The clinical presentation and outcomes of COVID-19 in immunocompromised hosts in comparison to comorbid and immunocompetent patients: retrospective study of 384 cases
Öz
Objective:
Immunocompromised hosts (ICH) are at a higher risk of severe infections and mortality. This study aimed to examine the clinical manifestations and outcomes of ICH who were admitted to the hospital for COVID-19.
Method:
A total of 384 patients (mean age 61.515.9 y, 168 female) who were hospitalized between March 2020 and December 2020 were included in the study. These patients were examined in three groups: the ICH (n=40), comorbid patients (n=101), and the control group comprising immunocompetent patients without any comorbidities (n=243). All clinical and laboratory data were retrieved from the electronic hospital records and compared between the three groups retrospectively.
Results:
The mean age was 61.215.0 for ICH, 66.112.3 for comorbid, and 59.617.0 for control groups (p=0.003). We found that the mean leukocyte and neutrophil counts, C-reactive protein (CRP), ferritin, and D-Dimer levels were significantly higher and the albumin level was lower in ICH compared to the other two groups (p<0.05). On CT scans, ground-glass opacities were seen less frequently in ICH compared to the other groups (p=0.035). The mortality rate was 32.5% in the ICH, 22.8% in the comorbid, and 15.2% in the control groups (p=0.019). Within the ICH group, the mean leukocyte and neutrophil counts and LDH levels were higher and the SpO2/FiO₂ ratio was lower in patients who died (p<0.05).
Conclusion:
We found that had higher mortality in ICH with COVID-19. Being ICH condition, elder age, elevated LDH levels, and decreased Sat/FiO2 were associated with increased mortality.
Anahtar Kelimeler
Clinical outcomes COVID-19 immunocompromised immunosuppressed pandemic
Kaynakça
- “Archived: WHO Timeline - COVID-19.” https://www.who.int/news/item/27-04-2020-who-timeline---covid-19 (accessed May 10, 2022).
- “WHO Coronavirus (COVID-19) Dashboard | WHO Coronavirus (COVID-19) Dashboard With Vaccination Data.” https://covid19.who.int/ (accessed Nov. 18, 2022).
- D. Wang et al., “Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China,” JAMA, vol. 323, no. 11, pp. 1061–1069, Mar. 2020, doi: 10.1001/JAMA.2020.1585.
- X. Wang et al., “Clinical characteristics of non-critically ill patients with novel coronavirus infection (COVID 19) in a Fangcang Hospital,” Clinical Microbiology and Infection, vol. 26, no. 8, p. 1063, Aug. 2020, doi: 10.1016/J.CMI.2020.03.032.
- D. Ward et al., “The effect of immunosuppressants on the prognosis of SARS-CoV-2 infection,” The European Respiratory Journal, vol. 59, no. 4, p. 2100769, Apr. 2022, doi: 10.1183/13993003.00769-2021.
- M. Fung and J. M. Babik, “COVID-19 in Immunocompromised Hosts: What We Know So Far,” Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, vol. 72, no. 2, pp. 340–350, Jan. 2021, doi: 10.1093/CID/CIAA863.
- Y. Zhou et al., “Comorbidities and the risk of severe or fatal outcomes associated with coronavirus disease 2019: A systematic review and meta-analysis,” International Journal of Infectious Diseases, vol. 99, p. 47, Oct. 2020, doi: 10.1016/J.IJID.2020.07.029.
- J. P. Kooman and F. M. Van Der Sande, “COVID-19 in ESRD and Acute Kidney Injury,” Blood Purification, vol. 50, no. 5, p. 1, Jul. 2021, doi: 10.1159/000513214.
- M. Syed-Ahmed and M. Narayanan, “Immune Dysfunction and Risk of Infection in Chronic Kidney Disease,” Advances in chronic kidney disease, vol. 26, no. 1, pp. 8–15, Jan. 2019, doi: 10.1053/J.ACKD.2019.01.004.
- 10. M. W. Robinson, C. Harmon, and C. O’Farrelly, “Liver immunology and its role in inflammation and homeostasis,” Cellular and Molecular Immunology, vol. 13, no. 3, p. 267, May 2016, doi: 10.1038/CMI.2016.3.
- E. Guillen et al., “Case report of COVID-19 in a kidney transplant recipient: Does immunosuppression alter the clinical presentation?,” American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, vol. 20, no. 7, pp. 1875–1878, Jul. 2020, doi: 10.1111/AJT.15874.
