tetano
Editor, Senior Moderator
Clin Infect Dis
. 2021 Jan 7;ciaa1488.
doi: 10.1093/cid/ciaa1488. Online ahead of print.
Association Between Chronic Use of Immunosuppresive Drugs and Clinical Outcomes From Coronavirus Disease 2019 (COVID-19) Hospitalization: A Retrospective Cohort Study in a Large US Health System
Kathleen M Andersen[SUP] 1 2 [/SUP], Hemalkumar B Mehta[SUP] 1 2 [/SUP], Natasha Palamuttam[SUP] 3 [/SUP], Daniel Ford[SUP] 4 [/SUP], Brian T Garibaldi[SUP] 5 [/SUP], Paul G Auwaerter[SUP] 6 [/SUP], Jodi Segal[SUP] 1 2 4 7 [/SUP], G Caleb Alexander[SUP] 1 2 4 [/SUP]
Affiliations
Abstract
Background: It is unclear whether chronic use of immunosuppressive drugs worsens or improves the severity of coronavirus disease 2019 (COVID-19), with plausible mechanisms for both.
Methods: Retrospective cohort study in 2121 consecutive adults with acute inpatient hospital admission between 4 March and 29 August 2020 with confirmed or suspected COVID-19 in a large academic health system, with adjustment for confounding with propensity score-derived stabilized inverse probability of treatment weights. Chronic immunosuppression was defined as prescriptions for immunosuppressive drugs current at the time of admission. Outcomes included mechanical ventilation, in-hospital mortality, and length of stay.
Results: There were 2121 patients admitted with laboratory-confirmed (1967, 93%) or suspected (154, 7%) COVID-19 during the study period, with a median age of 55 years (interquartile range, 40-67). Of these, 108 (5%) were classified as immunosuppressed before COVID-19, primarily with prednisone (>7.5 mg/day), tacrolimus, or mycophenolate mofetil. Among the entire cohort, 311 (15%) received mechanical ventilation; the median (interquartile range) length of stay was 5.2 (2.5-10.6) days, and 1927 (91%) survived to discharge. After adjustment, there were no significant differences in the risk of mechanical ventilation (hazard ratio
, .79; 95% confidence interval [CI], .46-1.35), in-hospital mortality (HR, .66; 95% CI, .28-1.55), or length of stay (HR, 1.16; 95% CI, .92-1.47) among individuals with immunosuppression and counterparts.
Conclusions: Chronic use of immunosuppressive drugs was neither associated with worse nor better clinical outcomes among adults hospitalized with COVID-19 in one US health system.
Keywords: COVID-19; clinical outcomes; immunosuppression; prescription medicines.
. 2021 Jan 7;ciaa1488.
doi: 10.1093/cid/ciaa1488. Online ahead of print.
Association Between Chronic Use of Immunosuppresive Drugs and Clinical Outcomes From Coronavirus Disease 2019 (COVID-19) Hospitalization: A Retrospective Cohort Study in a Large US Health System
Kathleen M Andersen[SUP] 1 2 [/SUP], Hemalkumar B Mehta[SUP] 1 2 [/SUP], Natasha Palamuttam[SUP] 3 [/SUP], Daniel Ford[SUP] 4 [/SUP], Brian T Garibaldi[SUP] 5 [/SUP], Paul G Auwaerter[SUP] 6 [/SUP], Jodi Segal[SUP] 1 2 4 7 [/SUP], G Caleb Alexander[SUP] 1 2 4 [/SUP]
Affiliations
- PMID: 33410884
- DOI: 10.1093/cid/ciaa1488
Abstract
Background: It is unclear whether chronic use of immunosuppressive drugs worsens or improves the severity of coronavirus disease 2019 (COVID-19), with plausible mechanisms for both.
Methods: Retrospective cohort study in 2121 consecutive adults with acute inpatient hospital admission between 4 March and 29 August 2020 with confirmed or suspected COVID-19 in a large academic health system, with adjustment for confounding with propensity score-derived stabilized inverse probability of treatment weights. Chronic immunosuppression was defined as prescriptions for immunosuppressive drugs current at the time of admission. Outcomes included mechanical ventilation, in-hospital mortality, and length of stay.
Results: There were 2121 patients admitted with laboratory-confirmed (1967, 93%) or suspected (154, 7%) COVID-19 during the study period, with a median age of 55 years (interquartile range, 40-67). Of these, 108 (5%) were classified as immunosuppressed before COVID-19, primarily with prednisone (>7.5 mg/day), tacrolimus, or mycophenolate mofetil. Among the entire cohort, 311 (15%) received mechanical ventilation; the median (interquartile range) length of stay was 5.2 (2.5-10.6) days, and 1927 (91%) survived to discharge. After adjustment, there were no significant differences in the risk of mechanical ventilation (hazard ratio
, .79; 95% confidence interval [CI], .46-1.35), in-hospital mortality (HR, .66; 95% CI, .28-1.55), or length of stay (HR, 1.16; 95% CI, .92-1.47) among individuals with immunosuppression and counterparts.
Conclusions: Chronic use of immunosuppressive drugs was neither associated with worse nor better clinical outcomes among adults hospitalized with COVID-19 in one US health system.
Keywords: COVID-19; clinical outcomes; immunosuppression; prescription medicines.