Risk prediction of covid-19 related death and hospital admission in adults after covid-19 vaccination: national prospective cohort study

Autor: Ruth H. Keogh, Nazmus Haq, Karla Diaz-Ordaz, Andrew Hayward, Julia Hippisley-Cox, Malcolm G Semple, Peter W.M. Johnson, Peter Sellen, Ewen M Harrison, Nisha Mehta, Ronan A Lyons, Jonathan S. Nguyen-Van-Tam, Carol Coupland, Shamim Rahman, Jonathan Valabhji, Aziz Sheikh, Frank Kee, Kamlesh Khunti
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Adult
Male
medicine.medical_specialty
COVID-19 Vaccines
risk prediction
Covid-19
death and hospital admission
Covid-19 vaccination
Databases
Factual
Comorbidity
Corrections
Risk Assessment
SDG 3 - Good Health and Well-being
Internal medicine
ChAdOx1 nCoV-19
medicine
Humans
Prospective Studies
Prospective cohort study
Kidney transplantation
BNT162 Vaccine
Aged
COVID-19 Vaccines - administration & dosage - immunology
Aged
80 and over
business.industry
SARS-CoV-2
Research
Incidence (epidemiology)
Vaccination
COVID-19
Vaccination - statistics & numerical data
General Medicine
Middle Aged
medicine.disease
COVID-19 - immunology - mortality
Confidence interval
United Kingdom
Hospitalization
United Kingdom - epidemiology
Female
Hospitalization - statistics & numerical data
Risk assessment
business
Body mass index
Kidney disease
Zdroj: Hippisley-Cox, J, Coupland, C A, Mehta, N, Keogh, R H, Diaz-Ordaz, K, Khunti, K, Lyons, R A, Kee, F, Sheikh, A, Rahman, S, Valabhji, J, Harrison, E M, Sellen, P, Haq, N, Semple, M G, Johnson, P W M, Hayward, A & Nguyen-Van-Tam, J S 2021, ' Risk prediction of covid-19 related death and hospital admission in adults after covid-19 vaccination: national prospective cohort study ', BMJ, vol. 374, n2244 . https://doi.org/10.1136/bmj.n2244
The BMJ
Hippisley-Cox, J, Coupland, C A C, Mehta, N, Keogh, R H, Diaz-Ordaz, K, Khunti, K, Lyons, R A, Kee, F, Sheikh, A, Rahman, S, Valabhji, J, Harrison, E M, Sellen, P, Haq, N, Semple, M G, Johnson, P WM, Hayward, A & Nguyen-Van-Tam, J S 2021, ' Risk prediction of covid-19 related death and hospital admission in adults after covid-19 vaccination : national prospective cohort study ', British Medical Journal (BMJ), vol. 374, 2244 . https://doi.org/10.1136/bmj.n2244 (
ISSN: 0959-8138
1756-1833
DOI: 10.1136/bmj.n2244
Popis: Objectives To derive and validate risk prediction algorithms to estimate the risk of covid-19 related mortality and hospital admission in UK adults after one or two doses of covid-19 vaccination. Design Prospective, population based cohort study using the QResearch database linked to data on covid-19 vaccination, SARS-CoV-2 results, hospital admissions, systemic anticancer treatment, radiotherapy, and the national death and cancer registries. Settings Adults aged 19-100 years with one or two doses of covid-19 vaccination between 8 December 2020 and 15 June 2021. Main outcome measures Primary outcome was covid-19 related death. Secondary outcome was covid-19 related hospital admission. Outcomes were assessed from 14 days after each vaccination dose. Models were fitted in the derivation cohort to derive risk equations using a range of predictor variables. Performance was evaluated in a separate validation cohort of general practices. Results Of 6 952 440 vaccinated patients in the derivation cohort, 5 150 310 (74.1%) had two vaccine doses. Of 2031 covid-19 deaths and 1929 covid-19 hospital admissions, 81 deaths (4.0%) and 71 admissions (3.7%) occurred 14 days or more after the second vaccine dose. The risk algorithms included age, sex, ethnic origin, deprivation, body mass index, a range of comorbidities, and SARS-CoV-2 infection rate. Incidence of covid-19 mortality increased with age and deprivation, male sex, and Indian and Pakistani ethnic origin. Cause specific hazard ratios were highest for patients with Down’s syndrome (12.7-fold increase), kidney transplantation (8.1-fold), sickle cell disease (7.7-fold), care home residency (4.1-fold), chemotherapy (4.3-fold), HIV/AIDS (3.3-fold), liver cirrhosis (3.0-fold), neurological conditions (2.6-fold), recent bone marrow transplantation or a solid organ transplantation ever (2.5-fold), dementia (2.2-fold), and Parkinson’s disease (2.2-fold). Other conditions with increased risk (ranging from 1.2-fold to 2.0-fold increases) included chronic kidney disease, blood cancer, epilepsy, chronic obstructive pulmonary disease, coronary heart disease, stroke, atrial fibrillation, heart failure, thromboembolism, peripheral vascular disease, and type 2 diabetes. A similar pattern of associations was seen for covid-19 related hospital admissions. No evidence indicated that associations differed after the second dose, although absolute risks were reduced. The risk algorithm explained 74.1% (95% confidence interval 71.1% to 77.0%) of the variation in time to covid-19 death in the validation cohort. Discrimination was high, with a D statistic of 3.46 (95% confidence interval 3.19 to 3.73) and C statistic of 92.5. Performance was similar after each vaccine dose. In the top 5% of patients with the highest predicted covid-19 mortality risk, sensitivity for identifying covid-19 deaths within 70 days was 78.7%. Conclusion This population based risk algorithm performed well showing high levels of discrimination for identifying those patients at highest risk of covid-19 related death and hospital admission after vaccination.
Databáze: OpenAIRE
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