- H. Zhang, H. Dai, and X. Xie, “Solid Organ Transplantation During the COVID-19 Pandemic,” Frontiers in immunology, vol. 11, Jun. 2020, doi: 10.3389/FIMMU.2020.01392.
- O. Manuel and M. Estabrook, “RNA respiratory viral infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice,” Clinical transplantation, vol. 33, no. 9, Sep. 2019, doi: 10.1111/CTR.13511.
- H. Akbari et al., “The role of cytokine profile and lymphocyte subsets in the severity of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis,” Life sciences, vol. 258, Oct. 2020, doi: 10.1016/J.LFS.2020.118167.
- Y. Gao et al., “Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID 19,” Journal of medical virology, vol. 92, no. 7, pp. 791–796, Jul. 2020, doi: 10.1002/JMV.25770.
- I. Suárez-García et al., “In-hospital mortality among immunosuppressed patients with COVID-19: Analysis from a national cohort in Spain,” PloS one, vol. 16, no. 8, Aug. 2021, doi: 10.1371/JOURNAL.PONE.0255524.
- C. Huang et al., “Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China,” Lancet (London, England), vol. 395, no. 10223, p. 497, Feb. 2020, doi: 10.1016/S0140-6736(20)30183-5.
- M. Leppkes et al., “Vascular occlusion by neutrophil extracellular traps in COVID-19,” EBioMedicine, vol. 58, Aug. 2020, doi: 10.1016/J.EBIOM.2020.102925.
- B. Schurink et al., “Viral presence and immunopathology in patients with lethal COVID-19: a prospective autopsy cohort study,” The Lancet. Microbe, vol. 1, no. 7, pp. e290–e299, Nov. 2020, doi: 10.1016/S2666 5247(20)30144-0.
- A. Abrishami, S. Samavat, B. Behnam, M. Arab-Ahmadi, M. Nafar, and M. Sanei Taheri, “Clinical Course, Imaging Features, and Outcomes of COVID-19 in Kidney Transplant Recipients,” European urology, vol. 78, no. 2, pp. 281–286, Aug. 2020, doi: 10.1016/J.EURURO.2020.04.064.
- K. Sharma et al., “Demographic and clinico-radiological profile on High-Resolution Computerized Tomography (HRCT) thorax in mild or asymptomatic clinically suspected COVID-19 patients in high endemicity area of India-Can HRCT be the first screening tool? -The DECRYPTION study,” The Indian journal of radiology & imaging, vol. 31, no. Suppl 1, pp. S122–S127, Jan. 2021, doi: 10.4103/IJRI.IJRI_796_20.
- S. Salehi, A. Abedi, S. Balakrishnan, and A. Gholamrezanezhad, “Coronavirus Disease 2019 (COVID-19): A Systematic Review of Imaging Findings in 919 Patients,” AJR. American journal of roentgenology, vol. 215, no. 1, pp. 87–93, Jul. 2020, doi: 10.2214/AJR.20.23034.
- K. Yang et al., “Clinical characteristics, outcomes, and risk factors for mortality in patients with cancer and COVID-19 in Hubei, China: a multicentre, retrospective, cohort study,” The Lancet. Oncology, vol. 21, no. 7, pp. 904–913, Jul. 2020, doi: 10.1016/S1470-2045(20)30310-7.
- C. S and K. A, “Does the Charlson comorbidity index help predict the risk of death in COVID-19 patients?,” Northern clinics of Istanbul, vol. 9, no. 2, 2022, doi: 10.14744/NCI.2022.33349.
- Y. EE et al., “Evaluation of the relationship between acute kidney injury and renin angiotensin system inhibition in COVID-19 patients,” Northern clinics of Istanbul, vol. 9, no. 6, 2022, doi: 10.14744/NCI.2022.87360.
Bağışıklığı baskılanmış hastalarda COVİD-19'un klinik prezentasyonu ve sonuçları, komorbid ve sağlıklı hastalarla kıyaslama: 384 olgunun retrospektif araştırılması
Öz
Amaç:
Bağışıklığı baskılanmış hastalar (BBH) ciddi enfeksiyonlar ve mortalite için yüksek risk taşırlar. Bu çalışma COVİD-19 nedeniyle hastaneye yatırılan BBH’da klinik seyrin ve sonuçların incelenmesini amaçlamaktadır.
