OC 33.2 - Hyperinflammatory state and death in patients affected by COVID-19: role of vaccines.

Monday, July 11, 2022

11:00 AM – 11:15 AM

Location: ExCel Center, ICC Capital Suite Room 7&12

Presentation Format: In-Person

Presenting Author(s)

Laura Marchini, MD

Medical Resident
University of Perugia
Perugia, Umbria, Italy

Co-Author(s)

Maria Cristina Vedovati, MD

Professor
Vascular and Emergency Medicine, University of Perugia
Perugia, Umbria, Italy
CB

Cecilia Becattini, PhD

Professor
University of Perugia
Perugia, Umbria, Italy

Background: Systemic hyperinflammation in patients with COVID-19 is associated with a higher probability of severe disease and poor prognosis. The COVID-19 vaccines are expected to be associated with a lower risk of moderate-severe disease. However, data on the effects of vaccination on the inflammatory state and adverse outcomes in patients affected by COVID-19 are lacking.

Aims: To evaluate the association of hyperinflammation state and adverse outcome among vaccinated and unvaccinated patients for SARS-CoV-2 infection.

Methods: We performed an observational study on COVID-19 patients admitted to a non-ICU ward at Perugia Hospital from August to December 2021. The inclusion criteria were: age ≥ 18 years, hospitalization due to respiratory failure, and SARS-CoV-2 infection confirmed by nasopharyngeal RT-PCR swab. A patient was defined as vaccinated after a full cycle. Study outcomes were all-cause-death or symptomatic venous thromboembolism (VTE) and hyperinflammation state (defined as at least four values among CRP, LDH, ferritin, CPK, D-dimer above the threshold).

Results: Overall, 182 patients were included (mean age 68 years, range 18-98). All-cause death occurred in 16 patients (8.8%). Vaccinated patients were older (76 vs 61 years); they had a higher rate of comorbidities and a lower rate of NIV/HFNC requirement than unvaccinated patients. After age adjustment, the hyperinflammation state was significantly more frequent in unvaccinated compared to vaccinated patients (65 vs 37%, p= 0.004). Lack of vaccination was an independent predictor of in-hospital all-cause-death (HR 2.71, 95% CI 1.05-7.00, p=0.040) and all-cause-death or symptomatic VTE (HR 3.10, 95% CI 1.31-7.35, p=0.010). The risk of symptomatic VTE was not significantly higher in unvaccinated compared to vaccinated patients (5 vs 1%, HR 5.66, 95% CI 0.63-50.85).

Conclusion(s): Covid-19 vaccination is associated with a lower hyperinflammation state and lower risk of death compared to lack of vaccination. These findings should be confirmed in a larger population.