Epidemiology, Clinical Features and Outcomes of Hospitalized Patients with COVID-19 by Vaccination status: A Multicenter Historical Cohort Study

Introduction: COVID-19 disease resulted in over six million deaths worldwide. Although vaccines against SARS-CoV-2 demonstrated efficacy, breakthrough infections became increasingly common. There is still a lack of data regarding the severity and outcomes of COVID-19 among vaccinated compared to unvaccinated individuals. Methods This was a historical cohort study of adult patients hospitalized for COVID-19 in five Ascension hospitals in southeast Michigan. Electronic medical records were reviewed. Vaccine information was collected from the Michigan Care Improvement Registry. Data were analyzed using Student’s t-test, analysis of variance, the chi-squared test, the Mann-Whitney and Kruskal-Wallis tests, and multivariable logistic regression. Results Of 341 patients, the mean age was 57.9 ± 18.3 years, 54.8% (187/341) were female and 48.7% (166/341) were black/African American. Most patients were unvaccinated, 65.7%, with 8.5% and 25.8% receiving one dose or at least two doses, respectively. Unvaccinated patients were younger than fully vaccinated (p = 0.001) and were more likely to be black/African American (p = 0.002). Fully vaccinated patients were 5.3 times less likely to have severe/critical disease (WHO classification) than unvaccinated patients (OR = 0.19, p < 0.001), after controlling for age, BMI, race, home steroid use and serum albumin levels on admission. The case fatality rate in fully vaccinated patients was 3.4% compared to 17.9% in unvaccinated patients (p = 0.003). Unvaccinated patients also had higher rates of complications. Conclusions More in-hospital complications, severe disease, and death were observed in unvaccinated and partially vaccinated than in fully vaccinated patients. Factors associated with severe COVID-19 disease included advanced age, obesity, low serum albumin and home steroid use.