Immunocompromised Patients With COVID-19 and Risk for ICU Admission, Mortality

Immunocompromised individuals hospitalized with COVID-19 were more likely to be admitted to the intensive care unit (ICU) and to have in-hospital mortality compared with nonimmunocompromised individuals. These findings were published in the Morbidity and Mortality Weekly Report.

People who are immunocompromised are at increased risk for severe COVID-19-related outcomes. In the United States, these individuals account for 2.7% of the adult population. In order to evaluate in-hospital risks, researchers from the California Emerging Infections Program sourced data for this study from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET). This database included hospital records from 10 states. COVID-19-related ICU admission and mortality were evaluated between March 2020 and February 2022 on the basis of immunocompromised status.

Among the 22,345 inpatients, 12.2% were immunocompromised overall, 11.1% during the pre-Delta, 10.9% during the Delta, and 17.3% during the Omicron waves. The immunocompromised cohort was older (P <.01), more identified as White (52.4% vs 47.7%; P <.01), fewer were unvaccinated (70.1% vs 86.1%; P <.01), and more had nonneurologic comorbidities (all P ≤.05).

The most common immunocompromised condition was solid organ malignancy (37.2%) or was caused by immunosuppressive (32.2%) or steroid (26.5%) therapies.

Stratified by vaccination status, a larger proportion of the immunocompromised individuals who were unvaccinated were admitted to the ICU (26.6% vs 22.8%) and died (14.5% vs 11.0%). Similarly, immunocompromised individuals who were vaccinated were also associated with higher ICU admission (25.0% vs 18.7%) and mortality (16.5% vs 9.6%) rates.

Immunocompromised status was associated with increased risk for ICU admission among unvaccinated (adjusted odds ratio [aOR], 1.26; 95% CI, 1.08-1.49; P <.01) and vaccinated (aOR, 1.40; 95% CI, 1.01-1.92; P <.05) individuals as well as mortality among unvaccinated (aOR, 1.34; 95% CI, 1.05-1.70; P <.05) and vaccinated (aOR, 1.87; 95% CI, 1.28-2.75; P <.01) individuals.

Among the immunocompromised cohort, there were no differences in risk for ICU admission (aOR, 1.01; 95% CI, 0.64-1.58) or mortality (aOR, 1.34; 95% CI, 0.71-2.51) on the basis of vaccination status. For the nonimmunocompromised cohort, vaccination decreased risk for mortality (aOR, 0.58; 95% CI, 0.39-0.86; P <.05) but not for ICU admission (aOR, 0.85; 95% CI, 0.60-1.12).

The major limitation of this study was that it did not control for time since vaccination and as immunocompromised individuals were eligible for vaccines earlier, the protective effect of vaccination may have waned more among the immunocompromised population.

“Once hospitalized, immunocompromised patients with COVID-19 had increased odds of ICU admission or in-hospital death, irrespective of vaccination status, compared with nonimmunocompromised patients, after adjusting for differences in demographic and clinical characteristics,” the researchers concluded.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Singson JRC, Kirley PD, Pham H, et al. Factors associated with severe outcomes among immunocompromised adults hospitalized for COVID-19 — COVID-NET, 10 states, March 2020-February 2022. MMWR Morb Mortal Wkly Rep. Published online July 8, 2022. doi:10.15585/mmwr.mm7127a3

This article originally appeared on Neurology Advisor