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en Espa&#241;a&#44; ha tra&#237;do el ingreso en la Unidad de Cuidados Intensivos &#40;UCI&#41; de pacientes con la vacuna administrada&#44; ya sea de forma parcial o completa&#44; quienes se han unido a los habituales no vacunados&#46; Esto hace que nos encontremos con un nuevo tipo de paciente cuya evoluci&#243;n no conocemos&#46; El objetivo del estudio es evaluar los efectos de la vacunaci&#243;n en la evoluci&#243;n de los pacientes con neumon&#237;a por SARS-CoV-2 ingresados en la UCI&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El periodo de estudio &#40;quinta ola&#41; fue del 2 de julio del 2021 al 8 de septiembre del 2021&#59; este periodo se defini&#243; por el intervalo en que la incidencia acumulada a los 14 d&#237;as superaba los 150 casos&#47;100&#46;000 habitantes&#44; que seg&#250;n las directrices del Ministerio de Sanidad de Espa&#241;a &#40;MSE&#41; se categoriza como una situaci&#243;n epidemiol&#243;gica de riesgo alto<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>&#46; El diagn&#243;stico de la infecci&#243;n por SARS-CoV-2 se realiz&#243; mediante reacci&#243;n en cadena de polimerasa &#40;PCR&#41; en muestras de exudado nasofar&#237;ngeo &#40;82&#37;&#41;&#44; broncoaspirado &#40;11&#37;&#41; o lavado broncoalveolar &#40;LBA&#41; &#40;7&#37;&#41;&#46; La vacunaci&#243;n completa se defini&#243;&#44; seg&#250;n el plan estrat&#233;gico del MSE&#44; como quienes hab&#237;an recibido la segunda dosis en los 7 &#40;Comirnaty&#174;&#41; y 14 &#40;Spikevax&#174; y Vaxzevria&#174;&#41; d&#237;as previos&#59; en el caso de la Vaccine Janssen&#174; a partir de los 14 d&#237;as de la &#250;nica dosis<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a>&#46; Las variables cuantitativas son expresadas como mediana y rango intercuart&#237;lico &#40;RIQ&#41; y las categ&#243;ricas como recuento &#40;porcentaje&#41;&#46; Para comparaciones de variables cuantitativas utilizamos la prueba ANOVA &#40;an&#225;lisis de la varianza&#41;&#44; con estudios post hoc para evidenciar diferencias entre grupos&#46; Para comparar variables categ&#243;ricas utilizamos la prueba de la chi al cuadrado con la aproximaci&#243;n de Fisher si no se cumplen las condiciones de aplicaci&#243;n&#46; Se considera significativo todo valor de p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Los datos se obtuvieron del registro de enfermos de COVID-19 del Servicio de Medicina Intensiva de nuestra instituci&#243;n&#44; previa aceptaci&#243;n del comit&#233; de &#233;tica y de investigaci&#243;n local&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El total de pacientes ingresados en este periodo fue de 76&#59; de los cuales 50 &#40;65&#44;8&#37;&#41; no estaban vacunados&#44; 11 &#40;14&#44;5&#37;&#41; parcialmente vacunados y 15 &#40;19&#44;7&#37;&#41; ten&#237;an una pauta completa&#46; Entre los vacunados&#44; la vacuna fue Comirnaty&#174; &#40;desarrollada por BioNTech y Pfizer&#41; en un 53&#44;9&#37; &#40;14&#47;26&#41;&#44; Spikevax&#174; &#40;desarrollada por Moderna&#41; 3&#44;9&#37; &#40;1&#47;26&#41;&#44; Vaxzevria&#174; &#40;desarrollada por AstraZeneca&#41; 23&#44;1 &#40;6&#47;26&#41; y COVID-19 Vaccine Janssen&#174; &#40;desarrollada por Janssen&#44; una compa&#241;&#237;a de Johnson&#38;Johnson&#41; 19&#44;2&#37; &#40;5&#47;26&#41;&#46; Los motivos de la no vacunaci&#243;n fue no estar citado en un 54&#37; &#40;27&#47;50&#41;&#44; rechazo voluntario en un 20&#37; &#40;10&#47;50&#41; y rechazo involuntario &#40;motivos laborales o de salud&#41; en un 26&#37; &#40;13&#47;50&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se describen las caracter&#237;sticas basales y los &#237;ndices de gravedad entre los grupos&#46; La <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> compara&#44; entre los grupos&#44; el soporte respiratorio recibido&#44; las complicaciones que aparecieron y la evoluci&#243;n&#46; Todos los pacientes fallecieron en la UCI&#44; ninguno en la planta hospitalaria tras el alta de la UCI&#46; En la <a class="elsevierStyleCrossRef" href="#sec0010">tabla 3 MES &#40;material