Differences in the Evolution of Clinical, Biochemical, and Hematological Indicators in Hospitalized Patients with COVID-19 According to Their Vaccination Scheme: A Cohort Study in One of the World’s Highest Hospital Mortality Populations
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Subjects
2.2. Measures and Follow-Up
2.3. Sample Size
2.4. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Differences in Clinical Characteristics between Vaccinated and Unvaccinated Individuals
3.3. Hospitalization Days and Survival
3.4. Risk Factors for Death in Hospitalized Patients with COVID-19, including Vaccination Schedule
3.5. Clinical Differences between Those Vaccinated with BNT162b2 and ChAdOx1-S
3.6. Evolution of Some Clinical Parameters during the First 6 Days
3.7. Predictors of Death Based on Vaccination Status
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Clinical Characteristic | Vaccinated | |||
---|---|---|---|---|
All | No | Yes | p | |
n = 514 | n = 288 | n = 226 | ||
Medical personal history | ||||
Age (years) | 63.3 ± 16.1 | 62.2 ± 16.3 | 64.6 ± 15.7 | 0.084 * |
≥60 years | 63.1% | 57.1% | 70.8% | 0.001 ** |
Male (%) | 61.9% | 61.5% | 62.4% | 0.451 ** |
Data on the COVID vaccination scheme | ||||
Vaccinated | 56.0% | 44.0% | ||
ChAdOx1-S a | 17.9% | |||
BNT162b2 b | 21.7% | |||
Ad5-nCoV | 2.7% | |||
CorovaVac c | 1.7% | |||
Complete primary series | 38.2% | |||
Booster vaccinations d | 8.9% | |||
Days since last application | 132.9 ± 97.0 |
Clinical | Vaccinated | p * | |||||
---|---|---|---|---|---|---|---|
Characteristic | No | ChAdOx1-S | BNT162b2 | Inter- | No vs. | No vs. | ChAdOx1-S |
n = 288 (100%) | n = 73 (100%) | n = 101 (100%) | Group | ChAdOx1-S | BNT162b2 | vs. BNT162b2 | |
≥60 years | 57.1% | 57.5% | 90.1% | <0.001 | 0.527 | <0.001 | <0.001 |
Male (%) | 61.5% | 61.6% | 65.3% | 0.777 | |||
Diabetes | 38.0% | 54.8% | 50.5% | 0.009 * | 0.007 | 0.019 | 0.342 |
HBP | 34.3% | 56.2% | 54.5% | <0.001 * | 0.001 | <0.001 | 0.473 |
BMI | 30.4 ± 7.2 | 29.3 ± 4.2 | 30.6 ± 7.5 | 0.264 | |||
Smoking | 9.6% | 1.4% | 6.1% | 0.025 * | 0.013 | 0.197 | 0.135 |
CKD | 16.3% | 40.3% | 29.7% | <0.001 | <0.001 | 0.003 | 0.100 |
Charlson Index | 3.2 ± 2.1 | 4.2 ± 2.1 | 4.7 ± 1.7 | <0.001 * | 0.001 | <0.001 | 0.106 |
Clinical data at hospital admission | |||||||
PSI | 107 ± 42 | 106 ± 37 | 117 ± 36 | 0.110 | |||
