免疫功能低下患者的 COVID-19 相关结局：韩国的一项全国性研究。
COVID-19-related outcomes in immunocompromised patients: A nationwide study in Korea.
机构信息
Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea.
出版信息
PLoS One. 2021 Oct 1;16(10):e0257641. doi: 10.1371/journal.pone.0257641. eCollection 2021.
BACKGROUND
Given the rapid increased in confirmed coronavirus disease 2019 (COVID-19) and related mortality, it is important to identify vulnerable patients. Immunocompromised status is considered a risk factor for developing severe COVID-19. We aimed to determine whether immunocompromised patients with COVID-19 have an increased risk of mortality.
METHOD
The groups' baseline characteristics were balanced using a propensity score-based inverse probability of treatment weighting approach. Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated for the risks of in-hospital mortality and other outcomes according to immunocompromised status using a multivariable logistic regression model. We identified immunocompromised status based on a diagnosis of malignancy or HIV/AIDS, having undergone organ transplantation within 3 years, prescriptions for corticosteroids or oral immunosuppressants for ≥30 days, and at least one prescription for non-oral immunosuppressants during the last year.
RESULTS
The 6,435 COVID-19 patients (≥18 years) included 871 immunocompromised (13.5%) and 5,564 non-immunocompromised (86.5%). Immunocompromised COVID-19 patients were older (60.1±16.4 years vs. 47.1±18.7 years, absolute standardized mean difference: 0.738). The immunocompromised group had more comorbidities, a higher Charlson comorbidity index, and a higher in-hospital mortality rate (9.6% vs. 2.3%; p < .001). The immunocompromised group still had a significantly higher in-hospital mortality rate after inverse probability of treatment weighting (6.4% vs. 2.0%, p < .001). Multivariable analysis adjusted for baseline imbalances revealed that immunocompromised status was independently associated with a higher risk of mortality among COVID-19 patients (adjusted odds ratio [aOR]: 2.09, 95% CI: 1.62-2.68, p < .001).
CONCLUSIONS
Immunocompromised status among COVID-19 patients was associated with a significantly increased risk of mortality.
背景
鉴于确诊的 2019 年冠状病毒病（COVID-19）和相关死亡率的迅速增加，识别高危患者非常重要。免疫功能低下被认为是发生严重 COVID-19 的危险因素。我们旨在确定 COVID-19 免疫功能低下患者的死亡率是否增加。
方法
采用倾向评分逆概率处理加权法平衡两组的基线特征。采用多变量逻辑回归模型，根据免疫功能低下状态计算住院死亡率和其他结局的比值比（OR）及其 95%置信区间（CI）。我们根据恶性肿瘤或 HIV/AIDS 诊断、3 年内接受过器官移植、皮质类固醇或口服免疫抑制剂处方≥30 天、以及过去一年至少有一次非口服免疫抑制剂处方，确定免疫功能低下状态。
结果
纳入的 6435 例（≥18 岁）COVID-19 患者中，871 例（13.5%）为免疫功能低下，5564 例（86.5%）为非免疫功能低下。免疫功能低下的 COVID-19 患者年龄较大（60.1±16.4 岁比 47.1±18.7 岁，绝对标准化均数差：0.738）。免疫功能低下组有更多的合并症、更高的 Charlson 合并症指数和更高的住院死亡率（9.6%比 2.3%；p<.001）。经倾向评分逆概率处理加权后，免疫功能低下组的住院死亡率仍显著较高（6.4%比 2.0%，p<.001）。调整基线不平衡因素的多变量分析显示，免疫功能低下状态与 COVID-19 患者的死亡率升高独立相关（调整比值比[aOR]：2.09，95%CI：1.62-2.68，p<.001）。
结论
COVID-19 患者的免疫功能低下状态与死亡率显著增加相关。
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