Journal of thoracic disease · 2025
Prognosis of critically ill immunocompromised patients with COVID-19 admitted for acute respiratory failure: a retrospective propensity score analysis.
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Bernard de Lajartre Océane, Le Corre Alexia, Bichon Anaelle, Terzi Nicolas, Gacouin Arnaud, Maamar Adel, Tadie Jean-Marc
Аннотация
BACKGROUND: Since the introduction of coronavirus disease 2019 (COVID-19) vaccination, the proportion of immunocompromised patients among critically ill individuals admitted to the intensive care unit (ICU) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia seems to have increased significantly. However, data on this specific critically ill population remain limited. The aim of our study is to explore the impact of immunocompromised status on ICU outcomes in COVID-19 patients admitted for acute respiratory failure (ARF).
METHODS: In this retrospective study, data from adult patients admitted for ARF-related to SARS-CoV-2 pneumonia were collected. To study the impact of immunocompromised status, immunocompromised and non-immunocompromised patients were matched using propensity scores. A Cox-proportional hazard model was used to determine whether immunocompromised status during the ICU stay was associated with ICU mortality.
RESULTS: Between March 2021, the time of admission of the first vaccinated patients, and December 2022, we identified 294 patients (220 non-immunocompromised, 74 immunocompromised). The immunocompromised group had a greater risk of mortality in the ICU (31.1% vs. 8.6%, P<0.001) and a greater risk of ICU acquiring infections (52.7% vs. 19.5%, P<0.001). After matching, the immunocompromised group exhibited significantly greater rates of acquired infections (52.7% vs. 29.7%, P=0.008) and longer ICU stays {13 [interquartile range (IQR), 7-28.8] vs. 8 (IQR, 3-23) days, P=0.046}. According to the Cox proportional hazard model, immunosuppression was not a significant risk factor for death in the ICU {hazard ratio (HR): 1.58 [95% confidence interval (CI): 0.79-3.14]; P=0.24} but was associated with ICU acquired infections [HR: 2.27 (95% CI: 1.02-5.06); P=0.044].
CONCLUSIONS: After adjustment for prognostic variables, the immunocompromised status of patients admitted to the ICU for SARS-CoV-2-related ARF was not associated with increased mortality, despite a significantly longer ICU stay and a greater rate of ICU acquired infections.
METHODS: In this retrospective study, data from adult patients admitted for ARF-related to SARS-CoV-2 pneumonia were collected. To study the impact of immunocompromised status, immunocompromised and non-immunocompromised patients were matched using propensity scores. A Cox-proportional hazard model was used to determine whether immunocompromised status during the ICU stay was associated with ICU mortality.
RESULTS: Between March 2021, the time of admission of the first vaccinated patients, and December 2022, we identified 294 patients (220 non-immunocompromised, 74 immunocompromised). The immunocompromised group had a greater risk of mortality in the ICU (31.1% vs. 8.6%, P<0.001) and a greater risk of ICU acquiring infections (52.7% vs. 19.5%, P<0.001). After matching, the immunocompromised group exhibited significantly greater rates of acquired infections (52.7% vs. 29.7%, P=0.008) and longer ICU stays {13 [interquartile range (IQR), 7-28.8] vs. 8 (IQR, 3-23) days, P=0.046}. According to the Cox proportional hazard model, immunosuppression was not a significant risk factor for death in the ICU {hazard ratio (HR): 1.58 [95% confidence interval (CI): 0.79-3.14]; P=0.24} but was associated with ICU acquired infections [HR: 2.27 (95% CI: 1.02-5.06); P=0.044].
CONCLUSIONS: After adjustment for prognostic variables, the immunocompromised status of patients admitted to the ICU for SARS-CoV-2-related ARF was not associated with increased mortality, despite a significantly longer ICU stay and a greater rate of ICU acquired infections.