RESUMEN:
Antecedentes: El impacto de la disminución de la efectividad de la vacuna en la gravedad de los hallazgos relacionados con COVID-19 descubiertos mediante exámenes radiológicos sigue siendo poco explorado. Propósito: Evaluar la efectividad de las vacunas a lo largo del tiempo contra los resultados clínicos y radiológicos severos relacionados con las infecciones por SARS-CoV-2. Materiales y Métodos: Este estudio retrospectivo multicéntrico incluyó pacientes de la base de datos del Cohorte de Imágenes de COVID-19 de Corea que fueron hospitalizados por COVID-19 entre junio de 2021 y diciembre de 2022. Los pacientes que habían recibido al menos una dosis de una vacuna contra el SARS-CoV-2 fueron categorizados según el tiempo transcurrido entre el diagnóstico y su última vacunación. Se utilizó un análisis de regresión logística multivariable ajustado para estimar la efectividad de la vacuna contra un compuesto de resultados clínicos severos (ventilación invasiva, oxigenación por membrana extracorpórea o muerte hospitalaria) y neumonía radiológica severa (≥25% de afectación pulmonar), y se compararon las razones de probabilidades (OR) entre pacientes vacunados dentro de los 90 días del diagnóstico y aquellos vacunados más de 90 días antes del diagnóstico. Resultados: De 4196 pacientes con COVID-19 (edad media, 66 años ± 17 [DE]; 2132 [51%] mujeres, 2064 [49%] hombres), la proporción de neumonía severa desde su vacunación más reciente fue la siguiente: 90 días o menos, 18% (277 de 1527); entre 91 y 120 días, 22% (172 de 783); entre 121 y 180 días, 27% (274 de 1032); entre 181 y 240 días, 32% (159 de 496); y más de 240 días, 31% (110 de 358). Los pacientes vacunados más de 240 días antes del diagnóstico mostraron mayores probabilidades de resultados clínicos severos en comparación con los pacientes vacunados dentro de los 90 días (OR = 1.94 [IC del 95%: 1.16, 3.24]; P = .01). De manera similar, los pacientes vacunados más de 240 días antes del diagnóstico mostraron mayores probabilidades de neumonía severa en radiografías de tórax en comparación con los pacientes vacunados dentro de los 90 días (OR = 1.65 [IC del 95%: 1.13, 2.40]; P = .009). No se observó diferencia en las probabilidades de resultados clínicos severos (P = .13 a P = .68) o neumonía severa (P = .15 a P = .86) entre los pacientes vacunados 91–240 días antes del diagnóstico y aquellos vacunados dentro de los 90 días del diagnóstico. Conclusión: La efectividad de la vacuna contra resultados clínicos severos y neumonía severa relacionada con la infección por SARS-CoV-2 disminuyó gradualmente, con mayores probabilidades de ambos observados en pacientes vacunados más de 240 días antes del diagnóstico.

ABSTRACT:
Background: The impact of waning vaccine effectiveness on the severity of COVID-19–related findings discovered with radiologic examinations remains underexplored. Purpose: To evaluate the effectiveness of vaccines over time against severe clinical and radiologic outcomes related to SARS-CoV-2 infections. Materials and Methods: This multicenter retrospective study included patients in the Korean Imaging Cohort of COVID-19 database who were hospitalized for COVID-19 between June 2021 and December 2022. Patients who had received at least one dose of a SARS-CoV-2 vaccine were categorized based on the time elapsed between diagnosis and their last vaccination. Adjusted multivariable logistic regression analysis was used to estimate vaccine effectiveness against a composite of severe clinical outcomes (invasive ventilation, extracorporeal membrane oxygenation, or in-hospital death) and severe radiologic pneumonia (≥25% of lung involvement), and odds ratios (ORs) were compared between patients vaccinated within 90 days of diagnosis and those vaccinated more than 90 days before diagnosis. Results: Of 4196 patients with COVID-19 (mean age, 66 years ± 17 [SD]; 2132 [51%] women, 2064 [49%] men), the ratio of severe pneumonia since their most recent vaccination was as follows: 90 days or less, 18% (277 of 1527); between 91 and 120 days, 22% (172 of 783); between 121 and 180 days, 27% (274 of 1032); between 181 and 240 days, 32% (159 of 496); and more than 240 days, 31% (110 of 358). Patients vaccinated more than 240 days before diagnosis showed increased odds of severe clinical outcomes compared with patients vaccinated within 90 days (OR = 1.94 [95% CI: 1.16, 3.24]; P = .01). Similarly, patients vaccinated more than 240 days before diagnosis showed increased odds of severe pneumonia on chest radiographs compared with patients vaccinated within 90 days (OR = 1.65 [95% CI: 1.13, 2.40]; P = .009). No difference in odds of severe clinical outcomes (P = .13 to P = .68) or severe pneumonia (P = .15 to P = .86) were observed between patients vaccinated 91–240 days before diagnosis and those vaccinated within 90 days of diagnosis. Conclusion: Vaccine effectiveness against severe clinical outcomes and severe pneumonia related to SARS-CoV-2 infection gradually declined, with increased odds of both observed in patients vaccinated more than 240 days before diagnosis.

ABSTRACT:
Background: The impact of waning vaccine effectiveness on the severity of COVID-19–related findings discovered with radiologic examinations remains underexplored. Purpose: To evaluate the effectiveness of vaccines over time against severe clinical and radiologic outcomes related to SARS-CoV-2 infections. Materials and Methods: This multicenter retrospective study included patients in the Korean Imaging Cohort of COVID-19 database who were hospitalized for COVID-19 between June 2021 and December 2022. Patients who had received at least one dose of a SARS-CoV-2 vaccine were categorized based on the time elapsed between diagnosis and their last vaccination. Adjusted multivariable logistic regression analysis was used to estimate vaccine effectiveness against a composite of severe clinical outcomes (invasive ventilation, extracorporeal membrane oxygenation, or in-hospital death) and severe radiologic pneumonia (≥25% of lung involvement), and odds ratios (ORs) were compared between patients vaccinated within 90 days of diagnosis and those vaccinated more than 90 days before diagnosis. Results: Of 4196 patients with COVID-19 (mean age, 66 years ± 17 [SD]; 2132 [51%] women, 2064 [49%] men), the ratio of severe pneumonia since their most recent vaccination was as follows: 90 days or less, 18% (277 of 1527); between 91 and 120 days, 22% (172 of 783); between 121 and 180 days, 27% (274 of 1032); between 181 and 240 days, 32% (159 of 496); and more than 240 days, 31% (110 of 358). Patients vaccinated more than 240 days before diagnosis showed increased odds of severe clinical outcomes compared with patients vaccinated within 90 days (OR = 1.94 [95% CI: 1.16, 3.24]; P = .01). Similarly, patients vaccinated more than 240 days before diagnosis showed increased odds of severe pneumonia on chest radiographs compared with patients vaccinated within 90 days (OR = 1.65 [95% CI: 1.13, 2.40]; P = .009). No difference in odds of severe clinical outcomes (P = .13 to P = .68) or severe pneumonia (P = .15 to P = .86) were observed between patients vaccinated 91–240 days before diagnosis and those vaccinated within 90 days of diagnosis. Conclusion: Vaccine effectiveness against severe clinical outcomes and severe pneumonia related to SARS-CoV-2 infection gradually declined, with increased odds of both observed in patients vaccinated more than 240 days before diagnosis.