suplementario&#44; anexo&#41;</a> se muestra la mortalidad en la UCI seg&#250;n los pacientes estandarizando por la edad &#40;seg&#250;n tengan m&#225;s o menos de 55 a&#241;os&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Hasta ahora sabemos que la vacunaci&#243;n dificulta la infecci&#243;n y&#44; si esta ocurre&#44; la probabilidad de desarrollar una enfermedad grave es mucho menor<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>&#46; Esto &#250;ltimo&#44; ha sido clave para disminuir la presi&#243;n asistencial en hospitales y las UCI&#59; adem&#225;s&#44; que ha modificado el perfil de los pacientes que ingresan con enfermedad grave por SARS-CoV-2<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;8</span></a>&#46; Sin embargo&#44; no conocemos c&#243;mo evolucionan los pacientes que han sido vacunados e ingresan en la UCI por neumon&#237;a grave por SARS-CoV-2&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Al inicio del periodo de estudio&#44; en Espa&#241;a&#44; alrededor de 18 millones de personas adultas hab&#237;an recibido la pauta completa<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&#46; En nuestra cohorte&#44; los no vacunados fueron m&#225;s j&#243;venes&#44; con una mediana de edad de 51&#44;5 &#40;RIQ&#58; 35&#44;8-60&#41; a&#241;os&#44; en comparaci&#243;n con los parcialmente &#40;mediana&#58; 62&#59; RIQ&#58; 44-67&#41; y los completamente vacunados &#40;mediana&#58; 57&#59; RIQ&#58; 49-68&#41;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;045&#46; La mortalidad y la estancia en la UCI fue similar&#44; con una mediana de 22 &#40;RIQ&#58; 14-27&#41; d&#237;as para los vacunados en comparaci&#243;n con los 25 &#40;RIQ&#58; 14-36&#41; d&#237;as de los no vacunados&#46; Los &#237;ndices de gravedad presentaron una tendencia a ser mayores en los no vacunados&#44; aunque sin significaci&#243;n estad&#237;stica&#46; Ajustando los resultados por la edad&#44; vemos que en los menores de 55 a&#241;os no hay fallecimientos entre los vacunados parcial o completamente&#44; mientras que en los no vacunados la mortalidad es del 6&#44;3&#37; &#40;<a class="elsevierStyleCrossRef" href="#sec0010">tabla 3 MES</a>&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">La necesidad de VMI entre los vacunados con pauta completa fue de un 93&#37; vs&#46; el 78&#37; de los no vacunados y los d&#237;as de VMI fueron 7 &#40;RIQ&#58; 1-10&#41; en los que ten&#237;an la pauta completa y 8 &#40;RIQ&#58; 1-20&#41; en los no vacunados&#46; La maniobra de dec&#250;bito prono la precisaron un 57&#37; de los vacunados completamente y el 64&#37; de los no vacunados&#46; En las complicaciones evolutivas hay una tendencia a presentar menos tromboembolia pulmonar y fracaso renal &#40;definido como una valoraci&#243;n mayor de <span class="elsevierStyleSmallCaps">ii</span> de la clasificaci&#243;n del grupo de Acute Kidney Injury Network&#41;&#59; Con relaci&#243;n a las infecciones&#44; no hubo infecciones por virus de herpes simple &#40;VHS&#41; entre los que ten&#237;an alguna pauta de vacunaci&#243;n&#44; mientras en los no vacunados ocurri&#243; en un 8&#37; de los casos &#40;con diagn&#243;stico realizado por PCR en LBA&#41;&#46; La aspergilosis pulmonar asociada a COVID-19 &#40;CAPA&#41; probada o probable<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> ocurri&#243; en un 8&#37; de los no vacunados y en un 18&#37; de los vacunados con pauta completa&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El grupo de pacientes vacunado con la pauta incompleta muestra caracter&#237;sticas comunes e h&#237;bridas entre los vacunados completamente y los no vacunados&#46; Las limitaciones de este estudio vienen marcadas por el tama&#241;o muestral que dif&#237;cilmente nos permite sacar conclusiones definitivas&#46; Pero a la vez&#44; la inmediatez del proceso epidemiol&#243;gico que atravesamos nos permite destacar que la infecci&#243;n grave por SARS-CoV-2 en un paciente plenamente vacunado puede tener diferentes caracter&#237;sticas evolutivas y complicaciones que son preciso conocer&#46; Otra limitaci&#243;n es no contar con la variante del virus&#44; lo