Gereç ve Yöntem:
Mart 2020 ve Aralık 2020 tarihleri arasında hastaneye kaldırılan 384 hasta (ortalama yaş 61.5±15.9, 168 kadın) çalışmaya dahil edildi. Bu hastalar 3 gruba ayrıldı: BBH (n=40), komorbid hastalar (n=101) ve kontrol grubu olarak immünkompetan hastalar (n=243). Tüm klinik ve laboratuvar verileri elektronik hasta dosyasından alındı ve üç grup karşılaştırıldı.
Bulgular:
Ortalama yaş bağışıklığı baskılanmış hastalar için 61.2±15.0, komorbid hastalar için 66.1±12.3, kontrol grubu için 59.6±17.0 olarak hesaplandı. BBH grubunda diğer iki grup ile kıyaslandığında istatistiksel olarak anlamlı şekilde ortalama lökosit ve nötrofil sayısı, C-reaktif protein, ferritin ve D-Dimer düzeylerinin artmış olduğu, albümin seviyelerinin ise azalmış olduğu bulunmuştur (p<0.05). Toraks BT incelemelerinde buzlu cam alanları BBH’da diğer hastalarla kıyaslandığında daha az gözlemlenmiştir (p=0.035). Mortalite oranları BBH grubu için %32.5, komorbid hastalar için %22.8 ve kontrol grubu için %15.2 olarak gözlemlenmiştir (p=0.019). BBH grubunda ölen hastalarda, ortalama lökosit ve nötrofil sayısı ve LDH düzeyleri yüksek iken, SpO2/FiO2 oranı düşük olduğu gözlemlenmiştir (p<0.05).
Sonuç:
COVİD-19’lu bağışıklığı baskılanmış hastalarda mortalite oranı daha fazla olarak bulunmuştur. Bağışıklığı baskılanmış olmak, ileri yaş, artmış LDH düzeyleri ve azalmış Sat/FiO2 düzeylerinin mortalite ile ilişkili olduğu gözlemlenmiştir.
Anahtar Kelimeler
Bağışıklığı baskılanmış COVİD-19 immunsuprese klinik sonuç pandemi
Kaynakça
- “Archived: WHO Timeline - COVID-19.” https://www.who.int/news/item/27-04-2020-who-timeline---covid-19 (accessed May 10, 2022).
- “WHO Coronavirus (COVID-19) Dashboard | WHO Coronavirus (COVID-19) Dashboard With Vaccination Data.” https://covid19.who.int/ (accessed Nov. 18, 2022).
- D. Wang et al., “Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China,” JAMA, vol. 323, no. 11, pp. 1061–1069, Mar. 2020, doi: 10.1001/JAMA.2020.1585.
- X. Wang et al., “Clinical characteristics of non-critically ill patients with novel coronavirus infection (COVID 19) in a Fangcang Hospital,” Clinical Microbiology and Infection, vol. 26, no. 8, p. 1063, Aug. 2020, doi: 10.1016/J.CMI.2020.03.032.
- D. Ward et al., “The effect of immunosuppressants on the prognosis of SARS-CoV-2 infection,” The European Respiratory Journal, vol. 59, no. 4, p. 2100769, Apr. 2022, doi: 10.1183/13993003.00769-2021.
- M. Fung and J. M. Babik, “COVID-19 in Immunocompromised Hosts: What We Know So Far,” Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, vol. 72, no. 2, pp. 340–350, Jan. 2021, doi: 10.1093/CID/CIAA863.
- Y. Zhou et al., “Comorbidities and the risk of severe or fatal outcomes associated with coronavirus disease 2019: A systematic review and meta-analysis,” International Journal of Infectious Diseases, vol. 99, p. 47, Oct. 2020, doi: 10.1016/J.IJID.2020.07.029.
- J. P. Kooman and F. M. Van Der Sande, “COVID-19 in ESRD and Acute Kidney Injury,” Blood Purification, vol. 50, no. 5, p. 1, Jul. 2021, doi: 10.1159/000513214.
- M. Syed-Ahmed and M. Narayanan, “Immune Dysfunction and Risk of Infection in Chronic Kidney Disease,” Advances in chronic kidney disease, vol. 26, no. 1, pp. 8–15, Jan. 2019, doi: 10.1053/J.ACKD.2019.01.004.
