COVID-19 in immunocompromised patients: A systematic review of cancer, hematopoietic cell and solid organ transplant patients

Belsky, Jennifer A.; Tullius, Brian P.; Lamb, Margaret; Sayegh, Rouba; Stanek, Joseph; Auletta, Jeffery J.

doi:10.1016/j.jinf.2021.01.022

Cited by 194 publications

(203 citation statements)

References 138 publications

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“…However, the effect of this condition in COVID-19 risk/mortality may depend on the type of immunosuppression. Thus, while cancer and solid organ transplant patients seem to present higher rates of mortality (Belsky et al, 2021) and autoinmune diseases's a Mean difference between survivors and deceased along four laboratory measurements (days 0, 3, 6 and 9 after TCZ administration) using generalized estimating equation; b Parameters analyzed in logarithmic units; CI: confidence interval; q-value: p-value adjusted by multiple comparisons with Benjamini-Hochber method. In bold if p-value < 0.05.…”

Section: Discussionmentioning

confidence: 99%

Tocilizumab in COVID-19: Factors Associated With Mortality Before and After Treatment

et al. 2021

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Tocilizumab (TCZ) has been administered in SARS-CoV-2 pneumonia but the factors associated with mortality before and after treatment remain unclear. Cox regression models were used to estimate the predictors of time to death in a cohort of hospitalized patients with COVID-19 receiving TCZ. In addition, the mean differences between discharged and deceased patients in laboratory parameters measured before and 3, 6 and 9 days after TCZ administration were estimated with weighted generalized estimation equations. The variables associated with time to death were immunosuppression (Hazard Ratio-HR 3.15; 95% confidence interval-CI 1.17, 8.51), diabetes mellitus (HR 2.63; 95% CI 1.23–5.64), age (HR 1.05; 95% CI 1.02–1.09), days since diagnosis until TCZ administration (HR 1.05, 95% CI 1.00–1.09), and platelets (HR 0.27; 95% CI: 0.11, 0.69). In the post-TCZ analysis and compared to discharged patients, deceased patients had more lactate dehydrogenase (p = 0.013), troponin I (p = 0.013), C-reactive protein (p = 0.013), neutrophils (p = 0.024), and fewer platelets (p = 0.013) and lymphocytes (p = 0.013) as well as a lower average PaO2/FiO2 ratio. In conclusion, in COVID-19 diagnosed patients receiving TCZ, early treatment decreased the risk of death, while age, some comorbidities and baseline lower platelet counts increased that risk. After TCZ administration, lower platelet levels were again associated with mortality, together with other laboratory parameters.

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Section: Discussionmentioning

confidence: 99%

Tocilizumab in COVID-19: Factors Associated With Mortality Before and After Treatment

et al. 2021

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“…16,17 Therefore, immunosuppression could potentially be beneficial in the COVID-19 management. 18 However, previous systematic review reported that immunocompromised patients with COVID-19 had higher comorbidities, rates of intensive care and hospital mortality 19 , indicating the potential risk of immunosuppression in COVID-19. Thus, in this narrative review, we explore the documented effects of immunosuppressive medications (e.g., corticosteroids, interleukin (IL)-1 inhibitors, IL-6 inhibitors and kinase inhibitors) and immunomodulators (e.g., interferon alpha (IFNα), interferon beta (IFNβ), non-SARS-CoV-2 specific immunoglobulin and convalescent plasma) in COVID-19 (Table 1) and propose some potential immunologic targets to test in the foreseeable future.…”

Section: Introductionmentioning

confidence: 99%

“…The 2019 coronavirus disease (COVID- 19) is caused by severe acute respiratory syndrome-associated coronavirus type-2 (SARS-CoV-2) infection. In the first year of its appearance, COVID-19 has affected more than 150 million individuals and killed 3 million people worldwide.…”

