Outcome of COVID-19 in hospitalised immunocompromised patients: An analysis of the WHO ISARIC CCP-UK prospective cohort study.
<h4>Background</h4>Immunocompromised patients may be at higher risk of mortality if hospitalised with Coronavirus Disease 2019 (COVID-19) compared with immunocompetent patients. However, previous studies have been contradictory. We aimed to determine whether immunocompromised patients we...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2023-01-01
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| Series: | PLoS Medicine |
| Online Access: | https://doi.org/10.1371/journal.pmed.1004086 |
| _version_ | 1827862867695632384 |
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| author | Lance Turtle Mathew Thorpe Thomas M Drake Maaike Swets Carlo Palmieri Clark D Russell Antonia Ho Stephen Aston Daniel G Wootton Alex Richter Thushan I de Silva Hayley E Hardwick Gary Leeming Andy Law Peter J M Openshaw Ewen M Harrison ISARIC4C investigators J Kenneth Baillie Malcolm G Semple Annemarie B Docherty |
| author_facet | Lance Turtle Mathew Thorpe Thomas M Drake Maaike Swets Carlo Palmieri Clark D Russell Antonia Ho Stephen Aston Daniel G Wootton Alex Richter Thushan I de Silva Hayley E Hardwick Gary Leeming Andy Law Peter J M Openshaw Ewen M Harrison ISARIC4C investigators J Kenneth Baillie Malcolm G Semple Annemarie B Docherty |
| author_sort | Lance Turtle |
| collection | DOAJ |
| description | <h4>Background</h4>Immunocompromised patients may be at higher risk of mortality if hospitalised with Coronavirus Disease 2019 (COVID-19) compared with immunocompetent patients. However, previous studies have been contradictory. We aimed to determine whether immunocompromised patients were at greater risk of in-hospital death and how this risk changed over the pandemic.<h4>Methods and findings</h4>We included patients > = 19 years with symptomatic community-acquired COVID-19 recruited to the ISARIC WHO Clinical Characterisation Protocol UK prospective cohort study. We defined immunocompromise as immunosuppressant medication preadmission, cancer treatment, organ transplant, HIV, or congenital immunodeficiency. We used logistic regression to compare the risk of death in both groups, adjusting for age, sex, deprivation, ethnicity, vaccination, and comorbidities. We used Bayesian logistic regression to explore mortality over time. Between 17 January 2020 and 28 February 2022, we recruited 156,552 eligible patients, of whom 21,954 (14%) were immunocompromised. In total, 29% (n = 6,499) of immunocompromised and 21% (n = 28,608) of immunocompetent patients died in hospital. The odds of in-hospital mortality were elevated for immunocompromised patients (adjusted OR 1.44, 95% CI [1.39, 1.50], p < 0.001). Not all immunocompromising conditions had the same risk, for example, patients on active cancer treatment were less likely to have their care escalated to intensive care (adjusted OR 0.77, 95% CI [0.7, 0.85], p < 0.001) or ventilation (adjusted OR 0.65, 95% CI [0.56, 0.76], p < 0.001). However, cancer patients were more likely to die (adjusted OR 2.0, 95% CI [1.87, 2.15], p < 0.001). Analyses were adjusted for age, sex, socioeconomic deprivation, comorbidities, and vaccination status. As the pandemic progressed, in-hospital mortality reduced more slowly for immunocompromised patients than for immunocompetent patients. This was particularly evident with increasing age: the probability of the reduction in hospital mortality being less for immunocompromised patients aged 50 to 69 years was 88% for men and 83% for women, and for those >80 years was 99% for men and 98% for women. The study is limited by a lack of detailed drug data prior to admission, including steroid doses, meaning that we may have incorrectly categorised some immunocompromised patients as immunocompetent.<h4>Conclusions</h4>Immunocompromised patients remain at elevated risk of death from COVID-19. Targeted measures such as additional vaccine doses, monoclonal antibodies, and nonpharmaceutical preventive interventions should be continually encouraged for this patient group.<h4>Trial registration</h4>ISRCTN 66726260. |
| first_indexed | 2024-03-12T14:00:41Z |
| format | Article |
| id | doaj.art-4fb1993f132a44399141afa021dbfa59 |
| institution | Directory Open Access Journal |
| issn | 1549-1277 1549-1676 |
| language | English |
| last_indexed | 2024-03-12T14:00:41Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Medicine |
