Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 8;20(8):e0330110.
doi: 10.1371/journal.pone.0330110. eCollection 2025.

Immunosuppression variably impacts outcomes for patients hospitalized with COVID-19: A retrospective cohort study

Vijeeth Guggilla  1   2 , Jennifer A Pacheco  3 , Alexandre M Carvalho  2 , Grant R Whitmer  4 , Anna E Pawlowski  5 , Jodi L Johnson  6   7   8   9 , Catherine A Gao  10 , Chad J Achenbach  11   12 , Theresa L Walunas  1   4   6   9   11
Affiliations

Immunosuppression variably impacts outcomes for patients hospitalized with COVID-19: A retrospective cohort study

Vijeeth Guggilla et al. PLoS One. .

Abstract

Background: Adults with immunosuppression are more likely to develop severe COVID-19 than adults without immunosuppression. Less is known about differences in outcomes for adults with immunosuppression who are hospitalized with COVID-19.

Methods: A retrospective cohort study of adults hospitalized with COVID-19 at Northwestern Medicine hospitals between 03/01/2020 and 05/31/2022 was performed. Regression analyses were performed comparing in-hospital mortality, intensive care unit (ICU) admission, oxygenation requirements, and hospital/ICU length of stay among patients without immunosuppression (n = 9079) and patients with immunosuppression (n = 873).

Results: Patients with immunosuppression had significantly higher mortality than patients without immunosuppression (OR: 1.33, 95% CI: 1.11-1.60). This effect was even stronger when controlling for age at admission, diabetes, obesity, SARS-CoV-2 variant era, and COVID-19 medication use (adjusted OR: 1.78, 95% CI: 1.46-2.16). ICU admission (adjusted OR: 1.64, 95% CI: 1.41-1.90) and invasive ventilation (adjusted OR: 1.68, 95% CI: 1.36-2.06) were also significantly higher in patients with immunosuppression. Hospitalization length (median: 7 days) and ICU length of stay (median: 2.5 days) were longer in patients with immunosuppression compared to patients without immunosuppression (median: 5 days, adjusted p < 0.001; median: 2 days, adjusted p = 0.04). Subgroup analyses showed that patients with solid organ transplant, HIV with low CD4 cell count, and secondary immunodeficiency had significantly higher adjusted mortality and ICU admission compared to patients without immunosuppression. Patients with solid organ transplant also had significantly higher invasive ventilation and ICU length of stay.

Conclusions: Patients with immunosuppression had worse outcomes than patients without immunosuppression. Subgroup analyses showed that patients with solid organ transplant had the worst outcomes overall. Patients with HIV had similar outcomes as patients without immunosuppression unless CD4 cell count was low.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. In-hospital mortality of the COVID-19 study population across groups.
In-hospital mortality was extracted from the electronic health record data available for each patient. In-hospital mortality for the entire non-exposure (without immunosuppression) and exposure (with immunosuppression) groups is shown, followed by in-hospital mortality for the exposure subgroups.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Belsky JA, Tullius BP, Lamb MG, Sayegh R, Stanek JR, Auletta JJ. COVID-19 in immunocompromised patients: A systematic review of cancer, hematopoietic cell and solid organ transplant patients. J Infect. 2021;82(3):329–38. - PMC - PubMed
    1. Ssentongo P, Heilbrunn ES, Ssentongo AE, Advani S, Chinchilli VM, Nunez JJ, et al. Epidemiology and outcomes of COVID-19 in HIV-infected individuals: a systematic review and meta-analysis. Sci Rep. 2021;11(1):6283. doi: 10.1038/s41598-021-85359-3 - DOI - PMC - PubMed
    1. Danwang C, Noubiap JJ, Robert A, Yombi JC. Outcomes of patients with HIV and COVID-19 co-infection: a systematic review and meta-analysis. AIDS Res Ther. 2022;19(1):3. doi: 10.1186/s12981-021-00427-y - DOI - PMC - PubMed
    1. Bytyci J, Ying Y, Lee LYW. Immunocompromised individuals are at increased risk of COVID-19 breakthrough infection, hospitalization, and death in the post-vaccination era: A systematic review. Immun Inflamm Dis. 2024;12(4):e1259. doi: 10.1002/iid3.1259 - DOI - PMC - PubMed
    1. Western Cape Department of Health in collaboration with the National Institute for Communicable Diseases, South Africa. Risk Factors for Coronavirus Disease 2019 (COVID-19) Death in a Population Cohort Study from the Western Cape Province, South Africa. Clin Infect Dis Off Publ Infect Dis Soc Am. 2021. Oct 5;73(7):e2005–15. - PMC - PubMed