cual puede afectar tanto a la respuesta inmunitaria como a la respuesta a la infecci&#243;n de la cohorte&#46; Futuros estudios con muestras mayores ayudar&#225;n a perfilar mejor estos hallazgos&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Si bien la quinta ola ha significado el control de la epidemia en gran medida por el impacto de las vacunas&#44; es necesario destacar que no se encontraron grandes diferencias en la evoluci&#243;n en la UCI entre vacunados y no vacunados&#46; Sin embargo&#44; la mayor&#237;a de los pacientes &#40;66&#37;&#41; ingresados en este periodo no hab&#237;an recibido la vacuna&#59; adem&#225;s&#44; los no vacunados fueron m&#225;s j&#243;venes y no hubo fallecidos entre los menores de 55 a&#241;os que hab&#237;an recibido alguna dosis de la vacuna&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No vacunaci&#243;n&#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#41; &#40;65&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;413&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;3-4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;3-4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;645&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>APACHE II&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9 &#40;7-12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ECMO&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TEP confirmado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;14&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;40&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;9&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;114&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;23&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;18&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;621&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;41&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;36&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;815&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;395&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infecci&#243;n por aspergillus&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;617&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20&#44;5 &#40;15&#44;5-36&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;13&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;658&nbsp;\t\t\t\t\t\t\n
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CARTA CIENTÍFICA
Efectos de la vacunación contra la COVID-19 en la evolución de los pacientes críticos
Effects of vaccination against COVID-19 on the evolution of critically ill patients
G. Morales Varas
Autor para correspondencia
guillermo.moralesvaras@gmail.com

Autor para correspondencia.
, M. Sánchez Casado, R. Padilla Peinado, F. Morán Gallego, M. Buj Vicente, A. Rodríguez Villamizar
Unidad de Cuidados Intensivos, Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Toledo, Toledo, España
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en Espa&#241;a&#44; ha tra&#237;do el ingreso en la Unidad de Cuidados Intensivos &#40;UCI&#41; de pacientes con la vacuna administrada&#44; ya sea de forma parcial o completa&#44; quienes se han unido a los habituales no vacunados&#46; Esto hace que nos encontremos con un nuevo tipo de paciente cuya evoluci&#243;n no conocemos&#46; El objetivo del estudio es evaluar los efectos de la vacunaci&#243;n en la evoluci&#243;n de los pacientes con neumon&#237;a por SARS-CoV-2 ingresados en la UCI&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El periodo de estudio &#40;quinta ola&#41; fue del 2 de julio del 2021 al 8 de septiembre del 2021&#59; este periodo se defini&#243; por el intervalo en que la incidencia acumulada a los 14 d&#237;as superaba los 150 casos&#47;100&#46;000 habitantes&#44; que seg&#250;n las directrices del Ministerio de Sanidad de Espa&#241;a &#40;MSE&#41; se categoriza como una situaci&#243;n epidemiol&#243;gica de riesgo alto<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>&#46; El diagn&#243;stico de la infecci&#243;n por SARS-CoV-2 se realiz&#243; mediante reacci&#243;n en cadena de polimerasa &#40;PCR&#41; en muestras de exudado nasofar&#237;ngeo &#40;82&#37;&#41;&#44; broncoaspirado &#40;11&#37;&#41; o lavado broncoalveolar &#40;LBA&#41; &#40;7&#37;&#41;&#46; La vacunaci&#243;n completa se defini&#243;&#44; seg&#250;n el plan estrat&#233;gico del MSE&#44; como quienes hab&#237;an recibido la segunda dosis en los 7 &#40;Comirnaty&#174;&#41; y 14 &#40;Spikevax&#174; y Vaxzevria&#174;&#41; d&#237;as previos&#59; en el caso de la Vaccine Janssen&#174; a partir de los 14 d&#237;as de la &#250;nica dosis<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a>&#46; Las variables cuantitativas son expresadas como mediana y rango intercuart&#237;lico &#40;RIQ&#41; y las categ&#243;ricas como recuento &#40;porcentaje&#41;&#46; Para comparaciones de variables cuantitativas utilizamos la prueba ANOVA &#40;an&#225;lisis de la varianza&#41;&#44; con estudios post hoc para evidenciar diferencias entre grupos&#46; Para comparar variables categ&#243;ricas utilizamos la prueba de la chi al cuadrado con la aproximaci&#243;n de Fisher si no se cumplen las condiciones de aplicaci&#243;n&#46; Se considera significativo todo valor de p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Los datos se obtuvieron del registro de enfermos de COVID-19 del Servicio de Medicina Intensiva de nuestra instituci&#243;n&#44; previa aceptaci&#243;n del comit&#233; de &#233;tica y de investigaci&#243;n local&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El total de pacientes ingresados en este periodo fue de 76&#59; de los cuales 50 &#40;65&#44;8&#37;&#41; no estaban vacunados&#44; 11 &#40;14&#44;5&#37;&#41; parcialmente vacunados y 15 &#40;19&#44;7&#37;&#41; ten&#237;an una pauta completa&#46; Entre los vacunados&#44; la vacuna fue Comirnaty&#174; &#40;desarrollada por BioNTech y Pfizer&#41; en un 53&#44;9&#37; &#40;14&#47;26&#41;&#44; Spikevax&#174; &#40;desarrollada por Moderna&#41; 3&#44;9&#37; &#40;1&#47;26&#41;&#44; Vaxzevria&#174; &#40;desarrollada por AstraZeneca&#41; 23&#44;1 &#40;6&#47;26&#41; y COVID-19 Vaccine Janssen&#174; &#40;desarrollada por Janssen&#44; una compa&#241;&#237;a de Johnson&#38;Johnson&#41; 19&#44;2&#37; &#40;5&#47;26&#41;&#46; Los motivos de la no vacunaci&#243;n fue no estar citado en un 54&#37; &#40;27&#47;50&#41;&#44; rechazo voluntario en un 20&#37; &#40;10&#47;50&#41; y rechazo involuntario &#40;motivos laborales o de salud&#41; en un 26&#37; &#40;13&#47;50&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se describen las caracter&#237;sticas basales y los &#237;ndices de gravedad entre los grupos&#46; La <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> compara&#44; entre los grupos&#44; el soporte respiratorio recibido&#44; las complicaciones que aparecieron y la evoluci&#243;n&#46; Todos los pacientes fallecieron en la UCI&#44; ninguno en la planta hospitalaria tras el alta de la UCI&#46; En la <a class="elsevierStyleCrossRef" href="#sec0010">tabla 3 MES &#40;material suplementario&#44; anexo&#41;</a> se muestra la mortalidad en la UCI seg&#250;n los pacientes estandarizando por la edad &#40;seg&#250;n tengan m&#225;s o menos de 55 a&#241;os&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Hasta ahora sabemos que la vacunaci&#243;n dificulta la infecci&#243;n y&#44; si esta ocurre&#44; la probabilidad de desarrollar una enfermedad grave es mucho menor<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>&#46; Esto &#250;ltimo&#44; ha sido clave para disminuir la presi&#243;n asistencial en hospitales y las UCI&#59; adem&#225;s&#44; que ha modificado el perfil de los pacientes que ingresan con enfermedad grave por SARS-CoV-2<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;8</span></a>&#46; Sin embargo&#44; no conocemos c&#243;mo evolucionan los pacientes que han sido vacunados e ingresan en la UCI por neumon&#237;a grave por SARS-CoV-2&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Al inicio del periodo de estudio&#44; en Espa&#241;a&#44; alrededor de 18 millones de personas adultas hab&#237;an recibido la pauta completa<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&#46; En nuestra cohorte&#44; los no vacunados fueron