Clinical characteristics and outcomes of immunosuppressed patients hospitalized with COVID‐19: experience from London
| Autor: | Thomas A N Reed, Poppy Utting, Dorina Condurache, Nidhi Vaid, Maddalena Ardissino, David Cohen, Jack W Goodall, Megan Miscampbell |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Male medicine.medical_specialty medicine.medical_treatment Pneumonia Viral 030204 cardiovascular system & hematology 03 medical and health sciences Immunocompromised Host 0302 clinical medicine Internal medicine London Global health medicine Internal Medicine Intubation Humans Continuous positive airway pressure Hospital Mortality Pandemics Aged Aged 80 and over Continuous Positive Airway Pressure business.industry SARS-CoV-2 Mortality rate COVID-19 Immunosuppression Middle Aged medicine.disease Hospitalization 030104 developmental biology Cohort Female Cytokine storm business Immunosuppressive Agents Cohort study |
| Zdroj: | Journal of Internal Medicine |
| ISSN: | 1365-2796 0954-6820 |
| DOI: | 10.1111/joim.13172 |
| Popis: | Background Coronavirus disease 2019 (COVID-19) is a global health emergency. Despite the widely hypothesized role of a cytokine storm in disease severity, no study thus far has explored the association between immunosuppression and disease severity in patients hospitalized with COVID-19. Objective This study aimed to examine the association between the use of immunosuppressant medication and outcomes of patients hospitalized with COVID-19. Methods Nine hundred and eighty-one consecutive patients hospitalized between 12 March 2020 and 15 April 2020, who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), were enrolled in this cohort study and subdivided by immunosuppression status. The patients were followed up for a minimum of 28 days (median 37 days) for the primary end-point of mortality. Secondary end-points included the composite of intubation or death, and the composite of mortality, intubation or continuous positive airway pressure (CPAP) requirement. Results During the follow-up period, 354 (36.1%) of study patients died. The immunosuppressed cohort (n = 31) had significantly higher mortality rates (aHR: 2.067, 95% CI: 1.20-3.57, P = 0.009). There was no association between immunosuppression and the composite end-point of mortality or intubation (aHR: 1.49 95% CI: 0.88-2.51, P = 0.14) and of the composite end-point of mortality, intubation or CPAP (aHR: 1.36 95% CI: 0.81-2.30 P = 0.245). Conclusion In this cohort study of 981 confirmed COVID-19 patients consecutively hospitalized at a large North West London hospital, immunosuppressant use was associated with significantly higher mortality rates. These results support the current UK government's early isolation ('shielding') policy for these individuals and should be used to guide future research. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text