Avery Robin K, Chiang Teresa Po-Yu, Marr Kieren A, Brennan Daniel C, Sait Afrah S, Garibaldi Brian T, Shah Pali, Ostrander Darin, Steinke Seema Mehta, Permpalung Nitipong, Cochran Willa, Makary Martin A, Garonzik-Wang Jacqueline, Segev Dorry L, Massie Allan B
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Am J Transplant. 2021 Jul;21(7):2498-2508. doi: 10.1111/ajt.16431. Epub 2021 Feb 21.
Immunosuppression and comorbidities might place solid organ transplant (SOT) recipients at higher risk from COVID-19, as suggested by recent case series. We compared 45 SOT vs. 2427 non-SOT patients who were admitted with COVID-19 to our health-care system (March 1, 2020 - August 21, 2020), evaluating hospital length-of-stay and inpatient mortality using competing-risks regression. We compared trajectories of WHO COVID-19 severity scale using mixed-effects ordinal logistic regression, adjusting for severity score at admission. SOT and non-SOT patients had comparable age, sex, and race, but SOT recipients were more likely to have diabetes (60% vs. 34%, p < .001), hypertension (69% vs. 44%, p = .001), HIV (7% vs. 1.4%, p = .024), and peripheral vascular disorders (19% vs. 8%, p = .018). There were no statistically significant differences between SOT and non-SOT in maximum illness severity score (p = .13), length-of-stay (sHR: 1.1 , p = .5), or mortality (sHR: 0.4 , p = .19), although the severity score on admission was slightly lower for SOT (median [IQR] 3 [3, 4]) than for non-SOT (median [IQR] 4 [3-4]) (p = .042) Despite a higher risk profile, SOT recipients had a faster decline in disease severity over time (OR = 0.81 , p < .001) compared with non-SOT patients. These findings have implications for transplant decision-making during the COVID-19 pandemic, and insights about the impact of SARS-CoV-2 on immunosuppressed patients.
近期的病例系列研究表明，免疫抑制和合并症可能使实体器官移植（SOT）受者感染新型冠状病毒肺炎（COVID-19）的风险更高。我们比较了45例因COVID-19入住我们医疗系统的SOT患者与2427例非SOT患者（2020年3月1日至2020年8月21日），使用竞争风险回归评估住院时间和住院死亡率。我们使用混合效应有序逻辑回归比较了世界卫生组织（WHO）COVID-19严重程度量表的轨迹，并对入院时的严重程度评分进行了调整。SOT患者和非SOT患者在年龄、性别和种族方面具有可比性，但SOT受者更有可能患有糖尿病（60%对34%，p <.001）、高血压（69%对44%，p =.001）、艾滋病毒（7%对1.4%，p =.024）和外周血管疾病（19%对8%，p =.018）。SOT患者和非SOT患者在最大疾病严重程度评分（p =.13）、住院时间（sHR：1.1，p =.5）或死亡率（sHR：0.4，p =.19）方面没有统计学上的显著差异，尽管SOT患者入院时的严重程度评分略低于非SOT患者（中位数[四分位间距]3[3,4]），而非SOT患者为中位数[四分位间距]4[3 - 4]）（p =.042）。尽管风险更高，但与非SOT患者相比，SOT受者疾病严重程度随时间的下降更快（OR = 0.81，p <.001）。这些发现对COVID-19大流行期间的移植决策具有启示意义，并为严重急性呼吸综合征冠状病毒2（SARS-CoV-2）对免疫抑制患者的影响提供了见解。