| spelling | doaj.art-4fb1993f132a44399141afa021dbfa592023-08-22T05:31:19ZengPublic Library of Science (PLoS)PLoS Medicine1549-12771549-16762023-01-01201e100408610.1371/journal.pmed.1004086Outcome of COVID-19 in hospitalised immunocompromised patients: An analysis of the WHO ISARIC CCP-UK prospective cohort study.Lance TurtleMathew ThorpeThomas M DrakeMaaike SwetsCarlo PalmieriClark D RussellAntonia HoStephen AstonDaniel G WoottonAlex RichterThushan I de SilvaHayley E HardwickGary LeemingAndy LawPeter J M OpenshawEwen M HarrisonISARIC4C investigatorsJ Kenneth BaillieMalcolm G SempleAnnemarie B Docherty<h4>Background</h4>Immunocompromised patients may be at higher risk of mortality if hospitalised with Coronavirus Disease 2019 (COVID-19) compared with immunocompetent patients. However, previous studies have been contradictory. We aimed to determine whether immunocompromised patients were at greater risk of in-hospital death and how this risk changed over the pandemic.<h4>Methods and findings</h4>We included patients > = 19 years with symptomatic community-acquired COVID-19 recruited to the ISARIC WHO Clinical Characterisation Protocol UK prospective cohort study. We defined immunocompromise as immunosuppressant medication preadmission, cancer treatment, organ transplant, HIV, or congenital immunodeficiency. We used logistic regression to compare the risk of death in both groups, adjusting for age, sex, deprivation, ethnicity, vaccination, and comorbidities. We used Bayesian logistic regression to explore mortality over time. Between 17 January 2020 and 28 February 2022, we recruited 156,552 eligible patients, of whom 21,954 (14%) were immunocompromised. In total, 29% (n = 6,499) of immunocompromised and 21% (n = 28,608) of immunocompetent patients died in hospital. The odds of in-hospital mortality were elevated for immunocompromised patients (adjusted OR 1.44, 95% CI [1.39, 1.50], p < 0.001). Not all immunocompromising conditions had the same risk, for example, patients on active cancer treatment were less likely to have their care escalated to intensive care (adjusted OR 0.77, 95% CI [0.7, 0.85], p < 0.001) or ventilation (adjusted OR 0.65, 95% CI [0.56, 0.76], p < 0.001). However, cancer patients were more likely to die (adjusted OR 2.0, 95% CI [1.87, 2.15], p < 0.001). Analyses were adjusted for age, sex, socioeconomic deprivation, comorbidities, and vaccination status. As the pandemic progressed, in-hospital mortality reduced more slowly for immunocompromised patients than for immunocompetent patients. This was particularly evident with increasing age: the probability of the reduction in hospital mortality being less for immunocompromised patients aged 50 to 69 years was 88% for men and 83% for women, and for those >80 years was 99% for men and 98% for women. The study is limited by a lack of detailed drug data prior to admission, including steroid doses, meaning that we may have incorrectly categorised some immunocompromised patients as immunocompetent.<h4>Conclusions</h4>Immunocompromised patients remain at elevated risk of death from COVID-19. Targeted measures such as additional vaccine doses, monoclonal antibodies, and nonpharmaceutical preventive interventions should be continually encouraged for this patient group.<h4>Trial registration</h4>ISRCTN 66726260.https://doi.org/10.1371/journal.pmed.1004086 |
| spellingShingle | Lance Turtle Mathew Thorpe Thomas M Drake Maaike Swets Carlo Palmieri Clark D Russell Antonia Ho Stephen Aston Daniel G Wootton Alex Richter Thushan I de Silva Hayley E Hardwick Gary Leeming Andy Law Peter J M Openshaw Ewen M Harrison ISARIC4C investigators J Kenneth Baillie Malcolm G Semple Annemarie B Docherty Outcome of COVID-19 in hospitalised immunocompromised patients: An analysis of the WHO ISARIC CCP-UK prospective cohort study. PLoS Medicine |
| title | Outcome of COVID-19 in hospitalised immunocompromised patients: An analysis of the WHO ISARIC CCP-UK prospective cohort study. |
| title_full | Outcome of COVID-19 in hospitalised immunocompromised patients: An analysis of the WHO ISARIC CCP-UK prospective cohort study. |
| title_fullStr | Outcome of COVID-19 in hospitalised immunocompromised patients: An analysis of the WHO ISARIC CCP-UK prospective cohort study. |
| title_full_unstemmed | Outcome of COVID-19 in hospitalised immunocompromised patients: An analysis of the WHO ISARIC CCP-UK prospective cohort study. |
| title_short | Outcome of COVID-19 in hospitalised immunocompromised patients: An analysis of the WHO ISARIC CCP-UK prospective cohort study. |
| title_sort | outcome of covid 19 in hospitalised immunocompromised patients an analysis of the who isaric ccp uk prospective cohort study |
| url | https://doi.org/10.1371/journal.pmed.1004086 |
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