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. 2021 Aug 3;16(8):e0255524.
doi: 10.1371/journal.pone.0255524. eCollection 2021.

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

Inés Suárez-García  1   2 , Isabel Perales-Fraile  2   3 , Andrés González-García  4 , Arturo Muñoz-Blanco  5 , Luis Manzano  6 , Martín Fabregate  6 , Jesús Díez-Manglano  7 , Eva Fonseca Aizpuru  8 , Francisco Arnalich Fernández  9 , Alejandra García García  10 , Ricardo Gómez-Huelgas  11 , José-Manuel Ramos-Rincón  12 ; SEMI-COVID-19 Network
Affiliations

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

Inés Suárez-García et al. PLoS One. .

Abstract

Background: Whether 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.

Methods: We 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 27th until 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.

Results: Among 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.

Conclusions: IS patients hospitalized with COVID-19 have a higher odds of in-hospital complications and death compared to non-IS patients.

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Conflict of interest statement

The authors have declared that no competing interests exist.

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