Lindahl Hannes, Kahn Fredrik, Nilsdotter-Augustinsson Åsa, Fredrikson Mats, Hedberg Pontus, Killander Möller Isabela, Hansson Lotta, Blixt Lisa, Eketorp Sylvan Sandra, Österborg Anders, Aleman Soo, Carlander Christina, Nyström Sofia, Bergman Peter
Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Sciences Lund, Section for Infection Medicine, Lund University, Lund, Sweden; Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden.
J Allergy Clin Immunol. 2025 Feb;155(2):387-397.e6. doi: 10.1016/j.jaci.2024.10.013. Epub 2024 Oct 22.
It is thought that patients with inborn errors of immunity (IEI) are more susceptible to severe coronavirus disease 2019 (COVID-19) than the general population, but a quantification of this potential risk is largely missing.
We assessed the impact of COVID-19 on patients with IEI.
A nationwide cohort study was performed to estimate the relative risk (RR) for hospitalization, intensive care, and death within 30 days after a positive severe acute respiratory syndrome coronavirus 2 test result in an IEI population (n = 2392) compared to the general population (n = 8,270,705) using data from Swedish national registries. Three time periods were studied: the prevaccination period, and the Alpha/Delta and Omicron periods. Adjustment was made for demographics, income, comorbidities, and vaccination status.
During the prevaccination period, 25.2% of the IEI population was hospitalized, compared to 17.5% and 5.2% during the Alpha/Delta and Omicron periods, respectively. For the 3 time periods, the adjusted RR [95% confidence interval] for hospitalization in the IEI population compared to the general population was 3.1 [2.1-4.2], 3.5 [2.4-4.8], and 4.3 [2.5-6.7], respectively. The respective values for intensive care after COVID-19 were 5.6 [2.6-10.8], 4.7 [1.7-10.1], and 4.7 [1.7-10.1] for the 3 periods. Five patients (0.6%) in the IEI population died within 30 days of a positive PCR test result compared to 18,773 (0.2%) in the general population during the 3 study periods.
Patients with IEI had a 3 to 4 times higher risk for hospitalization and a 5 times higher risk for intensive care during COVID-19 compared to the general population.
人们认为，先天性免疫缺陷（IEI）患者比普通人群更容易感染重症2019冠状病毒病（COVID-19），但这种潜在风险的量化在很大程度上缺失。
我们评估了COVID-19对IEI患者的影响。
进行了一项全国性队列研究，利用瑞典国家登记处的数据，估计IEI人群（n = 2392）与普通人群（n = 8270705）相比，在严重急性呼吸综合征冠状病毒2检测结果呈阳性后30天内住院、重症监护和死亡的相对风险（RR）。研究了三个时间段：疫苗接种前时期、阿尔法/德尔塔时期和奥密克戎时期。对人口统计学、收入、合并症和疫苗接种状况进行了调整。
在疫苗接种前时期，25.2%的IEI人群住院，而在阿尔法/德尔塔时期和奥密克戎时期分别为17.5%和5.2%。在这三个时间段内，与普通人群相比，IEI人群住院的调整后RR[95%置信区间]分别为3.1[2.1 - 4.2]、3.5[2.4 - 4.8]和4.3[2.5 - 6.7]。COVID-19后重症监护的相应值在这三个时期分别为5.6[2.6 - 10.8]、4.7[1.7 - 10.1]和4.7[1.7 - 10.1]。在3个研究期间，IEI人群中有5名患者（0.6%）在PCR检测结果呈阳性后30天内死亡，而普通人群中有18773名患者（0.2%）死亡。
与普通人群相比，IEI患者在COVID-19期间住院风险高3至4倍，重症监护风险高5倍。