m&#225;s j&#243;venes&#44; con una mediana de edad de 51&#44;5 &#40;RIQ&#58; 35&#44;8-60&#41; a&#241;os&#44; en comparaci&#243;n con los parcialmente &#40;mediana&#58; 62&#59; RIQ&#58; 44-67&#41; y los completamente vacunados &#40;mediana&#58; 57&#59; RIQ&#58; 49-68&#41;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;045&#46; La mortalidad y la estancia en la UCI fue similar&#44; con una mediana de 22 &#40;RIQ&#58; 14-27&#41; d&#237;as para los vacunados en comparaci&#243;n con los 25 &#40;RIQ&#58; 14-36&#41; d&#237;as de los no vacunados&#46; Los &#237;ndices de gravedad presentaron una tendencia a ser mayores en los no vacunados&#44; aunque sin significaci&#243;n estad&#237;stica&#46; Ajustando los resultados por la edad&#44; vemos que en los menores de 55 a&#241;os no hay fallecimientos entre los vacunados parcial o completamente&#44; mientras que en los no vacunados la mortalidad es del 6&#44;3&#37; &#40;<a class="elsevierStyleCrossRef" href="#sec0010">tabla 3 MES</a>&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">La necesidad de VMI entre los vacunados con pauta completa fue de un 93&#37; vs&#46; el 78&#37; de los no vacunados y los d&#237;as de VMI fueron 7 &#40;RIQ&#58; 1-10&#41; en los que ten&#237;an la pauta completa y 8 &#40;RIQ&#58; 1-20&#41; en los no vacunados&#46; La maniobra de dec&#250;bito prono la precisaron un 57&#37; de los vacunados completamente y el 64&#37; de los no vacunados&#46; En las complicaciones evolutivas hay una tendencia a presentar menos tromboembolia pulmonar y fracaso renal &#40;definido como una valoraci&#243;n mayor de <span class="elsevierStyleSmallCaps">ii</span> de la clasificaci&#243;n del grupo de Acute Kidney Injury Network&#41;&#59; Con relaci&#243;n a las infecciones&#44; no hubo infecciones por virus de herpes simple &#40;VHS&#41; entre los que ten&#237;an alguna pauta de vacunaci&#243;n&#44; mientras en los no vacunados ocurri&#243; en un 8&#37; de los casos &#40;con diagn&#243;stico realizado por PCR en LBA&#41;&#46; La aspergilosis pulmonar asociada a COVID-19 &#40;CAPA&#41; probada o probable<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> ocurri&#243; en un 8&#37; de los no vacunados y en un 18&#37; de los vacunados con pauta completa&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El grupo de pacientes vacunado con la pauta incompleta muestra caracter&#237;sticas comunes e h&#237;bridas entre los vacunados completamente y los no vacunados&#46; Las limitaciones de este estudio vienen marcadas por el tama&#241;o muestral que dif&#237;cilmente nos permite sacar conclusiones definitivas&#46; Pero a la vez&#44; la inmediatez del proceso epidemiol&#243;gico que atravesamos nos permite destacar que la infecci&#243;n grave por SARS-CoV-2 en un paciente plenamente vacunado puede tener diferentes caracter&#237;sticas evolutivas y complicaciones que son preciso conocer&#46; Otra limitaci&#243;n es no contar con la variante del virus&#44; lo cual puede afectar tanto a la respuesta inmunitaria como a la respuesta a la infecci&#243;n de la cohorte&#46; Futuros estudios con muestras mayores ayudar&#225;n a perfilar mejor estos hallazgos&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Si bien la quinta ola ha significado el control de la epidemia en gran medida por el impacto de las vacunas&#44; es necesario destacar que no se encontraron grandes diferencias en la evoluci&#243;n en la UCI entre vacunados y no vacunados&#46; Sin embargo&#44; la mayor&#237;a de los pacientes &#40;66&#37;&#41; ingresados en este periodo no hab&#237;an recibido la vacuna&#59; adem&#225;s&#44; los no vacunados fueron m&#225;s j&#243;venes y no hubo fallecidos entre los menores de 55 a&#241;os que hab&#237;an recibido alguna dosis de la vacuna&#46;</p></span>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>D&#237;as de VM invasiva&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dec&#250;bito prono&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;658&nbsp;\t\t\t\t\t\t\n
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ISSN: 02105691
Idioma original: Español
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