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. 2021 Aug 15;10(16):3595.
doi: 10.3390/jcm10163595.

Severe Lymphopenia as a Predictor of COVID-19 Mortality in Immunosuppressed Patients

María Martínez-Urbistondo  1 , Ángela Gutiérrez-Rojas  1 , Ane Andrés  1 , Isabel Gutiérrez  1 , Gabriela Escudero  1 , Sonia García  1 , Andrea Gutiérrez  1 , Enrique Sánchez  1 , Jesús Herráiz  1 , Sara De La Fuente  1 , Alejandro Callejas  1 , Carmen De Mendoza  1 , Víctor Moreno-Torres  1
Affiliations

Severe Lymphopenia as a Predictor of COVID-19 Mortality in Immunosuppressed Patients

María Martínez-Urbistondo et al. J Clin Med. .

Abstract

Background: Coronavirus disease 2019 (COVID-19) has a high mortality in certain group of patients. We analysed the impact of baseline immunosuppression in COVID-19 mortality and the role of severe lymphopenia in immunocompromised subjects.

Methods: We analysed all patients admitted with COVID-19 in a tertiary hospital in Madrid between March 1st and April 30th 2020. Epidemiological and clinical data, including severe lymphopenia (<500 lymphocytes/mm3) during admission, were analysed and compared based on their baseline immunosuppression condition.

Results: A total of 1594 patients with COVID-19 pneumonia were hospitalised during the study period. 166 (10.4%) were immunosuppressed. Immunocompromised patients were younger (64 vs. 67 years, p = 0.02) but presented higher rates of hypertension, diabetes, heart, neurological, lung, kidney and liver disease (p < 0.05). They showed more severe lymphopenia (53% vs 24.1%, p < 0.001), lower SapO2/FiO2 ratios (251 vs 276, p = 0.02) during admission and higher mortality rates (27.1% vs 13.5%, p < 0.001). After adjustment, immunosuppression remained as an independent factor related to mortality (Odds Ratio (OR): 2.24, p < 0.001). In the immunosuppressed group, age (OR = 1.06, p = 0.01), acute respiratory distress syndrome (ARDS) (OR = 12.27, p = 0.017) and severe lymphopenia (OR = 3.48, p = 0.04) were the factors related to high mortality rate.

Conclusion: Immunosuppression is an independent mortality risk factor in COVID-19. Severe lymphopenia should be promptly identified in these patients.

Keywords: COVID-19; immunosuppression; severe lymphopenia.

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Conflict of interest statement

The authors declare no conflict of interest.

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