tetano
Editor, Senior Moderator
J Med Virol
. 2020 Nov 9.
doi: 10.1002/jmv.26656. Online ahead of print.
Non-severe immunosuppression might be associated with a lower risk of moderate-severe acute respiratory distress syndrome in COVID-19: a pilot study
Enric Monreal[SUP] 1 [/SUP], Susana Sainz de la Maza[SUP] 1 [/SUP], Pedro Gull?n[SUP] 2 [/SUP], Elena Natera-Villalba[SUP] 1 [/SUP], Juan Luis Chico-Garc?a[SUP] 1 [/SUP], ?lvaro Beltr?n-Corbellini[SUP] 1 [/SUP], Javier Mart?nez-Sanz[SUP] 3 [/SUP], Nuria Garc?a-Barrag?n[SUP] 1 [/SUP], Javier Buis?n[SUP] 1 [/SUP], Rafael Toledano[SUP] 1 [/SUP], Araceli Alonso-Canovas[SUP] 1 [/SUP], Paula P?rez-Torre[SUP] 1 [/SUP], Mar?a Consuelo Matute-Lozano[SUP] 1 [/SUP], Jose Luis L?pez-Send?n[SUP] 1 [/SUP], Guillermo Garc?a-Ribas[SUP] 1 [/SUP], ??igo Corral[SUP] 1 [/SUP], Jes?s Fort?n[SUP] 3 [/SUP], Beatriz Montero-Errasqu?n[SUP] 4 [/SUP], Luis Manzano[SUP] 5 [/SUP], Luis M?iz-Carro[SUP] 6 [/SUP], Lucienne Costa-Frossard[SUP] 1 [/SUP], Jaime Masjuan[SUP] 1 [/SUP], COVID-HRC group
Affiliations
Abstract
Problem: The role of immunosuppression among Coronavirus disease 2019 (COVID-19) patients has not been elucidated and management may be challenging.
Methods: Observational study with confirmed COVID-19 patients. The primary endpoint was development of moderate-severe acute respiratory distress syndrome (ARDS). Time to moderate-severe ARDS, the need for mechanical or non-invasive ventilation (MV/NIV), death, and a composite of death or MV/NIV were secondary endpoints.
Results: Of 138 patients included, 27 (19.6%) were immunosuppressed (IS) and 95 (68.8%) were male, with a median (IQR) age of 68 (54-78) years. A significantly lower proportion of IS patients (25.9%) compared to non-IS patients (52.3%) developed moderate-severe ARDS, in both unadjusted (0.32 (95%CI, 0.13-0.83, p=0.017) and adjusted (aOR 0.25 [95%CI, 0.08-0.80], p=0.019) analyses. After stratifying by pathologies, only IS patients with autoimmune diseases remained significant (aOR 0.25 [95%CI, 0.07-0.98], p=0.046). Non-significant trends towards a longer time to moderate or severe ARDS, a lower need for MV/NIV, and a lower risk of death or MV/NIV were detected among IS.
Conclusions: In our cohort of COVID-19 patients, non-severe immunosuppression was associated with a lower risk of moderate-severe ARDS, especially among AD. This suggests a potential protective effect from a hypothesized hyper-inflammatory response. This article is protected by copyright. All rights reserved.
Keywords: COVID-19; acute respiratory distress syndrome; autoimmune diseases; immunosuppression; severe acute respiratory syndrome coronavirus 2.
. 2020 Nov 9.
doi: 10.1002/jmv.26656. Online ahead of print.
Non-severe immunosuppression might be associated with a lower risk of moderate-severe acute respiratory distress syndrome in COVID-19: a pilot study
Enric Monreal[SUP] 1 [/SUP], Susana Sainz de la Maza[SUP] 1 [/SUP], Pedro Gull?n[SUP] 2 [/SUP], Elena Natera-Villalba[SUP] 1 [/SUP], Juan Luis Chico-Garc?a[SUP] 1 [/SUP], ?lvaro Beltr?n-Corbellini[SUP] 1 [/SUP], Javier Mart?nez-Sanz[SUP] 3 [/SUP], Nuria Garc?a-Barrag?n[SUP] 1 [/SUP], Javier Buis?n[SUP] 1 [/SUP], Rafael Toledano[SUP] 1 [/SUP], Araceli Alonso-Canovas[SUP] 1 [/SUP], Paula P?rez-Torre[SUP] 1 [/SUP], Mar?a Consuelo Matute-Lozano[SUP] 1 [/SUP], Jose Luis L?pez-Send?n[SUP] 1 [/SUP], Guillermo Garc?a-Ribas[SUP] 1 [/SUP], ??igo Corral[SUP] 1 [/SUP], Jes?s Fort?n[SUP] 3 [/SUP], Beatriz Montero-Errasqu?n[SUP] 4 [/SUP], Luis Manzano[SUP] 5 [/SUP], Luis M?iz-Carro[SUP] 6 [/SUP], Lucienne Costa-Frossard[SUP] 1 [/SUP], Jaime Masjuan[SUP] 1 [/SUP], COVID-HRC group
Affiliations
- PMID: 33165922
- DOI: 10.1002/jmv.26656
Abstract
Problem: The role of immunosuppression among Coronavirus disease 2019 (COVID-19) patients has not been elucidated and management may be challenging.
Methods: Observational study with confirmed COVID-19 patients. The primary endpoint was development of moderate-severe acute respiratory distress syndrome (ARDS). Time to moderate-severe ARDS, the need for mechanical or non-invasive ventilation (MV/NIV), death, and a composite of death or MV/NIV were secondary endpoints.
Results: Of 138 patients included, 27 (19.6%) were immunosuppressed (IS) and 95 (68.8%) were male, with a median (IQR) age of 68 (54-78) years. A significantly lower proportion of IS patients (25.9%) compared to non-IS patients (52.3%) developed moderate-severe ARDS, in both unadjusted (0.32 (95%CI, 0.13-0.83, p=0.017) and adjusted (aOR 0.25 [95%CI, 0.08-0.80], p=0.019) analyses. After stratifying by pathologies, only IS patients with autoimmune diseases remained significant (aOR 0.25 [95%CI, 0.07-0.98], p=0.046). Non-significant trends towards a longer time to moderate or severe ARDS, a lower need for MV/NIV, and a lower risk of death or MV/NIV were detected among IS.
Conclusions: In our cohort of COVID-19 patients, non-severe immunosuppression was associated with a lower risk of moderate-severe ARDS, especially among AD. This suggests a potential protective effect from a hypothesized hyper-inflammatory response. This article is protected by copyright. All rights reserved.
Keywords: COVID-19; acute respiratory distress syndrome; autoimmune diseases; immunosuppression; severe acute respiratory syndrome coronavirus 2.