Progression to Critical Illness and Death in Patients With Breakthrough Hospitalizations

Geehan Suleyman; Raef Fadel; Ayman Alsaadi; Luis Ng Sueng; Ali Ghandour; Ahmad Alkhatib; Tarandeep Singh; Austin Parsons; Joseph Miller; Mayur Ramesh; Indira Brar; George Alangaden

doi:10.1093/ofid/ofac213

Progression to Critical Illness and Death in Patients With Breakthrough Hospitalizations

Open Forum Infect Dis. 2022 Apr 21;9(7):ofac213. doi: 10.1093/ofid/ofac213. eCollection 2022 Jul.

Authors

Affiliations

¹ Division of Infectious Disease, Henry Ford Hospital, Detroit, Michigan, USA.
² Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA.
³ Wayne State University School of Medicine, Detroit, Michigan, USA.

Abstract

Background: Characterization of disease progression and outcomes after coronavirus disease 2019 (COVID-19)-related hospitalization in vaccinated compared with unvaccinated individuals is limited.

Methods: This was a retrospective case-control study of symptomatic vaccinated (cases) and unvaccinated (controls) participants hospitalized for COVID-19 between December 30, 2020, and September 30, 2021, in Southeast Michigan. Hospitalized adult patients with lab-confirmed COVID-19 were identified through daily census report. Breakthrough infection was defined as detection of severe acute respiratory syndrome coronavirus 2 ≥14 days after completion of the primary vaccination series. The association between prior vaccination and critical COVID-19 illness (composite of intensive care unit [ICU] admission, invasive mechanical ventilation [IMV], 28-day mortality) was examined.

Results: Two hundred ten (39%) fully vaccinated and 325 (61%) unvaccinated patients were evaluated. Compared with controls, cases were older, had more comorbidities (4 [3-7] vs 2 [1-4]; P < .001), and were more likely to be immunocompromised. Cases had less severe symptoms compared with controls (2 [1-2] vs 2 [2-3]; P < .001) and were less likely to progress to critical COVID-19 illness (33.3% vs 45.5%; P < .001); 28-day mortality was significantly lower in cases (11.0% vs 24.9%; P < .001). Symptom severity (odds ratio [OR], 2.59; 95% CI, 1.61-4.16; P < .001) and modified Sequential Organ Failure Assessment score on presentation (OR, 1.74; 95% CI, 1.48-2.06; P < .001) were independently associated with development of critical COVID-19 illness. Prior vaccination (OR, 0.528; 95% CI, 0.307-0.910; P = .020) was protective.

Conclusions: COVID-19-vaccinated patients were less likely to develop critical COVID-19 illness and more likely to survive. Disease severity at presentation was a predictor of adverse outcomes regardless of vaccination status.

Keywords: COVID-19; breakthrough hospitalizations; critical illness; mortality; risk factors.