Disease phase | <0.001 | <0.001 | <0.001 | 0.058 | |||
Viral | 27.7% | 60.3% | 45.0% | ||||
Pulmonary | 57.1% | 28.8% | 30.0% | ||||
Inflammation | 15.2% | 11.0% | 25.0% | ||||
C-GRAM | 135 ± 36 | 131 ± 41 | 134 ± 32 | 0.692 | |||
NEWS-2 | 7.7 ± 3.5 | 6.5 ± 3.1 | 6.6 ± 3.0 | 0.003 | 0.011 | 0.007 | 0.843 |
Neutrophils | 7309 ± 5972 | 10,604 ± 7244 | 9606 ± 6101 | <0.001 | 0.001 | 0.001 | 0.336 |
Lymphocytes | 801 ± 793 | 1094 ± 714 | 1023 ± 789 | 0.004 | 0.005 | 0.019 | 0.554 |
PlateletsX1000 | 261 ± 122 | 267 ± 147 | 244 ± 103 | 0.390 | |||
NLR | 13.0 ± 12.5 | 15.3 ± 21.6 | 13.6 ± 12.9 | 0.487 | |||
D-Dimer | 2999 ± 2184 | 3142 ± 5579 | 2180 ± 3583 | 0.914 | |||
ESR | 29.8 ± 11.6 | 34.5 ± 16.8 | 23.8 ± 11.7 | 0.050 | 0.226 | 0.047 | 0. 045 |
CRP | 17.1 ± 18.6 | 15.5 ± 11.2 | 16.6 ± 28.8 | 0.971 * | |||
Ferritin | 845.8 ± 638.5 | 655.2 ± 586.2 | 559.7 ± 336.1 | 0.017 | 0.122 | 0.009 | 0.394 |
Creatinine | 2.2 ± 3.7 | 3.8 ± 4.4 | 2.4 ± 3.2 | 0.006 | 0.003 | 0.760 | 0.014 |
eGFR | 73.9 ± 48.7 | 51.9 ± 58.3 | 54.1 ± 36.7 | <0.001 | 0.003 | 0.002 | 0.999 |
AST | 50.1 ± 51.2 | 125.6 ± 397.6 | 67.5 ± 193.2 | 0.046 | 0.007 | 0.328 | 0.329 |
ALT | 41.2 ± 38.8 | 83.2 ± 216.2 | 42.4 + 122.8 | 0.035 | 0.008 | 0.900 | 0.195 |
ALP | 99.3 ± 65.6 | 139.8 ± 170.5 | 103.1 ± 70.8 | 0.068 | |||
LDH | 384.2 ± 209.5 | 502.4 ± 954.6 | 345.8 ± 288.0 | 0.078 | |||
Glucose | 191.5 ± 132.3 | 179.5 ± 129.2 | 214.9 ± 169.5 | 0.232 | |||
INR | 1.14 + 0.25 | 1.13 + 0.31 | 1.19 + 0.59 | 0.690 | |||
Main treatments during hospital stay | |||||||
AKI | 16.7% | 35.6% | 18.7% | 0.002 | 0.001 | 0.545 | 0.004 |
Paracetamol | 11.4% | 11.0% | 4.0% | 0.054 | |||
Anticoagulants | 89.3% | 86.3% | 94.1% | 0.193 | |||
Antibiotics | 48.7% | 42.3% | 49.0% | 0.746 | |||
Amine support | 9.7% | 6.8% | 8.0% | 0.689 | |||
Steroids | 90.6% | 93.2% | 93.1% | 0.642 | |||
Diuretics | 14.6% | 29.5% | 22.1% | 0.150 | |||
Mech. Vent. | 38.1% | 23.3% | 21.8% | 0.002 | 0.012 | 0.002 | 0.478 |
Hemodialysis | 9.0% | 19.2% | 5.0% | 0.010 | 0.015 | 0.139 | 0.003 |
Clinical | Vaccinated | p * | |||||
---|---|---|---|---|---|---|---|
Characteristic | No | ChAdOx1-S | BNT162b2 | Inter- | No vs. | No vs. | ChAdOx1-S |
n = 288 | n = 73 | n = 101 | Group | ChAdOx1-S | BNT162b2 | vs. BNT162b2 | |
Days hosp. | |||||||
All | 8.9 ± 6.1 | 7.6 ± 5.1 | 8.4 ± 6.2 | 0.207 | |||
