Department of Internal Medicine, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain.
Department of Internal Medicine, Hospital Universitario Puerta de Hierro-Majadahondada, Majadahonda, Spain.
Ann Transplant. 2021 Nov 12;26:e933152. doi: 10.12659/AOT.933152.
BACKGROUND It is unclear whether solid organ transplant (SOT) patients have more severe coronavirus disease 2019 (COVID-19) and worse outcome than the general population. MATERIAL AND METHODS We conducted a case-control study on 32 SOT recipients and 84 non-SOT controls matched for age and sex admitted for confirmed COVID-19. The primary endpoint was in-hospital all-cause mortality rate. Secondary endpoints included severe acute respiratory distress syndrome (ARDS), use of high-flow oxygen therapy, and length of hospital stay. RESULTS The median (IQR) Charlson comorbidity index (CCI) at admission was significantly higher in SOT recipients (6 (3-8) vs 3 (2-4); P<0.01). Fever was less frequent in SOT recipients (78% vs 94%, P=0.01). SOT recipients had a higher median SaO2/FiO2 at admission (452 [443-462] vs 443 [419-452], P<0.01) and reached the worst SaO2/FiO2 value later during hospitalization 15 (10-21) vs 11 (9-14) days, P=0.01). Both groups had a similar severe ARDS rate during hospitalization (33% vs 28%) (p=0.59). There were no significant differences during hospitalization in terms of highest level of respiratory support needed, or length of hospital stay: 8.5 (5.5-21) vs 11.5 (6.5-16.5) days; P=0.34) in SOT recipients when compared to controls. In-hospital all-cause mortality rates were significantly higher in SOT recipients (21.9% vs 4.7%, P<0.01; OR 1.08; 95% CI 0.10-10.98), but among patients who died, median CCI was similar between groups (8 [6-8] vs 7 [6-8]). CONCLUSIONS In our experience, hospitalized SOT recipients for COVID-19 had higher in-hospital mortality compared to non-SOT patients, probably due to the greater number of underlying comorbidities, and not directly related to chronic immunosuppression.
目前尚不清楚实体器官移植（SOT）患者的 2019 年冠状病毒病（COVID-19）是否更严重，结局是否更差。
我们对 32 名 SOT 受者和 84 名年龄和性别匹配的非 SOT 对照者进行了一项病例对照研究，这些患者因确诊的 COVID-19 而入院。主要终点是院内全因死亡率。次要终点包括严重急性呼吸窘迫综合征（ARDS）、高流量氧疗的使用和住院时间。
SOT 受者入院时的中位（IQR）Charlson 合并症指数（CCI）显著更高（6（3-8）与 3（2-4）；P<0.01）。发热在 SOT 受者中较少见（78%与 94%，P=0.01）。SOT 受者入院时的中位 SaO2/FiO2 较高（452[443-462]与 443[419-452]，P<0.01），并且在住院期间达到最差的 SaO2/FiO2 值较晚，为 15（10-21）天与 11（9-14）天，P=0.01）。两组在住院期间的严重 ARDS 发生率相似（33%与 28%）（P=0.59）。在需要的最高呼吸支持水平和住院时间方面，SOT 受者与对照组在住院期间无显著差异：8.5（5.5-21）与 11.5（6.5-16.5）天；P=0.34）。与非 SOT 患者相比，SOT 受者的院内全因死亡率显著更高（21.9%与 4.7%，P<0.01；OR 1.08；95% CI 0.10-10.98），但在死亡患者中，两组的中位 CCI 相似（8[6-8]与 7[6-8]）。
根据我们的经验，COVID-19 住院的 SOT 受者的院内死亡率高于非 SOT 患者，这可能是由于合并症更多，而与慢性免疫抑制无关。
