Current issue
Archive
Manuscripts accepted
About the Journal
Editorial office
Editorial board
Section Editors
Abstracting and indexing
Subscription
Contact
Ethical standards and procedures
Most read articles
Instructions for authors
Article Processing Charge (APC)
Regulations of paying article processing charge (APC)
INFECTIOUS DISEASES / CLINICAL RESEARCH
Outcomes of SARS-CoV-2 infection in patients under
treatment with pharmacological immunosuppression.
A Swiss cohort study
1
Gastroenterology and Hepatology, Ente Ospedaliero Cantonale, Università della Svizzera Italiana, Lugano, Switzerland
2
Epatocentro Ticino, Università della Svizzera Italiana, Lugano, Switzerland
3
King’s College London Faculty of Life Sciences & Medicine, Institute of Liver Studies, MowatLabs, London, United Kingdom
4
Intensive Care Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland
5
Clinical Trial Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland
6
Division of Pneumology, University Hospital of Geneva, Geneva, Switzerland
7
ICT (Information and Communication Technologies), Ente Ospedaliero Cantonale, Bellinzona, Switzerland
Submission date: 2022-04-15
Final revision date: 2022-06-30
Acceptance date: 2022-07-25
Online publication date: 2022-08-03
Corresponding author
Antonio Galante
Gastroenterology and Hepatology Ente Ospedaliero Cantonale Università della Svizzera Italiana Lugano, Switzerland Phone: +41 091 811 7637
Gastroenterology and Hepatology Ente Ospedaliero Cantonale Università della Svizzera Italiana Lugano, Switzerland Phone: +41 091 811 7637
Arch Med Sci 2025;21(3):845-851
KEYWORDS
COVID-19SARS-CoV-2immunosuppressionautoimmunitycancerrheumatologychronic obstructive pulmonary diseaseliver diseasesolid organ transplant
TOPICS
ABSTRACT
Introduction:
The impact of pharmacological immunosuppression (IS) on COVID-19 outcomes is unclear. This study aimed to investigate the outcomes of hospitalised patients undergoing IS and focussed on length of hospital stay, admission to intensive care unit (ICU) and mortality.
Material and methods:
Patients admitted to public hospitals in southern Switzerland with SARS-CoV-2 infection (n = 442) were prospectively included, and their demographic, clinical, laboratory and treatment data were collected and analysed. Patients under IS at hospital admission or during the 6 months prior to hospitalisation for a minimum of 4 weeks were compared to patients from the same cohort but without any history of IS.
Results:
Thirty-five patients (7.9%, 65.7% male, median age 70.6 years) were treated with IS at the time of hospital admission. Compared with patients without IS, immunosuppressed patients showed higher mortality (n = 16/35, 45.7% vs. n = 95/407, 23.3% p = 0.003) and longer hospital stay (median = 15.5 days vs. median = 11, p = 0.0144). Moreover, in the univariate and multivariable logistic regression analysis, IS was independently associated with mortality (OR = 2.76 [95% CI: 1.37–5.59] and 2.66 [95% CI: 1.19–5.94]) and in the linear univariate and multivariable regression analysis with the length of stay (p = 0.005 and p = 0.007). Furthermore, patients under IS were more often admitted to the ICU, although the association was not significant (p = 0.069).
Conclusions:
Patients under IS were at a significantly higher risk of severe and prolonged COVID-19, with higher mortality and more extended hospital stay than patients without IS.
The impact of pharmacological immunosuppression (IS) on COVID-19 outcomes is unclear. This study aimed to investigate the outcomes of hospitalised patients undergoing IS and focussed on length of hospital stay, admission to intensive care unit (ICU) and mortality.
Material and methods:
Patients admitted to public hospitals in southern Switzerland with SARS-CoV-2 infection (n = 442) were prospectively included, and their demographic, clinical, laboratory and treatment data were collected and analysed. Patients under IS at hospital admission or during the 6 months prior to hospitalisation for a minimum of 4 weeks were compared to patients from the same cohort but without any history of IS.
Results:
Thirty-five patients (7.9%, 65.7% male, median age 70.6 years) were treated with IS at the time of hospital admission. Compared with patients without IS, immunosuppressed patients showed higher mortality (n = 16/35, 45.7% vs. n = 95/407, 23.3% p = 0.003) and longer hospital stay (median = 15.5 days vs. median = 11, p = 0.0144). Moreover, in the univariate and multivariable logistic regression analysis, IS was independently associated with mortality (OR = 2.76 [95% CI: 1.37–5.59] and 2.66 [95% CI: 1.19–5.94]) and in the linear univariate and multivariable regression analysis with the length of stay (p = 0.005 and p = 0.007). Furthermore, patients under IS were more often admitted to the ICU, although the association was not significant (p = 0.069).
