Severe Lymphopenia as a Predictor of COVID-19 Mortality in Immunosuppressed Patients

Abstract

Background. Coronavirus disease 2019 (COVID-19) has a high mortality in certain group of patients. We analysed the impact of baseline immunosuppression in COVID-19 mortality and the role of severe lymphopenia in immunocompromised subjects. Methods. We analysed all patients admitted with COVID-19 in a tertiary hospital in Madrid between March 1st and April 30th 2020. Epidemiological and clinical data, including severe lymphopenia (<500 lymphocytes/mm3) during admission, were analysed and compared based on their baseline immunosuppression condition. Results. A total of 1594 patients with COVID-19 pneumonia were hospitalised during the study period. 166 (10.4%) were immunosuppressed. Immunocompromised patients were younger (64 vs. 67 years, p = 0.02) but presented higher rates of hypertension, diabetes, heart, neurological, lung, kidney and liver disease (p < 0.05). They showed more severe lymphopenia (53% vs 24.1%, p < 0.001), lower SapO2/FiO2 ratios (251 vs 276, p = 0.02) during admission and higher mortality rates (27.1% vs 13.5%, p < 0.001). After adjustment, immunosuppression remained as an independent factor related to mortality (Odds Ratio (OR): 2.24, p < 0.001). In the immunosuppressed group, age (OR = 1.06, p = 0.01), acute respiratory distress syndrome (ARDS) (OR = 12.27, p = 0.017) and severe lymphopenia (OR = 3.48, p = 0.04) were the factors related to high mortality rate. Conclusion. Immunosuppression is an independent mortality risk factor in COVID-19. Severe lymphopenia should be promptly identified in these patients.

Systemic Autoimmune Diseases in Patients Hospitalized with COVID-19 in Spain: A Nation-Wide Registry Study

“…In addition, the Charlson Comorbidity Index (CCI), which is a well-validated composite that predicts clinical outcomes in multiple illnesses, was calculated from the previous data [ 17 ]. Among other medical conditions, it included diabetes, heart failure, dementia, chronic kidney disease, liver disease and cancer, most of which have been associated with severe COVID-19 [ 3 , 4 , 6 ]. However, we excluded connective tissue disease from this index in order to analyze SAD as a separate variable.…”

“…In parallel, other authors identified better outcomes in the immunocompromised population and proposed a possible protecting role of a weaker immune response [ 5 ]. By contrast, other cohorts have indeed confirmed that baseline immunodeficiencies are associated with worse prognosis [ 6 , 7 ]. Taken together, it seems that the distinct etiologies of impaired immunity and the drugs prescribed for treatment might explain these differences in COVID-19 outcomes [ 7 , 11 ].…”

“…Certain conditions, including age, hypertension, obesity, chronic kidney disease or heart failure, among others, were soon revealed as predictors of COVID-19 severity [ 3 , 4 ]. However, the role of immunosuppression has been more controversial [ 5 , 6 , 7 ]. The proven efficacy of certain immunosuppressants, such as glucocorticoids and IL-6 inhibitors (e.g., tocilizumab), especially during the hyperinflammatory phase of the disease, suggests that immunosuppression could provide protection against COVID-19 [ 8 , 9 , 10 ].…”

Convalescent plasma treatment for SARS-CoV-2 infected high-risk patients: a matched pair analysis to the LEOSS cohort

“…The literature search revealed an increased mortality rate in immunocompromised patients with COVID-19. Martinez-Urbistando et al showed that illnesses causing immunodeficiency are an independent risk factor for increased mortality 5 . Mehta et al studied mortality rates in COVID-19 patients with active cancer and found a higher overall mortality rate of 28%; 25% in solid cancers and 37% in haematological cancer 28 .…”

“…In detail, 14 patients required no oxygen supplementation at first CP administration, 18 had low-flow oxygen requirement, 14 were receiving high-flow oxygen therapy or non-invasive ventilation (HF/NIV), 5 were intubated (IMV) and 4 received extracorporeal membrane oxygenation (ECMO) support. Patients received a median of 3 CPs (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14], with a mean of 7 days (range, 0-59) after symptom onset.…”