Comprehensive statistical analysis reveals significant benefits of COVID-19 vaccination in hospitalized patients: propensity score, covariate adjustment, and feature importance by permutation.
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de Moraes Eduardo Villela, Pires Magda Carvalho, Costa Amanda Abrantes Abreu, Nunes Aline Gabrielle Sousa, de Amorim Caroline Lopes, Manenti Euler Roberto Fernandes, Lucas Fernanda Barbosa, Rodrigues Fernanda d'Athayde, Anschau Fernando, do Nascimento Guilherme Fonseca, Vietta Giovanna Grunewald, Moreira Jessica Fernandes Benavides, Ruschel Karen Brasil, Costa Monica Aparecida, Duraes Pamela Andrea Alves, Van Der Sand Germani Pedro Augusto, Dos Reis Priscilla Pereira, Menezes Rochele Mosmann, da Rocha Leonardo Chaves Dutra, Gonçalves Marcos André, Tupinambas Unaí, Marcolino Milena Soriano
Аннотация
METHODS: This retrospective cohort included adult COVID-19 patients admitted from March 2021 to August 2022 from 27 hospitals. Clinical characteristics, vaccination status, and outcomes were extracted from medical records. Vaccinated and unvaccinated patients were compared using propensity score analyses, calculated based on variables associated with vaccination status and/or outcomes, including waves. The vaccination effect was also assessed by covariate adjustment and feature importance by permutation.
RESULTS: From the 3,188 patients, 1,963 (61.6%) were unvaccinated and 1,225 (38.4%) were fully vaccinated. Among these, 558 vaccinated individuals were matched with 558 unvaccinated ones. Vaccinated patients had lower rates of mortality (19.4% vs. 33.3%), invasive mechanical ventilation (IMV-18.3% vs. 34.6%), noninvasive mechanical ventilation (NIMV-10.6% vs. 22.0%), intensive care unit admission (ICU-32.0% vs. 44.1%) vasoactive drug use (21.1% vs. 32.6%), dialysis (8.2% vs. 14.7%) hospital length of stay (7.0 vs. 9.0 days), and thromboembolic events (3.9% vs.7.7%), p < 0.05 for all. Risk-adjusted multivariate analysis demonstrated a significant inverse association between vaccination and in-hospital mortality (adjusted odds ratio [aOR] = 0.42, 95% confidence interval [CI]: 0.31-0.56; p < 0.001) as well as IMV (aOR = 0.40, 95% CI: 0.30-0.53; p < 0.001). These results were consistent in all analyses, including feature importance by permutation.
CONCLUSION: Vaccinated patients admitted to hospital with COVID-19 had significantly lower mortality and other severe outcomes than unvaccinated ones during the Delta and Omicron waves. These findings have important implications for public health strategies and support the critical importance of vaccination efforts, particularly in low-income countries, where vaccination coverage remains suboptimal.