Conclusions:
Patients under IS were at a significantly higher risk of severe and prolonged COVID-19, with higher mortality and more extended hospital stay than patients without IS.
REFERENCES (55)
1.
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet Lond Engl 2020; 395: 497-506.
2.
Morens DM, Daszak P, Taubenberger JK. Escaping pandora’s box – another novel Coronavirus. N Engl J Med 2020; 382: 1293-5.
3.
Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708-20.
4.
Couch RB, Englund JA, Whimbey E. Respiratory viral infections in immunocompetent and immunocompromised persons. Am J Med 1997; 102: 2-9.
5.
Mohammed AH, Blebil A, Dujaili J, et al. The risk and impact of COVID-19 pandemic on immunosuppressed patients: cancer, HIV, and solid organ transplant recipients. AIDS Rev 2020; 22: 151-7.
6.
Ye Q, Wang B, Mao J. The pathogenesis and treatment of the `Cytokine Storm’ in COVID-19. J Infect 2020; 80: 607-13.
7.
Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet Lond Engl 2020; 395: 1033-4.
8.
Andersen KM, Mehta HB, Palamuttam N, et al. 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. Clin Infect Dis 2021; 73: e4124-30.
9.
Morlacchi LC, Rossetti V, Gigli L, et al. COVID-19 in lung transplant recipients: a case series from Milan, Italy. Transpl Infect Dis 2020; 22: e13356.
10.
Becchetti C, Zambelli MF, Pasulo L, et al. COVID-19 in an international European liver transplant recipient cohort. Gut 2020; 69: 1832-40.
11.
Latif F, Farr MA, Clerkin KJ, et al. Characteristics and outcomes of recipients of heart transplant with coronavirus disease 2019. JAMA Cardiol 2020; 5: 1165-9.
12.
Favà A, Cucchiari D, Montero N, et al. Clinical characteristics and risk factors for severe COVID-19 in hospitalized kidney transplant recipients: a multicentric cohort study. Am J Transplant 2020; 20: 3030-41.
13.
Azzi Y, Bartash R, Scalea J, et al. COVID-19 and solid organ transplantation: a review article. Transplantation 2021; 105: 37-55.
14.
Liu C, Zhao Y, Okwan-Duodu D, et al. COVID-19 in cancer patients: risk, clinical features, and management. Cancer Biol Med 2020; 17: 519-27.
15.
Akiyama S, Hamdeh S, Micic D, et al. Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis. Ann Rheum Dis 2020; 80 (3). DOI: htttps://doi.org/annrheumdis-2020-218946.
16.
Gianfrancesco M, Hyrich KL, Al-Adely S, et al. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 2020; 79: 859-66.
17.
Holcomb ZE, Santillan MR, Morss-Walton PC, et al. Risk of COVID-19 in dermatologic patients receiving long-term immunomodulatory therapy. J Am Acad Dermatol 2020; 83: 1215-8.
18.
Gisondi P, Bellinato F, Chiricozzi A, et al. The risk of COVID-19 pandemic in patients with moderate to severe plaque psoriasis receiving systemic treatments. Vaccines 2020; 8: 728.
19.
Tracking SARS-CoV-2 variants [Internet]. [cited 2022 Jan 13]. Available from: https://www.who.int/en/activit....
20.
Ferri C, Giuggioli D, Raimondo V, et al. COVID-19 and rheumatic autoimmune systemic diseases: report of a large Italian patients series. Clin Rheumatol 2020; 39: 3195-204.
21.
Ungaro RC, Brenner EJ, Gearry RB, et al. Effect of IBD medications on COVID-19 outcomes: results from an international registry. Gut 2021; 70: 725-32.
22.
Izadi Z, Brenner EJ, Mahil SK, et al. Association between tumor necrosis factor inhibitors and the risk of hospitalization or death among patients with immune-mediated inflammatory disease and COVID-19. JAMA Netw Open 2021; 4: e2129639.
23.
Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med 2020; 180: 934-43.
24.
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet Lond Engl 2020; 395: 1054-62.
25.
Guan WJ, Liang WH, Zhao Y, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J 2020; 55: 2000547.
26.
Grasselli G, Zangrillo A, Zanella A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA 2020; 323: 1574-81.
27.
Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA 2020; 323: 2052-9.
28.
Cummings MJ, Baldwin MR, Abrams D, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet Lond Engl 2020; 395: 1763-70.
29.
Murdaca G, Pioggia G, Negrini S. Vitamin D and Covid-19: an update on evidence and potential therapeutic implications. Clin Mol Allergy 2020; 18: 23.
30.
Boyarsky BJ, Werbel WA, Avery RK, et al. Immunogenicity of a single dose of SARS-CoV-2 messenger RNA vaccine in solid organ transplant recipients. JAMA 2021; 325: 1784-6.
