Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran.
School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Eur J Med Res. 2022 Oct 8;27(1):195. doi: 10.1186/s40001-022-00824-7.
Patients with immunodeficiency are usually more prone to worse outcomes of infectious diseases. However, there are some disagreements in the context of COVID-19, for example, in patients with human immunodeficiency virus (HIV). Herein, we aimed to systematically review the risk and predictors of COVID-19 mortality in people with primary or secondary immunodeficiency.
PubMed, Scopus, Web of Science, and Science Direct were searched. We followed a two-step screening process to identify eligible results. We first reviewed the title and abstract of the records and the unqualified studies were removed. Then, their full texts were evaluated based on their coherence with the purpose and inclusion/exclusion criteria, and those eligible for qualitative synthesis were included.
Twenty-two articles were included, which investigated a total of 109,326 with primary or secondary immunodeficiencies. Three studies investigated the pediatric and infant population, while other studies were conducted on the adult population. Overall, studies on both primary and secondary immunodeficiency conflicted as some reported higher and some mentioned lower mortality rates in patients with immunodeficiency.
Overall, there were two points of view in both types of immunodeficiencies. The first is the classical viewpoint that all immunodeficient patients are at a higher risk of infection leading to a higher mortality rate. The second types of studies found that immunodeficiency might play a less important or even an inverse role in mortality rates by lowering the severity of the inflammatory response. However, it is important to take note to comorbidities, such as DM, HTN, CAD, ESRD, history of lower respiratory infection, etc., and demographic factors, such as obesity and age > 70 years, as they appear to influence the mortality rate, especially in patients with secondary immunodeficiency.
免疫功能低下的患者通常更容易出现传染病的不良后果。然而，在 COVID-19 的情况下存在一些争议，例如在人类免疫缺陷病毒 (HIV) 患者中。在此，我们旨在系统地综述原发性或继发性免疫缺陷患者 COVID-19 死亡率的风险和预测因素。
我们检索了 PubMed、Scopus、Web of Science 和 Science Direct。我们采用两步筛选过程来识别合格的结果。我们首先审查了记录的标题和摘要，并去除了不合格的研究。然后，根据与目的和纳入/排除标准的一致性评估其全文，并纳入定性综合合格的研究。
共纳入 22 篇文章，总共调查了 109326 例原发性或继发性免疫缺陷患者。有 3 项研究调查了儿科和婴儿人群，而其他研究则针对成人人群进行。总体而言，对原发性和继发性免疫缺陷的研究存在分歧，一些研究报告免疫缺陷患者的死亡率较高，而另一些研究则提到死亡率较低。
总体而言，在这两种类型的免疫缺陷中存在两种观点。第一种是经典观点，即所有免疫缺陷患者都有更高的感染风险，导致更高的死亡率。第二种类型的研究发现，免疫缺陷可能通过降低炎症反应的严重程度而在死亡率方面发挥不太重要甚至相反的作用。然而，需要注意的是，合并症，如糖尿病、高血压、冠心病、终末期肾病、下呼吸道感染史等，以及人口统计学因素，如肥胖和年龄＞70 岁，似乎会影响死亡率，尤其是在继发性免疫缺陷患者中。
