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Multicenter Study
. 2024 Dec 3;14(1):30021.
doi: 10.1038/s41598-024-81099-2.

COVID-19 clinical phenotypes in vaccinated and nonvaccinated solid organ transplant recipients: a multicenter validation study

Carmen Infante-Domínguez  1   2 , Sonsoles Salto-Alejandre  1   2 , Rocío Álvarez-Marín  1   2 , Nuria Sabé  2   3 , Antonio Ramos-Martínez  4 , Asunción Moreno  5 , Kamilla Ferreira de Moraes  6 , Zaira R Palacios-Baena  2   7 , Patricia Muñoz  8 , Mario Fernández-Ruiz  2   9 , Marino Blanes  10 , Carmen Fariñas  2   11 , Elisa Vidal  2   12 , Esperanza Merino de Lucas  13   14 , Márcia Halpern  15 , Román Hernández-Gallego  16 , Matteo Bassetti  17 , Alessandra Mularoni  18 , Alex Gutiérrez-Dalmau  19 , Matteo Rinaldi  20   21 , Silvia Jiménez-Jorge  22 , Marta Bodro  5 , Luis Fernando Aranha-Camargo  6 , Maricela Valerio  8 , Javier Sánchez-Céspedes  1   2 , Belén Gutiérrez-Gutiérrez  2   7   23 , Maddalena Giannella  20   21 , Jesús Rodríguez-Baño  2   7   23 , Jerónimo Pachón  24   25 , Elisa Cordero  1   2   23 ; COVIDSOT, ORCHESTRA Working Teams
Collaborators, Affiliations
Multicenter Study

COVID-19 clinical phenotypes in vaccinated and nonvaccinated solid organ transplant recipients: a multicenter validation study

Carmen Infante-Domínguez et al. Sci Rep. .

Abstract

Clinical phenotypes of COVID-19, associated with mortality risk, have been identified in the general population. The present study assesses their applicability in solid organ transplant recipients (SOTR) hospital-admitted by COVID-19. In a cohort of 488 SOTR, nonvaccinated (n = 394) and vaccinated (n = 94) against SARS-CoV-2, we evaluated 16 demographic, clinical, analytical, and radiological variables to identify the clinical phenotypes A, B, and C. The median age was 61.0 (51-69) years, 330 (67.6%) and 158 (32.4%) were men and women, respectively, 415 (85%) had pneumonia, and 161 (33%) had SpO2 < 95% at admission. All-cause mortality occurred in 105 (21.5%) cases. It was higher in nonvaccinated versus vaccinated SOTR (23.4% vs 13.8%, P = 0.04). Patients in the entire cohort were classified into phenotypes A (n = 149, 30.5%), B (n = 187, 38.3%), and C (n = 152, 31.1%), with mortality rates of 8.7%, 16.6%, and 40.1%, respectively, which were similar to those of nonvaccinated SOTR (9.5%, 16.7%, and 52.0%) and lower in vaccinated SOTR (4.4%, 15.8%, and 17.3%, respectively), with difference between nonvaccinated and vaccinated in the phenotype C (P < 0.001). In conclusion, COVID-19 clinical phenotypes are useful in SOTR, and all-cause mortality decreases in vaccinated patients.

Keywords: COVID-19; Clinical phenotypes; Mortality; Multicenter cohort study; Solid organ transplant recipients.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Statement: The views expressed in this publication are the sole responsibility of the authors and the Commission is not responsible for any use that may be made of the information it contains.

Figures

Fig. 1
Fig. 1
Overall survival at day + 30 after COVID-19 diagnosis in patients with phenotype A, B y C in the all-solid organ transplant recipients (SOTR) cohort (a) n = 488, in nonvaccinated SOTR (b) n = 394, and in vaccinated SOTR (c) n = 94.
Fig. 2
Fig. 2
Discrimination power of the final multivariable model: receiving operative curve (ROC) plot (including age ≥ 70 years, SpO2 < 95%, neutrophils > 7500/µL, non-vaccination, and time from transplant onset to COVID-19 diagnosis < 6 months), expressed by an area under the ROC of 0.71 (95% CI 0.65–0.767), SE = 0.03 (under the non-parametric assumption), and p < 0.001 (being the null hypothesis a true area = 0.50).
See this image and copyright information in PMC

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