Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center(ADIR), Tehran University of Medical Sciences, Tehran, Iran.
Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Department of Infectious Diseases, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Immun Inflamm Dis. 2024 Apr;12(4):e1239. doi: 10.1002/iid3.1239.
As the effects of immunosuppression are not still clear on COVID-19 patients, we conducted this study to identify clinical and laboratory findings associated with pulmonary involvement in both immunocompromised and immunocompetent patients.
A case-control of 107 immunocompromised and 107 immunocompetent COVID-19 patients matched for age and sex with either positive RT-PCR or clinical-radiological findings suggestive of COVID-19 enrolled in the study. Their initial clinical features, laboratory findings, chest CT scans, and short-term outcomes (hospitalization time and intensive care unit [ICU] admission) were recorded. In addition, pulmonary involvement was assessed with the semi-quantitative scoring system (0-25).
Pulmonary involvement was significantly lower in immunocompromised patients in contrast to immunocompetent patients, especially in RLL (p = 0.001), LUL (p = 0.023), and both central and peripheral (p = 0.002), and peribronchovascular (p = 0.004) sites of lungs. Patchy (p < 0.001), wedged (p = 0.002), confluent (p = 0.002) lesions, and ground glass with consolidation pattern (p < 0.001) were significantly higher among immunocompetent patients. Initial signs and symptoms of immunocompromised patients including dyspnea (p = 0.008) and hemoptysis (p = 0.036), respiratory rate of over 25 (p < 0.001), and spo2 of below 93% (p = 0.01) were associated with higher pulmonary involvement. Total chest CT score was also associated with longer hospitalization (p = 0.016) and ICU admission (p = 0.04) among immunocompromised patients.
Pulmonary involvement score was not significantly different among immunocompromised and immunocompetent patients. Initial clinical findings (dyspnea, hemoptysis, higher RR, and lower Spo) of immunocompromised patients could better predict pulmonary involvement than laboratory findings.
由于免疫抑制对 COVID-19 患者的影响尚不清楚，我们进行了这项研究，以确定免疫抑制和免疫正常患者肺部受累的临床和实验室发现。
对 107 例免疫抑制和 107 例免疫正常的 COVID-19 患者进行病例对照研究，这些患者年龄和性别匹配，均通过 RT-PCR 阳性或临床放射学发现疑似 COVID-19。记录他们的初始临床特征、实验室检查结果、胸部 CT 扫描和短期结局（住院时间和重症监护病房 [ICU] 入院）。此外，使用半定量评分系统（0-25）评估肺部受累情况。
与免疫正常患者相比，免疫抑制患者的肺部受累明显较低，尤其是在右肺下叶（p=0.001）、左肺上叶（p=0.023）以及中央和外周（p=0.002）和支气管血管周围（p=0.004）肺部部位。免疫正常患者的斑片状（p<0.001）、楔形（p=0.002）、融合性（p=0.002）病变和磨玻璃影伴实变影（p<0.001）明显更高。免疫抑制患者的初始症状和体征，包括呼吸困难（p=0.008）和咯血（p=0.036）、呼吸频率超过 25 次/分（p<0.001）和 Spo2 低于 93%（p=0.01）与更高的肺部受累有关。总胸部 CT 评分也与免疫抑制患者的住院时间延长（p=0.016）和 ICU 入院（p=0.04）有关。
免疫抑制和免疫正常患者的肺部受累评分无显著差异。免疫抑制患者的初始临床发现（呼吸困难、咯血、更高的 RR 和更低的 Spo）比实验室发现更能预测肺部受累。