D. alive | 7.6 ± 5.1 | 6.8 ± 4.2 | 7.9 ± 5.1 | 0.492 | |||
D. dead | 10.2 ± 6.6 | 8.8 ± 6.0 | 9.2 ± 8.1 | 0.533 | |||
Deaths | 52.6% | 41.1% | 31.7% | 0.001 | 0.052 | <0.001 | 0.132 |
Death according to age | |||||||
<60 years | 40.3% | 29.0% | 20.0% | 0.245 | |||
≥60 years | 61.8% | 50.0% | 33.0% | <0.001 | 0.112 | <0.001 | 0.047 |
Deaths according to Disease phase at admission | |||||||
Viral | 34.2% | 20.5% | 19.1% | 0.104 | |||
Advanced ** | 59.8% | 72.4% | 43.4% | 0.024 | 0.134 | 0.023 | 0.010 |
Deaths according to PSI at admission | |||||||
PSI score < 120 | 32.2% | 21.7% | 11.1% | 0.002 | 0.115 | 0.001 | 0.107 |
PSI score ≥ 120 | 85.8% | 76.0% | 67.6% | 0.046 | 0.180 | 0.016 | 0.336 |
Death with booster vaccination | 38.1% | 30.4% | 0.414 |
95% CI | ||||
---|---|---|---|---|
Covariate | Ad RR | Lower | Upper | p |
Age ≥ 60 years | 1.46 | 0.91 | 2.37 | 0.119 |
Male | 0.97 | 0.63 | 1.50 | 0.887 |
Diabetes | 1.18 | 0.76 | 1.82 | 0.471 |
HBP | 0.83 | 0.53 | 1.29 | 0.405 |
Smoking | 4.50 | 2.00 | 10.14 | <0.001 |
CKD | 1.42 | 0.72 | 2.83 | 0.314 |
Charlson Index | 2.67 | 0.60 | 11.97 | 0.199 |
Admission phase | 4.01 | 2.47 | 6.50 | <0.001 |
NEWS-2 score ≥ 12 | 3.56 | 1.64 | 7.76 | 0.001 |
PSI score > 120 | 8.14 | 5.06 | 13.09 | <0.001 |
Mech. Vent. | 3.74 | 1.89 | 7.39 | <0.001 |
Creatinine ≥ 4mg/dL | 0.89 | 0.39 | 2.04 | 0.777 |
AKI | 1.10 | 0.63 | 1.92 | 0.726 |
Hemodialysis | 0.70 | 0.16 | 3.09 | 0.633 |
Neutrophils ≥ 8 × 10e3/uL | 3.76 | 2.34 | 6.02 | <0.001 |
Lymphocytes ≥ 680/uL | 0.53 | 0.34 | 0.84 | 0.007 |
AST ≥ 50UL | 1.40 | 0.81 | 2.42 | 0.229 |
ALT ≥ 45UL | 0.45 | 0.26 | 0.79 | 0.005 |
Ferritin ≥ 810 ng/mL | 0.91 | 0.58 | 1.42 | 0.668 |
ESR ≥ 30 mm/h | 1.42 | 0.66 | 3.05 | 0.370 |
Vaccine type | ||||
BNT162b2/ChAdOx1-S 2 doses α | 0.54 | 0.30 | 0.97 | 0.041 |
BNT162b2 2 doses α | 0.41 | 0.22 | 0.79 | 0.008 |
ChAdOx1-S 2 doses α | 1.04 | 0.48 | 2.29 | 0.915 |
Booster vaccination Ω | 1.74 | 0.68 | 4.45 | 0.247 |
95% CI | ||||
---|---|---|---|---|
Covariate | Ad RR | Lower | Upper | p |
Age ≥ 60 years | 7.61 | 2.74 | 21.11 | <0.001 |
Male | 1.42 | 0.62 | 3.24 | 0.407 |
Smoking | 0.88 | 0.20 | 3.88 | 0.861 |
CKD | 0.75 | 0.28 | 2.00 | 0.570 |
Charlson Index | 1.07 | 0.82 | 1.39 | 0.633 |
Admission phase | 2.30 | 1.14 | 4.63 | 0.020 |
NEWS-2 score ≥ 12 | 1.84 | 0.55 | 6.20 | 0.322 |
