Research highlights need to prioritize immunocompromised COVID patients

recently Weekly morbidity and mortality report (MMWR) Researchers published on the US Centers for Disease Control and Prevention (US-CDC) website found that immunocompromised patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were in the intensive care unit (ICU). We evaluated whether the risk was high. Hospitalization and death.

study: Factors Related to Severe Outcomes of Immunodeficient Adults Hospitalized for COVID-19 — COVID-NET, 10 States, March 2020-2022.. Image Credit: Halfpoint / Shutterstock

Background

People with immunodeficiency are generally at increased risk of developing severe coronavirus infection (COVID-19) in 2019 and subsequent outcomes such as admission to the ICU and death. However, there are no population-based studies that explain the serious outcomes of hospitalized COVID-19 patients with immunodeficiency.

Patients with immune deficiency have one or more predefined immune deficiencies, such as Acquired Immune Deficiency Syndrome (AIDS), and poorly differentiated cluster 4 (CD4).^{+ +} count. Cancer and solid organ transplant recipients receiving immunosuppressive therapy are also immunodeficient. Initial testing, non-pharmaceutical intervention (NPI), vaccination, antiviral treatment, and COVID-19 prophylactic use (eg, Evusheld) all provide additional protection for immunocompromised individuals, followed by severe COVID- 19 You can prevent the occurrence of results.

About research

In this study, researchers analyzed laboratory-confirmed COVID-19-related admission monitoring network (COVID-NET) data for adults admitted with COVID-19 (ages 18+) to determine immunodeficiency status and ICU admission. And their association with death during hospitalization. From March 1, 2020 to February 28, 2022.

The study population included both vaccinated and unvaccinated inpatients. Vaccinated patients were vaccinated with two or one COVID-19 vaccine, with or without booster shots, at least 14 days prior to laboratory-confirmed COVID-19 infection. The team did not individually analyze patients vaccinated with booster doses. Unvaccinated patients had not been vaccinated with COVID-19 before the SARS-CoV-2 test was positive.

In 99 counties in 14 states in the United States, a CDC-funded collaboration, COVID-NET, conducts population-based monitoring of COVID-19-related hospitalizations. COVID-NET defines COVID-19 cases based on positive reverse transcription-polymerase chain reaction (RT-PCR) within 14 days prior to or during hospitalization when an individual lives in the COVID-NET catchment area. To do. Researchers used Pearson’s chi-square test to compare variability between non-immun and immunocompromised cases. We also evaluated the demographic and clinical characteristics of each participant.

In addition, researchers performed bivariate and multivariate analysis on separate models. Multivariate analysis adjusted for age and gender. In addition, the study model was tuned for the major duration of variants, sites, and other factors with p <0.10 in bivariate analysis. They used SAS version 9.4 for all statistical analyzes that took sampling weights into account. For this purpose, researchers set the statistical significance to alpha = 0.05. All activities in the current review were in accordance with federal law and CDC policy.

Survey results

During the study period, 24,625 samples, 11% unweighted, underwent a thorough chart review, including 22,345 samples (90.7% of which were unweighted) that met the study selection criteria. Of these, 12.2% were immunocompromised, and 11.1%, 10.9%, and 17.3% were hospitalized during the pre-delta, delta, and omicron-dominated eras, respectively.

Patients with immunodeficiency were more likely to be non-Hispanic Caucasians or older. There was also a significantly higher incidence of all existing health conditions except neurological disorders and diabetes. Unvaccinated immunocompromised patients had higher odds for ICU admission and death, with adjusted odds ratios (aOR) of 1.26 and 1.34. Similarly, among vaccinated immunocompromised patients, the odds of ICU admission and death were high, with aORs of 1.40 and 1.87. As expected, patients who were not vaccinated against immunodeficiency had lower mortality rates than those who were not vaccinated (aOR = 0.58). Similarly, vaccinated non-immunocompromised patients had a lower probability of death than unvaccinated patients.

In addition, among patients with certain immunocompromised conditions (eg AIDS), the odds of death during hospitalization were even higher, resulting in an aOR of 2.03. However, regardless of immune status, the probability of death during hospitalization was higher in those receiving immunosuppressive therapy, those with multiple myeloma, or transplant recipients. Conversely, the odds of death during or after hospitalization were lower in patients with immunoglobulin deficiency.

The predominant era of SARS-CoV-2 mutants also changed serious consequences such as death. For example, prior to Delta and the Delta-dominant period, immunocompromised patients were usually more likely to die, regardless of vaccination status. However, during the Omicron-dominated era, the odds of death did not differ statistically, regardless of vaccination or immune status.

Conclusion

Overall, there were some important discoveries in the current study. First, among hospitalized COVID-19 patients in the United States, immunocompromised adults were overestimated (12.2% on COVID-NET). Pre-hospital COVID-19 vaccination was highly defensive against immunocompromised individuals and provided protection against COVID-19-related hospitalizations. However, vaccination status did not correlate with ICU admission or death after admission of immunocompromised patients.

Upon admission, immunocompromised COVID-19 patients were more likely to enter the ICU or die. However, it may also be because immunodeficiency conditions are likely to be associated with serious consequences. In particular, during the dominant period of Omicron, the probability of death for all patients was reduced, probably due to the low proportion of serious consequences associated with Omicron. Unfortunately, researchers have not been able to further stratify the decay of the effect after booster shots.