Abstract
BackgroundGiven the rapid increased in confirmed coronavirus disease 2019 (COVID-19) and related mortality, it is important to identify vulnerable patients. Immunocompromised status is considered a risk factor for developing severe COVID-19. We aimed to determine whether immunocompromised patients with COVID-19 have an increased risk of mortality.MethodThe groups’ baseline characteristics were balanced using a propensity score-based inverse probability of treatment weighting approach. Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated for the risks of in-hospital mortality and other outcomes according to immunocompromised status using a multivariable logistic regression model. We identified immunocompromised status based on a diagnosis of malignancy or HIV/AIDS, having undergone organ transplantation within 3 years, prescriptions for corticosteroids or oral immunosuppressants for ≥30 days, and at least one prescription for non-oral immunosuppressants during the last year.ResultsThe 6,435 COVID-19 patients (≥18 years) included 871 immunocompromised (13.5%) and 5,564 non-immunocompromised (86.5%). Immunocompromised COVID-19 patients were older (60.1±16.4 years vs. 47.1±18.7 years, absolute standardized mean difference: 0.738). The immunocompromised group had more comorbidities, a higher Charlson comorbidity index, and a higher in-hospital mortality rate (9.6% vs. 2.3%; p < .001). The immunocompromised group still had a significantly higher in-hospital mortality rate after inverse probability of treatment weighting (6.4% vs. 2.0%, p < .001). Multivariable analysis adjusted for baseline imbalances revealed that immunocompromised status was independently associated with a higher risk of mortality among COVID-19 patients (adjusted odds ratio [aOR]: 2.09, 95% CI: 1.62–2.68, p < .001).ConclusionsImmunocompromised status among COVID-19 patients was associated with a significantly increased risk of mortality.
Highlights
The coronavirus disease 2019 (COVID-19) pandemic is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has emerged as a global threat to healthcare systems
Multivariable analysis adjusted for baseline imbalances revealed that immunocompromised status was independently associated
Viral infections in immunocompromised patients are more likely to progress to severe disease [8], and immunocompromised status linked to malignancy or transplantation is considered a risk factor for developing severe COVID-19 [9,10,11]
Summary
The coronavirus disease 2019 (COVID-19) pandemic is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has emerged as a global threat to healthcare systems. Given the rapid increases in confirmed COVID-19 cases and related mortality, it is important to identify vulnerable patients. A meta-analysis of 3,027 patients with SARS-CoV-2 infection revealed that poor COVID-19-related outcomes were associated with age of >65 years and comorbidities (including hypertension and diabetes), but not malignancy [14]. In this setting, immunosuppressed status can be related to acquired immunodeficiency syndrome (AIDS), hematological or solid malignancies, organ transplantation, and immunosuppressive medications [15]. Given the rapid increased in confirmed coronavirus disease 2019 (COVID-19) and related mortality, it is important to identify vulnerable patients. We aimed to determine whether immunocompromised patients with COVID-19 have an increased risk of mortality
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