In-hospital mortality among immunosuppressed patients with COVID-19: Analysis from a national cohort in Spain

• DOI: 10.1371/journal.pone.0255524
• Publication Date: 2021-08-03T17:28:13Z
• Authors: Inés Suárez-García; Isabel Perales-Fr...; Andrés González-G...; Arturo Muñoz-Blanco; Luis Manzano; Martín Fabregate; Jesús Díez-Manglano; Eva Fonseca Aizpuru; Francisco Arnalic...; Alejandra García ...; Ricardo Gómez-Hue...; José-Manuel Ramos...
• Keywords: Male; Hospital mortality; Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Patient Care::Hospitalization; España; Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans; Mortalidad hospitalaria; Cohort Studies; 0302 clinical medicine; Odds Ratio; Medical Subject Headings::Phenomena and Processes::Immune System Phenomena::Immunocompromised Host; Hospital Mortality; Registries; Hematologic neoplasms; Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Mortality::Hospital Mortality; Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis; Medical Subject Headings::Diseases::Cardiovascular Diseases::Heart Diseases::Heart Failure; Aged, 80 and over; Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Models, Statistical::Logistic Models; Diagnóstico; Q; Insuficiencia cardíaca; R; Odds ratio; Middle Aged; Prognosis; Insuficiencia multiorgánica; Virus; 3. Good health; Medical Subject Headings::Check Tags::Male; Hospitalization; Myocarditis; Hematologic Neoplasms; Miocarditis; Medicine; Steroids; Female; Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Registries; Coronavirus Infections; Research Article; Science; Multiple Organ Failure; 610; Medical Subject Headings::Diseases::Cardiovascular Diseases::Heart Diseases::Cardiomyopathies::Myocarditis; Heart failure; Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Biological Therapy::Immunomodulation::Immunotherapy::Immunosuppression; Oportunidad relativa; Inmunosupresión; Immunocompromised Host; 03 medical and health sciences; Medical Subject Headings::Diseases::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections; Medical Subject Headings::Diseases::Hemic and Lymphatic Diseases::Hematologic Diseases::Hematologic Neoplasms; Medical Subject Headings::Persons::Persons::Age Groups::Adult::Middle Aged; 616; Humans; Medical Subject Headings::Persons::Persons::Age Groups::Adult::Aged::Aged, 80 and over; Aged; Retrospective Studies; Heart Failure; Medical Subject Headings::Diseases::Respiratory Tract Diseases::Lung Diseases::Respiratory Distress Syndrome, Adult; Medical Subject Headings::Chemicals and Drugs::Polycyclic Compounds::Steroids; SARS-CoV-2; Respiratory Distress Syndrome, Adult; COVID-19; Medical Subject Headings::Check Tags::Female; Medical Subject Headings::Geographical Locations::Geographic Locations::Europe::Spain; Huésped Inmunocomprometido; Multiple organ failure; Logistic Models; Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies; Medical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Shock::Multiple Organ Failure; Medical Subject Headings::Persons::Persons::Age Groups::Adult::Aged; Spain; Mortalidad; Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Case-Control Studies::Retrospective Studies; Immunosuppression; Neoplasias hematológicas; Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Odds Ratio

BackgroundWhether immunosuppressed (IS) patients have a worse prognosis of COVID-19 compared to non-IS patients is not known. The aim of this study was to evaluate the clinical characteristics and outcome of IS patients hospitalized with COVID-19 compared to non-IS patients.MethodsWe designed a retrospective cohort study. We included all patients hospitalized with laboratory-confirmed COVID-19 from the SEMI-COVID-19 Registry, a large multicentre national cohort in Spain, from March 27thuntil June 19th, 2020. We used multivariable logistic regression to assess the adjusted odds ratios (aOR) of in-hospital death among IS compared to non-IS patients.ResultsAmong 13 206 included patients, 2 111 (16.0%) were IS. A total of 166 (1.3%) patients had solid organ (SO) transplant, 1081 (8.2%) had SO neoplasia, 332 (2.5%) had hematologic neoplasia, and 570 (4.3%), 183 (1.4%) and 394 (3.0%) were receiving systemic steroids, biological treatments, and immunosuppressors, respectively. Compared to non-IS patients, the aOR (95% CI) for in-hospital death was 1.60 (1.43–1.79) for all IS patients, 1.39 (1.18–1.63) for patients with SO cancer, 2.31 (1.76–3.03) for patients with haematological cancer and 3.12 (2.23–4.36) for patients with SO transplant. The aOR (95% CI) for death for patients who were receiving systemic steroids, biological treatments and immunosuppressors compared to non-IS patients were 2.16 (1.80–2.61), 1.97 (1.33–2.91) and 2.06 (1.64–2.60), respectively. IS patients had a higher odds than non-IS patients of in-hospital acute respiratory distress syndrome, heart failure, myocarditis, thromboembolic disease and multiorgan failure.ConclusionsIS patients hospitalized with COVID-19 have a higher odds of in-hospital complications and death compared to non-IS patients.