- 10. M. W. Robinson, C. Harmon, and C. O’Farrelly, “Liver immunology and its role in inflammation and homeostasis,” Cellular and Molecular Immunology, vol. 13, no. 3, p. 267, May 2016, doi: 10.1038/CMI.2016.3.
- E. Guillen et al., “Case report of COVID-19 in a kidney transplant recipient: Does immunosuppression alter the clinical presentation?,” American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, vol. 20, no. 7, pp. 1875–1878, Jul. 2020, doi: 10.1111/AJT.15874.
- H. Zhang, H. Dai, and X. Xie, “Solid Organ Transplantation During the COVID-19 Pandemic,” Frontiers in immunology, vol. 11, Jun. 2020, doi: 10.3389/FIMMU.2020.01392.
- O. Manuel and M. Estabrook, “RNA respiratory viral infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice,” Clinical transplantation, vol. 33, no. 9, Sep. 2019, doi: 10.1111/CTR.13511.
- H. Akbari et al., “The role of cytokine profile and lymphocyte subsets in the severity of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis,” Life sciences, vol. 258, Oct. 2020, doi: 10.1016/J.LFS.2020.118167.
- Y. Gao et al., “Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID 19,” Journal of medical virology, vol. 92, no. 7, pp. 791–796, Jul. 2020, doi: 10.1002/JMV.25770.
- I. Suárez-García et al., “In-hospital mortality among immunosuppressed patients with COVID-19: Analysis from a national cohort in Spain,” PloS one, vol. 16, no. 8, Aug. 2021, doi: 10.1371/JOURNAL.PONE.0255524.
- C. Huang et al., “Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China,” Lancet (London, England), vol. 395, no. 10223, p. 497, Feb. 2020, doi: 10.1016/S0140-6736(20)30183-5.
- M. Leppkes et al., “Vascular occlusion by neutrophil extracellular traps in COVID-19,” EBioMedicine, vol. 58, Aug. 2020, doi: 10.1016/J.EBIOM.2020.102925.
- B. Schurink et al., “Viral presence and immunopathology in patients with lethal COVID-19: a prospective autopsy cohort study,” The Lancet. Microbe, vol. 1, no. 7, pp. e290–e299, Nov. 2020, doi: 10.1016/S2666 5247(20)30144-0.
- A. Abrishami, S. Samavat, B. Behnam, M. Arab-Ahmadi, M. Nafar, and M. Sanei Taheri, “Clinical Course, Imaging Features, and Outcomes of COVID-19 in Kidney Transplant Recipients,” European urology, vol. 78, no. 2, pp. 281–286, Aug. 2020, doi: 10.1016/J.EURURO.2020.04.064.
- K. Sharma et al., “Demographic and clinico-radiological profile on High-Resolution Computerized Tomography (HRCT) thorax in mild or asymptomatic clinically suspected COVID-19 patients in high endemicity area of India-Can HRCT be the first screening tool? -The DECRYPTION study,” The Indian journal of radiology & imaging, vol. 31, no. Suppl 1, pp. S122–S127, Jan. 2021, doi: 10.4103/IJRI.IJRI_796_20.
- S. Salehi, A. Abedi, S. Balakrishnan, and A. Gholamrezanezhad, “Coronavirus Disease 2019 (COVID-19): A Systematic Review of Imaging Findings in 919 Patients,” AJR. American journal of roentgenology, vol. 215, no. 1, pp. 87–93, Jul. 2020, doi: 10.2214/AJR.20.23034.
- K. Yang et al., “Clinical characteristics, outcomes, and risk factors for mortality in patients with cancer and COVID-19 in Hubei, China: a multicentre, retrospective, cohort study,” The Lancet. Oncology, vol. 21, no. 7, pp. 904–913, Jul. 2020, doi: 10.1016/S1470-2045(20)30310-7.
- C. S and K. A, “Does the Charlson comorbidity index help predict the risk of death in COVID-19 patients?,” Northern clinics of Istanbul, vol. 9, no. 2, 2022, doi: 10.14744/NCI.2022.33349.
- Y. EE et al., “Evaluation of the relationship between acute kidney injury and renin angiotensin system inhibition in COVID-19 patients,” Northern clinics of Istanbul, vol. 9, no. 6, 2022, doi: 10.14744/NCI.2022.87360.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 10 Haziran 2024 |
| Gönderilme Tarihi | 1 Mart 2023 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 63 Sayı: 2 |
