonary disease. Exploratory predictor analyses were performed using Least Absolute Shrinkage and Selection Operator (LASSO) regression.

Results: The analytic cohort comprised 167 patients: 69.0% were male, mean age was 58 years (95% CI [55 60]), and 42.0% were fully vaccinated. Full vaccination was associated with lower adjusted relative risk of mortality (RR: 0.46, 95% CI [0.13 0.99]) and ICU admission (RR: 0.59, 95% CI [0.28 0.89]). The adjusted absolute risk difference for ICU admission corresponded to an observational number needed to treat like estimate of four, which should be interpreted cautiously. In patients younger than 60 years, vaccination was associated with fewer ICU admissions (RR: 0.64, 95% CI [0.32 0.99]).

Conclusion: COVID-19 vaccination was associated with lower mortality and reduced ICU admission among hospitalized patients with COVID-19 in this retrospective single-center cohort. Because of the observational design, selected hospitalized CT-imaged population, and potential residual confounding, these findings should be interpreted as associations rather than proof of causal protection.

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