PSI score ≥ 120 | 3.91 | 1.50 | 10.22 | 0.006 |
Mech. Vent. | 1.24 | 0.41 | 3.78 | 0.701 |
Creatinine ≥ 4mg/dL | 0.58 | 0.17 | 2.00 | 0.389 |
AKI | 0.88 | 0.37 | 2.06 | 0.762 |
Neutrophils ≥ 8 × 10e3/uL | 0.87 | 0.37 | 2.05 | 0.753 |
Lymphocytes ≥ 680/uL | 0.95 | 0.44 | 2.03 | 0.893 |
AST ≥ 50UL | 1.42 | 0.61 | 3.30 | 0.410 |
ALT ≥ 45UL | 0.46 | 0.17 | 1.24 | 0.123 |
Ferritin ≥ 810 ng/mL | 0.21 | 0.09 | 0.46 | <0.001 |
ESR ≥ 30 mm/h | 0.91 | 0.58 | 1.42 | 0.668 |
Booster vaccination Ω | 0.32 | 0.13 | 0.75 | 0.009 |
Death | 0.27 | 0.10 | 0.70 | 0.008 |
95% CI | ||||
---|---|---|---|---|
Covariate | Ad RR | Lower | Upper | p |
Age ≥ 60 years | 3.25 | 1.70 | 6.22 | 0.000 |
Male | 1.78 | 1.10 | 2.88 | 0.018 |
Smoking | 0.38 | 0.15 | 0.94 | 0.037 |
CKD | 0.69 | 0.35 | 1.37 | 0.297 |
Charlson Index | 1.41 | 1.20 | 1.65 | 0.000 |
Admission phase | 0.88 | 0.55 | 1.42 | 0.622 |
NEWS-2 score ≥ 12 | 1.18 | 0.62 | 2.26 | 0.603 |
PSI score ≥ 120 | 1.50 | 0.82 | 2.74 | 0.186 |
Mech. Vent. | 1.13 | 0.60 | 2.12 | 0.686 |
Creatinine ≥ 4mg/dL | 1.58 | 0.73 | 3.38 | 0.237 |
AKI | 0.54 | 0.31 | 0.93 | 0.028 |
Neutrophils ≥ 8 × 10e3/uL | 2.43 | 1.51 | 3.89 | 0.000 |
Lymphocytes ≥ 680/uL | 3.63 | 2.34 | 5.62 | 0.000 |
AST ≥ 50UL | 1.02 | 0.59 | 1.78 | 0.919 |
ALT ≥ 45UL | 0.64 | 0.35 | 1.19 | 0.163 |
Ferritin ≥ 810 ng/mL | 0.74 | 0.46 | 1.19 | 0.220 |
ESR ≥ 30 mm/h | 1.03 | 0.47 | 2.22 | 0.939 |
Death | 0.38 | 0.19 | 0.72 | 0.004 |
Mean, First 6 Days | p-Value No vs. | ChAdOx1-S vs. | ||||
---|---|---|---|---|---|---|
No | ChAdOx1-S | BNT162b2 | ChAdOx1-S | BNT162b2 | BNT162b2 | |
Ferritin | 1043 ± 758 | 1031 ± 813 | 632 ± 473 | 0.646 | <0.001 | <0.001 |
Lymphocytes | 740.7 ± 776 | 1055 ± 699 | 1008 ± 836 | <0.001 | <0.001 | 0.148 |
PLR | 1259 ± 2317 | 339 ± 301 | 423 ± 460 | <0.001 | <0.001 | 0.055 |
NEWS-2 | 7.8 ± 3.8 | 6.3 ± 3.5 | 6.1 ± 3.4 | 0.004 | 0.028 | 0.450 |
PSI score | 110.5 ± 44 | 110.6 ± 39 | 119.3 ± 38 | 0.302 | <0.001 | <0.001 |
Variable | Group | AUC | S.E. | p | 95% CI | Cutoff | Sens | Spec | |
---|---|---|---|---|---|---|---|---|---|
PSI | Not vac | 0.92 | 0.01 | <0.001 | 0.91 | 0.93 | 118.0 | 0.80 | 0.10 |
ChAdOx1-S | 0.89 | 0.01 | <0.001 | 0.86 | 0.92 | 123.5 | 0.78 | 0.17 | |
BNT162b2 | 0.85 | 0.02 | <0.001 | 0.82 | 0.88 | 124.5 | 0.81 | 0.22 | |
Oxemia | Not vac | 0.35 | 0.02 | <0.001 | 0.31 | 0.39 | 74.0 | 0.92 | 0.95 |