31.
Lee ARYB, Wong SY, Chai LYA, et al. Efficacy of COVID-19 vaccines in immunocompromised patients: a systematic review and meta-analysis [Internet]. 2021 [cited 2021 Dec 2]. p. 2021.09.28.21264126. Available from: https://www.medrxiv.org/conten....
32.
Albillos A, Lario M, Álvarez-Mon M. Cirrhosis-associated immune dysfunction: distinctive features and clinical relevance. J Hepatol 2014; 61: 1385-96.
33.
Mao R, Qiu Y, He JS, et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020; 5: 667-78.
34.
Zhang C, Shi L, Wang FS. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol 2020; 5: 428-30.
35.
Ji D, Qin E, Xu J, et al. Non-alcoholic fatty liver diseases in patients with COVID-19: a retrospective study. J Hepatol 2020; 73: 451-3.
36.
Ponziani FR, Del Zompo F, Nesci A, et al. Liver involvement is not associated with mortality: results from a large cohort of SARS-CoV-2 positive patients. Aliment Pharmacol Ther 2020; 52: 1060-8.
37.
Philips CA, Ahamed R, Augustine P. SARS-CoV-2 related liver impairment – perception may not be the reality J Hepatol 2020; 73: 991-2.
38.
Middleton P, Hsu C, Lythgoe MP. Clinical outcomes in COVID-19 and cirrhosis: a systematic review and meta-analysis of observational studies. BMJ Open Gastroenterol 2021; 8: e000739.
39.
Robinson PC, Morand E. Divergent effects of acute versus chronic glucocorticoids in COVID-19. Lancet Rheumatol 2021; 3: e168-70.
40.
Wang Q, Berger NA, Xu R. When hematologic malignancies meet COVID-19 in the United States: Infections, death and disparities. Blood Rev 2021; 47: 100775.
41.
Colmenero J, Rodríguez-Perálvarez M, Salcedo M, et al. Epidemiological pattern, incidence, and outcomes of COVID-19 in liver transplant patients. J Hepatol 2021; 74: 148-55.
42.
D’Silva KM, Jorge A, Cohen A, et al. COVID-19 outcomes in patients with systemic autoimmune rheumatic diseases compared to the general population: a US Multicenter, Comparative Cohort Study. Arthritis Rheumatol 2021; 73: 914-20.
43.
Akiyama S, Hamdeh S, Micic D, et al. Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis. Ann Rheum Dis 2021: 80: 384-91.
44.
Ward D, Gørtz S, Ernst MT, et al. The effect of immunosuppressants on the prognosis of SARS-CoV-2 infection. Eur Respir J 2022; 59: 2100769.
45.
Quante M, Brake L, Tolios A, et al. SARS-CoV-2 in solid organ transplant recipients: a structured review of 2020. Transplant Proc 2021; 53: 2421-34.
46.
Mikuls TR, Johnson SR, Fraenkel L, et al. American College of Rheumatology Guidance for the management of rheumatic disease in adult patients during the COVID-19 pandemic: version 3. Arthritis Rheumatol 2021; 73: e1-12.
47.
Strangfeld A, Schäfer M, Gianfrancesco MA, et al. Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 2021; 80: 930-42.
48.
Nguyen NT, Chinn J, De Ferrante M, et al. Male gender is a predictor of higher mortality in hospitalized adults with COVID-19. PLoS One 2021; 16: e0254066.
49.
Marjot T, Moon AM, Cook JA, et al. Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: an international registry study. J Hepatol 2021; 74: 567-77.
50.
Marjot T, Buescher G, Sebode M, et al. SARS-CoV-2 infection in patients with autoimmune hepatitis. J Hepatol 2021; 74: 1335-43.
51.
Marjot T, Webb GJ, Barritt AS, et al. COVID-19 and liver disease: mechanistic and clinical perspectives. Nat Rev Gastroenterol Hepatol 2021; 18: 348-64.
52.
Coronavirus Disease 2019 (COVID-19) Treatment Guidelines [Internet]. Bethesda (MD): National Institutes of Health (US); 2021 [cited 2022 Mar 5]. Available from: http://www.ncbi.nlm.nih.gov/bo....
53.
Ghanei M. It is time to consider an anti-inflammatory therapy based on the pathophysiology of COVID-19 infection during the right time window? Arch Med Sci 2021; 17: 546-50.
54.
Lucio Liberato N, De Monte A, Caravella G. Tocilizumab in severe COVID-19. Arch Med Sci 2020; 16: 1457-8.
55.
Transplants [Internet]. COVID-19 Treat. Guidel. [cited 2022 Mar 5]. Available from: https://www.covid19treatmentgu....
Share
RELATED ARTICLE
| eISSN: | 1896-9151 |
| ISSN: | 1734-1922 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
