Efficacy of two doses of COVID-19 vaccine against severe COVID-19 in those with risk conditions and residual risk to the clinically extremely vulnerable: the REACT-SCOT case-control study

Objectives - To determine whether COVID-19 efficacy varies with clinical risk category and to investigate risk factors for severe COVID-19 in those who have received two doses of vaccine. Design - Matched case-control study (REACT-SCOT). Setting - Population of Scotland from 1 December 2020 to 19 August 2021. Main outcome measure - Severe COVID-19, defined as cases with entry to critical care or fatal outcome. Results - Efficacy against severe COVID-19 of two doses of vaccine was 93% (95 percent CI 90% to 95%) in those without designated risk conditions, 89% (95 percent CI 85% to 92%) in those with moderate risk conditions, but only 66% (95 percent CI 52% to 76%) in those designated as clinically extremely vulnerable (CEV) and eligible for shielding. Of the 330 cases of severe COVID-19 in double-vaccinated individuals, 47% had moderate risk conditions and 41% were CEV. In the double-vaccinated CEV group, the rate ratio for severe disease (with no risk condition as reference category) was highest in solid organ transplants at 98 (95% CI 29 to 332) but even in this subgroup the absolute risk of severe COVID-19 was low (14 cases in 16079 person-months of follow-up). Conclusions - Two doses of vaccine protect against severe COVID-19 in CEV individuals but the residual risk in double-vaccinated individuals remains far higher in those who are CEV than in those who are not. These results suggest that any policy of offering booster doses to doubly-vaccinated individuals should focus initially on the clinically vulnerable, and lay a basis for determining eligibility for passive immunization to protect those at highest risk.

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Relation of severe COVID-19 to polypharmacy and prescribing of psychotropic drugs: the REACT-SCOT case-control study

BMC Medicine ◽

10.1186/s12916-021-01907-8 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Paul M. McKeigue ◽

◽

Sharon Kennedy ◽

Amanda Weir ◽

Jen Bishop ◽

...

Keyword(s):

Primary Care ◽

Rate Ratio ◽

Case Control Study ◽

Fatal Outcome ◽

Case Control ◽

Care Practice ◽

Drug Classes ◽

Increased Risk ◽

Co Morbidity ◽

Control Study

Abstract Background The objective of this study was to investigate the relation of severe COVID-19 to prior drug prescribing. Methods Severe cases were defined by entry to critical care or fatal outcome. For this matched case-control study (REACT-SCOT), all 4251 cases of severe COVID-19 in Scotland since the start of the epidemic were matched for age, sex and primary care practice to 36,738 controls from the population register. Records were linked to hospital discharges since June 2015 and dispensed prescriptions issued in primary care during the last 240 days. Results Severe COVID-19 was strongly associated with the number of non-cardiovascular drug classes dispensed. This association was strongest in those not resident in a care home, in whom the rate ratio (95% CI) associated with dispensing of 12 or more drug classes versus none was 10.8 (8.8, 13.3), and in those without any of the conditions designated as conferring increased risk of COVID-19. Of 17 drug classes postulated at the start of the epidemic to be “medications compromising COVID”, all were associated with increased risk of severe COVID-19 and these associations were present in those without any of the designated risk conditions. The fraction of cases in the population attributable to exposure to these drug classes was 38%. The largest effect was for antipsychotic agents: rate ratio 4.18 (3.42, 5.11). Other drug classes with large effects included proton pump inhibitors (rate ratio 2.20 (1.72, 2.83) for = 2 defined daily doses/day), opioids (3.66 (2.68, 5.01) for = 50 mg morphine equivalent/day) and gabapentinoids. These associations persisted after adjusting for covariates and were stronger with recent than with non-recent exposure. Conclusions Severe COVID-19 is associated with polypharmacy and with drugs that cause sedation, respiratory depression, or dyskinesia; have anticholinergic effects; or affect the gastrointestinal system. These associations are not easily explained by co-morbidity. Measures to reduce the burden of mortality and morbidity from COVID-19 should include reinforcing existing guidance on reducing overprescribing of these drug classes and limiting inappropriate polypharmacy. Registration ENCEPP number https://EUPAS35558

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Six‐month risk of Pneumocystis pneumonia following acute cellular rejection: A case‐control study in solid organ transplant recipients

Clinical Transplantation ◽

10.1111/ctr.14322 ◽

2021 ◽

Author(s):

Seyed M. Hosseini‐Moghaddam ◽

Mostafa Shokoohi ◽

Gagandeep Singh ◽

Atul D. Nagpal ◽

Anthony M. Jevnikar

Keyword(s):

Case Control Study ◽

Organ Transplant ◽

Pneumocystis Pneumonia ◽

Case Control ◽

Acute Cellular Rejection ◽

Solid Organ ◽

Transplant Recipients ◽

Solid Organ Transplant Recipients ◽

Control Study ◽

Cellular Rejection

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A Complete Analysis of Variability for Estimates of Absolute Risk from a Population-Based Case-Control Study on Breast Cancer

Biometrical Journal ◽

10.1002/bimj.4710370102 ◽

1995 ◽

Vol 37 (1) ◽

pp. 1-24 ◽

Cited By ~ 4

Author(s):

Jacques Benichou

Keyword(s):

Breast Cancer ◽

Case Control Study ◽

Absolute Risk ◽

Population Based ◽

Case Control ◽

Complete Analysis ◽

Control Study

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Risk factors for noncatheter-related Candida bloodstream infections in intensive care units: A multicenter case-control study

Medical Mycology ◽

10.1093/mmy/myy127 ◽

2018 ◽

Vol 57 (6) ◽

pp. 668-674 ◽

Cited By ~ 1

Author(s):

Ferhat Arslan ◽

Hulya Caskurlu ◽

Sema Sarı ◽

Hayriye Cankar Dal ◽

Sema Turan ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Intensive Care Units ◽

Case Control Study ◽

Absolute Risk ◽

Subsequent Development ◽

Bloodstream Infections ◽

Case Control ◽

Prior Exposure ◽

Control Study

Abstract Candida bloodstream infections are associated with high mortality among critically ill patients in intensive care units (ICUs). Studies that explore the risk factors for candidemia may support better patient care in intensive care units. We conducted a retrospective, multicenter case-control study to investigate the risk factors for noncatheter-related Candida bloodstream infections (CBSI) in adult ICUs. Participants selected controls randomly on a 1:1 basis among all noncase patients stayed during the same period in ICUs. Data on 139 cases and 140 controls were deemed eligible. Among the controls, 69 patients died. The stratified Fine-Gray model was used to estimate the subdistribution Hazard ratios. The subdistribution hazards and 95% confidence intervals for final covariates were as follows: prior exposure to antimycotic agents, 2.21 (1.56–3.14); prior exposure to N-acetylcysteine, 0.11 (0.03–0.34) and prior surgical intervention, 1.26 (0.76–2.11). Of the patients, those exposed to antimycotic drugs, 87.1% (54/62) had breakthrough candidemia. Serious renal, hepatic, or hematologic side effects were comparable between patients those exposed and not-exposed to systemic antimycotic drugs. Untargeted administration of antimycotic drugs did not improve survival among candidemic patients (not-exposed, 63.6% [49/77]; exposed % 66.1 [41/62]; P = .899). This study documented that exposure to an antifungal agent is associated with increased the risk of subsequent development of CBSIs among nonneutropenic adult patients admitted to the ICU. Only two centers regularly prescribed N-acetylcysteine. Due to the limited number of subjects, we interpreted the positive effect of N-acetylcysteine on the absolute risk of CBSIs with caution.

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