ChAdOx1-S | 0.35 | 0.04 | 0.001 | 0.26 | 0.43 | 84.5 | 0.83 | 0.93 | |
BNT162b2 | 0.41 | 0.03 | 0.007 | 0.34 | 0.47 | 82.5 | 0.83 | 0.86 | |
Lymphocytes | Not vac | 0.39 | 0.02 | <0.001 | 0.36 | 0.42 | 535.0 | 0.44 | 0.59 |
ChAdOx1-S | 0.32 | 0.03 | <0.001 | 0.27 | 0.37 | 831.4 | 0.37 | 0.67 | |
BNT162b2 | 0.38 | 0.03 | <0.001 | 0.34 | 0.43 | 893.5 | 0.40 | 0.57 | |
Neutrophils | Not vac | 0.69 | 0.01 | <0.001 | 0.67 | 0.72 | 7311.5 | 0.62 | 0.30 |
ChAdOx1-S | 0.62 | 0.03 | <0.001 | 0.57 | 0.68 | 9710.9 | 0.65 | 0.43 | |
BNT162b2 | 0.72 | 0.02 | <0.001 | 0.68 | 0.76 | 9430.1 | 0.70 | 0.37 | |
LDH | Not vac | 0.75 | 0.02 | <0.001 | 0.72 | 0.78 | 367.5 | 0.62 | 0.25 |
ChAdOx1-S | 0.87 | 0.03 | <0.001 | 0.82 | 0.92 | 332.7 | 0.79 | 0.17 | |
BNT162b2 | 0.76 | 0.03 | <0.001 | 0.70 | 0.81 | 325.4 | 0.69 | 0.30 | |
Ferritin | Not vac | 0.64 | 0.02 | <0.001 | 0.60 | 0.67 | 875.1 | 0.59 | 0.41 |
ChAdOx1-S | 0.57 | 0.04 | 0.090 | 0.49 | 0.64 | 878.4 | 0.53 | 0.46 | |
BNT162b2 | 0.67 | 0.03 | <0.001 | 0.61 | 0.73 | 648.3 | 0.58 | 0.41 | |
CRP | Not vac | 0.74 | 0.02 | <0.001 | 0.71 | 0.78 | 12.2 | 0.60 | 0.25 |
ChAdOx1-S | 0.57 | 0.05 | 0.162 | 0.47 | 0.67 | 12.3 | 0.56 | 0.49 | |
BNT162b2 | 0.71 | 0.01 | <0.001 | 0.68 | 0.74 | 12.2 | 0.60 | 0.30 | |
D dimer | Not vac | 0.74 | 0.02 | <0.001 | 0.70 | 0.77 | 1009.5 | 0.64 | 0.31 |
ChAdOx1-S | 0.71 | 0.04 | <0.001 | 0.64 | 0.79 | 1231.7 | 0.62 | 0.48 | |
BNT162b2 | 0.69 | 0.03 | <0.001 | 0.62 | 0.75 | 1083.0 | 0.63 | 0.40 | |
eGFR | Not vac | 0.32 | 0.01 | <0.001 | 0.29 | 0.34 | 75.2 | 0.42 | 0.73 |
ChAdOx1-S | 0.43 | 0.03 | 0.009 | 0.37 | 0.48 | 36.3 | 0.46 | 0.59 | |
BNT162b2 | 0.431 | 0.024 | 0.005 | 0.384 | 0.479 | 60.00 | 0.436 | 0.598 |
Vaccine | p-Value No vs. | ChAdOx1-S vs. | ||||
---|---|---|---|---|---|---|
Variable | No | ChAdOx1-S | BNT162b2 | ChAdOx1-S | BNT162b2 | BNT162b2 |
PSI | 119.1 ± 45.5 | 117.5 ± 41.1 | 128.1 ± 42.3 | 0.496 | <0.001 | <0.001 |
Oxemia | 90.68 ± 10.18 | 90.91 ± 9.95 | 90.78 ± 10.43 | 0.826 | 0.925 | 0.807 |
pH | 7.339 ± 0.16 | 7.333 ± 0.15 | 7.360 ± 0.14 | 0.314 | 0.034 | 0.014 |
Lymphocytes | 691.9 ± 722.0 | 1040.4 ± 721.8 | 1091.1 ± 856.6 | <0.001 | <0.001 | 0.102 |
Neutrophils | 8309.4 ± 6674.1 | 11,972.3 ± 7959.6 | 10,479.9 ± 5828.0 | <0.001 | <0.001 | 0.024 |
LDH | 421.9 ± 400.2 | 416.3 ± 568.0 | 370.5 ± 258.2 | 0.814 | 0.046 | 0.166 |
