Li Xiaoyan, Li Lijuan
Department of Pulmonary and Critical Care Medicine, Renqiu Friendship Hospital, Cangzhou, 062550, China.
Heliyon. 2024 Oct 9;10(20):e39044. doi: 10.1016/j.heliyon.2024.e39044. eCollection 2024 Oct 30.
Previous studies evaluating the differences in COVID-19 mortality rates between immunocompromised patients and other patient groups have shown conflicting findings. This research aimed to compare the mortality rates of immunocompromised and immunocompetent patients during the Omicron-dominant period of the SARS-CoV-2 pandemic, and to identify factors associated with prognosis.
We conducted a retrospective analysis of 1085 adult patients (aged ≥18 years) admitted with COVID-19 pneumonia to the China-Japan Friendship Hospital between December 1, 2022, and January 31, 2023. We assessed the prevalence of comorbidities, incidence of co-infections and nosocomial infections, and 30-day mortality.
Among the 1085 patients, 254 were immunocompromised, and 831 were immunocompetent. Immunocompromised patients had higher rates of non-invasive ventilation use (30.3 % vs. 21.1 %), invasive ventilation (12.2 % vs. 5.3 %), and 30-day mortality (19.7 % vs. 13.7 %) compared to immunocompetent patients. However, overall mortality rates did not significantly differ based on immunocompromised status. Cox regression analysis identified that elevated troponin T (≥0.15 ng/mL), respiratory failure, high lactate dehydrogenase (≥272.5 U/L), elevated D-dimer (≥1.295 mg/L), increased C-reactive protein (≥90 mg/L), elevated interleukin-6 (>11.67 ng/L), high peripheral blood neutrophil count (>9.84 × 10⁹/L), and immunocompromised status were independent predictors of poor COVID-19 prognosis. In the immunocompetent group, current smoking and a history of interstitial lung disease were related to a worse prognosis.
COVID-19 pneumonia due to the Omicron variant may lead to worse outcomes in immunocompromised patients. In immunocompetent patients, careful monitoring is essential for those with respiratory failure, smoking history, or interstitial lung disease to prevent adverse outcomes.
既往评估免疫功能低下患者与其他患者群体之间新冠病毒疾病（COVID-19）死亡率差异的研究结果相互矛盾。本研究旨在比较在严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行的奥密克戎毒株主导时期免疫功能低下患者和免疫功能正常患者的死亡率，并确定与预后相关的因素。
我们对2022年12月1日至2023年1月31日期间因COVID-19肺炎入住中日友好医院的1085例成年患者（年龄≥18岁）进行了回顾性分析。我们评估了合并症的患病率、合并感染和医院感染的发生率以及30天死亡率。
在1085例患者中，254例为免疫功能低下患者，831例为免疫功能正常患者。与免疫功能正常患者相比，免疫功能低下患者无创通气使用率更高（30.3%对21.1%）、有创通气使用率更高（12.2%对5.3%）以及30天死亡率更高（19.7%对13.7%）。然而，总体死亡率并未因免疫功能低下状态而有显著差异。Cox回归分析确定，肌钙蛋白T升高（≥0.15 ng/mL）、呼吸衰竭、高乳酸脱氢酶（≥272.5 U/L）、D-二聚体升高（≥1.295 mg/L）、C反应蛋白升高（≥90 mg/L）、白细胞介素-6升高（>11.67 ng/L）、外周血中性粒细胞计数升高（>9.84×10⁹/L）以及免疫功能低下状态是COVID-19预后不良的独立预测因素。在免疫功能正常组中，当前吸烟和间质性肺疾病史与预后较差有关。
奥密克戎变异株引起的COVID-19肺炎可能导致免疫功能低下患者出现更差的结局。在免疫功能正常患者中，对于有呼吸衰竭、吸烟史或间质性肺疾病的患者，密切监测对于预防不良结局至关重要。