Section: Introductionmentioning

confidence: 99%

“…In some countries, the numbers are still soaring, while in some of the others, the cases are resurging, entering the second and third waves. Such increase could be attributed to several determinants, including the emergence of novel SARS-CoV-2 variants (e.g., N501Y, E484K, B1.1.7), psychological exhaustions (pandemic fatigue) altering the adherence to health protocols, viral reinfection, vaccination delay and the nonexistence of potent pharmacological treatments for COVID- 19. In most of the contracted patients, COVID-19 is asymptomatic or only causes mild to moderate non-life-threatening symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Immunomodulation as a Potent COVID-19 Pharmacotherapy: Past, Present and Future

Hertanto

Wiratama

Sutanto

et al. 2021

Preprint

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In the first year of its appearance, the 2019 coronavirus disease (COVID-19) has affected more than 150 million individuals and killed 3 million people worldwide. The pandemic has also triggered numerous global initiatives to tackle the newly emerging disease, including the development of SARS-CoV-2 vaccines and the attempt to discover potential pharmacological therapies. Nonetheless, despite the success of SARS-CoV-2 vaccines development, COVID-19 therapy remains challenging. Several repurposed drugs that were documented to be useful in small clinical trials have been shown to be ineffective in larger studies. Additionally, the pathophysiology of SARS-CoV-2 infection displayed the predominance of hyperinflammation and immune dysregulation in inducing multiorgan damage. Therefore, the potential benefits of both immune modulation and suppression in COVID-19 have been extensively discussed. Here, we reviewed the roles of immunomodulation as potential COVID-19 pharmacological modalities based on the existing data and proposed several new immunologic targets to be tested in the foreseeable future.

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“…2 While these infections, including SARS-CoV-2, have potential to be more severe in immunocompromised adults 3,4 , emerging data suggests that SARS-CoV-2 does not necessarily present with an increased risk of severe disease in immunocompromised children (ICC). [5][6][7][8] However, the persistence of SARS-CoV-2 infection in pediatric immunosuppressed patients is still unknown, with case series suggesting that infection can be more prolonged in this population. 9 An understanding of viral persistence in immunocompromised hosts has important public health implications.…”

Section: Introductionmentioning

confidence: 99%

SARS-CoV-2 Persistence in Immunocompromised Children

Dolan¹,

Levy²,

Moss³

et al. 2021

Preprint

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Introduction/Objectives: We evaluated the length of time immunocompromised children (ICC) remain positive for SARS-CoV-2, identified factors associated with viral persistence and determined cycle threshold (CT) values of children with viral persistence as a surrogate of viral load. Methods: We conducted a retrospective cohort study of ICC at a pediatric hospital from March 2020-2021. Immunocompromised status was defined as primary, secondary or acquired due to medical comorbidities/immunosuppressive treatment. The primary outcome was time to first-of-two consecutive negative SARS-CoV-2 Polymerase chain reaction (PCR) tests at least 24 hours apart. Testing of sequential clinical specimens from the same subject was conducted using the Centers for Disease Control (CDC) 2019-nCoV Real-Time RT-PCR Diagnostic Panel assay. Descriptive statistics, Kaplan-Meier curve median event times and log-rank-sum tests were used to compare outcomes between groups. Results: Ninety-one children met inclusion criteria. Median age was 15.5 years (IQR 8-18 yrs), 64% were male, 58% were white, and 43% were Hispanic/Latinx. Most (67%) were tested in outpatient settings and 58% were asymptomatic. The median time to two negative tests was 42 days (IQR 25.0,55.0), with no differences in median time by illness presentation or level of immunosuppression. Seven children had >1 sample available for repeat testing, and 5/7 (71%) children had initial CT values of <30, (moderate to high viral load); 4 children had CT values of <30 3-4 weeks later, suggesting persistent moderate to high viral loads. Conclusions: Most ICC with SARS-CoV-2 infection had mild disease, with prolonged viral persistence >6 weeks and moderate to high viral load.

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COVID-19 in immunocompromised patients: A systematic review of cancer, hematopoietic cell and solid organ transplant patients

Cited by 194 publications

References 138 publications

Tocilizumab in COVID-19: Factors Associated With Mortality Before and After Treatment

Tocilizumab in COVID-19: Factors Associated With Mortality Before and After Treatment

Immunomodulation as a Potent COVID-19 Pharmacotherapy: Past, Present and Future

SARS-CoV-2 Persistence in Immunocompromised Children

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