ALP | 92.4 ± 61.5 | 170.3 ± 162.8 | 106.1 ± 75.6 | <0.001 | 0.006 | 0.024 |
AST | 56.4 ± 177.4 | 80.6 ± 224.9 | 62.0 ± 171.5 | 0.148 | 0.628 | 0.402 |
ALT | 45.2 ± 58.6 | 63.6 ± 149.6 | 49.2 ± 121.7 | 0.002 | 0.389 | 0.520 |
Ferritin | 1129.4 ± 769.2 | 1130.3 ± 790.9 | 807.8 ± 616.3 | 0.673 | <0.001 | <0.001 |
Platelets | 257.5 ± 136.5 | 264.5 ± 155.6 | 270.1 ± 131.3 | 0.057 | 0.894 | 0.130 |
MPV | 10.7 ± 1.1 | 10.5 ± 1.0 | 10.7 ± 1.2 | 0.006 | 0.706 | 0.042 |
CRP | 14.8 ± 19.9 | 14.1 ± 9.1 | 13.0 ± 17.7 | 0.699 | 0.230 | 0.562 |
D dimer | 2475.5 + 12,065.1 | 3312.1 ± 4438.8 | 2090.2 ± 2737.1 | 0.444 | 0.611 | 0.002 |
eGFR | 84.8 ± 66.2 | 62.8 ± 65.4 | 70.9 ± 53.8 | 0.004 | < 0.001 | 0.826 |
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Mendoza-Hernandez, M.A.; Guzman-Esquivel, J.; Ramos-Rojas, M.A.; Santillan-Luna, V.V.; Sanchez-Ramirez, C.A.; Hernandez-Fuentes, G.A.; Diaz-Martinez, J.; Melnikov, V.; Rojas-Larios, F.; Martinez-Fierro, M.L.; et al. Differences in the Evolution of Clinical, Biochemical, and Hematological Indicators in Hospitalized Patients with COVID-19 According to Their Vaccination Scheme: A Cohort Study in One of the World’s Highest Hospital Mortality Populations. Vaccines 2024, 12, 72. https://doi.org/10.3390/vaccines12010072
Mendoza-Hernandez MA, Guzman-Esquivel J, Ramos-Rojas MA, Santillan-Luna VV, Sanchez-Ramirez CA, Hernandez-Fuentes GA, Diaz-Martinez J, Melnikov V, Rojas-Larios F, Martinez-Fierro ML, et al. Differences in the Evolution of Clinical, Biochemical, and Hematological Indicators in Hospitalized Patients with COVID-19 According to Their Vaccination Scheme: A Cohort Study in One of the World’s Highest Hospital Mortality Populations. Vaccines. 2024; 12(1):72. https://doi.org/10.3390/vaccines12010072
Chicago/Turabian StyleMendoza-Hernandez, Martha A., Jose Guzman-Esquivel, Marco A. Ramos-Rojas, Vanessa V. Santillan-Luna, Carmen A. Sanchez-Ramirez, Gustavo A. Hernandez-Fuentes, Janet Diaz-Martinez, Valery Melnikov, Fabian Rojas-Larios, Margarita L. Martinez-Fierro, and et al. 2024. "Differences in the Evolution of Clinical, Biochemical, and Hematological Indicators in Hospitalized Patients with COVID-19 According to Their Vaccination Scheme: A Cohort Study in One of the World’s Highest Hospital Mortality Populations" Vaccines 12, no. 1: 72. https://doi.org/10.3390/vaccines12010072