COVID-19-related outcomes in immunocompromised patients: A nationwide study in Korea

Given the rapid increased in confirmed coronavirus disease 2019 (COVID-19) and related mortality, it is important to identify vulnerable patients. Immunocompromised status is considered a risk factor for developing severe COVID-19. We aimed to determine whether immunocompromised patients with COVID-...

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Bibliographic Details
Published in:PloS one 2021-10, Vol.16 (10), p.e0257641-e0257641
Main Authors: Baek, Moon Seong, Lee, Min-Taek, Kim, Won-Young, Choi, Jae Chol, Jung, Sun-Young
Format: Article
Language:English
Subjects:
Age
Biology and Life Sciences
Confidence intervals
Coronaviruses
Corticoids
Corticosteroids
COVID-19
COVID-19 diagnostic tests
Diabetes
Disease
Health insurance
Heart failure
HIV
Hospitals
Human immunodeficiency virus
Hypertension
Immunocompromised host
Immunocompromised hosts
Immunosuppressive agents
Infections
Internal medicine
Malignancy
Medicine
Medicine and Health Sciences
Mortality
Oxygen therapy
Pandemics
Patient outcomes
Patients
Pharmacy
Polymerase chain reaction
Population
Prescription drugs
Public health
Regression models
Renal replacement therapy
Risk analysis
Risk factors
Severe acute respiratory syndrome coronavirus 2
Statistical analysis
Transplantation
Ventilation
Viral diseases
Weighting
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Summary:Given the rapid increased in confirmed coronavirus disease 2019 (COVID-19) and related mortality, it is important to identify vulnerable patients. Immunocompromised status is considered a risk factor for developing severe COVID-19. We aimed to determine whether immunocompromised patients with COVID-19 have an increased risk of mortality. The groups' baseline characteristics were balanced using a propensity score-based inverse probability of treatment weighting approach. Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated for the risks of in-hospital mortality and other outcomes according to immunocompromised status using a multivariable logistic regression model. We identified immunocompromised status based on a diagnosis of malignancy or HIV/AIDS, having undergone organ transplantation within 3 years, prescriptions for corticosteroids or oral immunosuppressants for [greater than or equal to]30 days, and at least one prescription for non-oral immunosuppressants during the last year. The 6,435 COVID-19 patients ([greater than or equal to]18 years) included 871 immunocompromised (13.5%) and 5,564 non-immunocompromised (86.5%). Immunocompromised COVID-19 patients were older (60.1±16.4 years vs. 47.1±18.7 years, absolute standardized mean difference: 0.738). The immunocompromised group had more comorbidities, a higher Charlson comorbidity index, and a higher in-hospital mortality rate (9.6% vs. 2.3%; p < .001). The immunocompromised group still had a significantly higher in-hospital mortality rate after inverse probability of treatment weighting (6.4% vs. 2.0%, p < .001). Multivariable analysis adjusted for baseline imbalances revealed that immunocompromised status was independently associated with a higher risk of mortality among COVID-19 patients (adjusted odds ratio [aOR]: 2.09, 95% CI: 1.62-2.68, p < .001). Immunocompromised status among COVID-19 patients was associated with a significantly increased risk of mortality.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0257641