A new BMJ study from the UK has identified risk factors that increase the likelihood of hospitalization or death in persons with Covid-19, who have been partially or fully vaccinated with a Covid-19 vaccine.1,2The study examined nearly 7 million vaccinated adults aged ≥19 years between December 8, 2020 and June 15 this year; 74.1% of the study population had been fully vaccinated with two doses. The prospective study utilized data obtained from general practice, national immunisation and SARS...
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Predicting severe outcomes in adults after Covid-19 vaccination
Dr Veena Aggarwal, Consultant Womens’ Health, MD and Chairperson, IJCP Group & Medtalks Trustee,, 21 September 2021 #Multispeciality
A new BMJ study from the UK has identified risk factors that increase the likelihood of hospitalization or death in persons with Covid-19, who have been partially or fully vaccinated with a Covid-19 vaccine.1,2
The study examined nearly 7 million vaccinated adults aged ≥19 years between December 8, 2020 and June 15 this year; 74.1% of the study population had been fully vaccinated with two doses. The prospective study utilized data obtained from general practice, national immunisation and SARS-CoV-2 testing results, national death registry, and hospital admissions. The outcome in terms of severe COVID-19 leading to death (primary outcome) and hospitalization (secondary outcome) from 14 days each vaccine dose was analysed using two new QCovid risk algorithms: QCovid2 (based on unvaccinated patients) and QCovid3 (based on vaccinated patients) (QCovid™ risk calculator). The original QCovid1 tool had been earlier used in England to identify patients at high risk of severe covid-19 outcome.
There were 2031 Covid-19-related deaths and 1929 COVID-related hospital admissions. Of these, 81 deaths (4%) and 71 admissions (3.7%) occurred ≥14 days following the second dose of the vaccine.
With the help of the QCovid tool, researchers could identify groups at greatest risk of either dying or developing severe Covid-19 that required hospitalization regardless of vaccination. Patients with Down’s syndrome were at the highest risk of hospitalization or death with cause specific hazard ratio (HR) of 12.7 followed by patients who had undergone kidney transplant (HR 8.1). Other risk groups included sickle cell disease (HR 7.7), chemotherapy (HR 4.3), care home residency (HR 4.1), HIV/AIDS (HR 3.3), liver cirrhosis (HR 3.0), neurological conditions (HR 2.6), recent bone marrow transplantation or a solid organ transplantation ever (HR 2.5), dementia (HR 2.2) and Parkinson’s disease (HR 2.2).
The risk of Covid-related hospitalization or mortality was also increased 1.2-2.0 times in patients with type 2 diabetes, coronary heart disease, stroke, atrial fibrillation, heart failure, COPD, peripheral vascular disease, thromboembolism, epilepsy, chronic kidney disease and hematological malignancy. The tool could identify risk of covid-19 deaths within 70 days with 78.7% accuracy in the top 5% of patients who had the highest predicted covid-19 mortality risk.
These associations persisted even after the second dose; however, the absolute risks decreased after full vaccination.
The findings of this study validate the sensitivity of a risk prediction tool in categorizing Covid patients who would need hospitalization or are at the highest risk of covid-19 related death despite vaccination. Such risk stratification tools can individualize risk assessment for targeted, early interventions and preventing the associated morbidity and mortality.
Hippisley-Cox J, et al. Risk prediction of covid-19 related death and hospital admission in adults after covid-19 vaccination: national prospective cohort study. BMJ 2021;2021 Sep 17;374:n2244, doi: 10.1136/bmj.n2244
Peter Russell. Study identifies at risk groups after COVID vaccination - Medscape - Sep 18, 2021.
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