Li S N, Ni W T, Li R, Chen Y W, Gao Z C
Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing100044, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2025 Jan 12;48(1):35-42. doi: 10.3760/cma.j.cn112147-20240218-00083.
To analyze the clinical features of COVID-19 infection in hospitalized immunocompromised patients in comparison with immunocompetent patients. A single-center retrospective observational study was conducted on 213 inpatients diagnosed with COVID-19 in the Peking University People's Hospital between December 2022 and October 2023. They were divided into an immunocompromised group (102 patients, 47.9%) and an immunocompetent group(111 patients, 52.1%), and clinical data were compared between the two groups. The immunocompromised group was further divided into death group (18 cases, 17.6%) and non-death group (84 cases, 82.4%). The differences in laboratory examination findings were compared. Further analysis was performed on the lymphocyte subset differences between the death group(10 patients, 9.8%) and the non-death group (36 patients, 35.3%) with complete data. The proportion of severe and critical cases and the mortality rate, were significantly higher in the immunocompromised group than the immunocompetent group (47.1% . 40.5%, 18.6% . 9.0%, 17.6% . 9.0%,0.05). The immunocompromised group had lower vaccination rate (26.5% . 44.1%, <0.05). Hypertension, kidney disease and infections were more common in the immunocompromised group (63.7% . 48.6%, 30.4% . 9.0%, 49.0% . 19.8%, all <0.05). CT findings of consolidation (40.2% . 18.9%), rate of antiviral treatment (48.0% . 30.6%) and the positive duration of viral nucleic acid [median 14(7.0, 19.3) days . 9(7.0, 18.0) days] were higher in the immunocomprised group (all <0.05). Lactate dehydrogenase (LDH), procalcitonin (PCT), interleukin-6 (IL-6) and ferritin were higher in the immunocompromised group than those in the immunocompetent group (all <0.05). In the death group, neutrophils (NEU), C-reactive protein (CRP), PCT, IL-6, ferritin and D-dimer were higher, while lymphocytes (LY), CD4T-cells, CD8T-cells, B-cell counts and hemoglobin (HGB) were significantly lower than those in the non-death group (all <0.05). More than 60% of patients in the immunocompromised group were classified as severe or critical type, with a higher mortality rate and decreased ability to clear severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Decreases in total lymphocytes, CD4T lymphocytes, CD8T lymphocytes, and B lymphocytes, along with elevated levels of procalcitonin, ferritin, and D-dimer, indicated poor prognosis.
分析住院免疫功能低下患者与免疫功能正常患者相比感染新型冠状病毒肺炎（COVID-19）的临床特征。对2022年12月至2023年10月期间北京大学人民医院确诊为COVID-19的213例住院患者进行了一项单中心回顾性观察研究。他们被分为免疫功能低下组（102例患者，47.9%）和免疫功能正常组（111例患者，52.1%），并比较两组的临床资料。免疫功能低下组进一步分为死亡组（18例，17.6%）和非死亡组（84例，82.4%）。比较实验室检查结果的差异。对数据完整的死亡组（10例患者，9.8%）和非死亡组（36例患者，35.3%）的淋巴细胞亚群差异进行了进一步分析。免疫功能低下组的重症和危重症病例比例及死亡率显著高于免疫功能正常组（47.1% 对40.5%，18.6% 对9.0%，17.6% 对9.0%，P<0.05）。免疫功能低下组的疫苗接种率较低（26.5% 对44.1%，P<0.05）。免疫功能低下组高血压、肾脏疾病和感染更为常见（63.7% 对48.6%，30.4% 对9.0%，49.0% 对19.8%，均P<0.05）。免疫功能低下组的实变CT表现（40.2% 对18.9%）、抗病毒治疗率（48.0% 对30.6%）和病毒核酸阳性持续时间[中位数14（7.0，19.3）天 对9（7.0，18.0）天]更高（均P<0.05）。免疫功能低下组的乳酸脱氢酶（LDH）、降钙素原（PCT）、白细胞介素-6（IL-6）和铁蛋白高于免疫功能正常组（均P<0.05）。在死亡组中，中性粒细胞（NEU）、C反应蛋白（CRP）、PCT、IL-6、铁蛋白和D-二聚体较高，而淋巴细胞（LY）、CD4T细胞、CD8T细胞、B细胞计数和血红蛋白（HGB）显著低于非死亡组（均P<0.05）。免疫功能低下组超过60%的患者被分类为重症或危重症类型，死亡率较高且清除严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的能力下降。总淋巴细胞、CD4T淋巴细胞、CD8T淋巴细胞和B淋巴细胞减少，同时降钙素原、铁蛋白和D-二聚体水平升高，提示预后不良。
