Clinical Characteristics and Outcomes of Immunocompromised Patients With Coronavirus Disease 2019 Caused by the Omicron Variant: A Prospective, Observational Study

Abstract

Background In the general population, illness after infection with the SARS-CoV-2 Omicron variant is less severe compared with previous variants. Data on the disease burden of Omicron in immunocompromised patients are lacking. We investigated the clinical characteristics and outcome of a cohort of immunocompromised patients with COVID-19 caused by Omicron. Methods Solid organ transplant recipients, patients on anti-CD20 therapy, and allogenic hematopoietic stem cell transplantation recipients on immunosuppressive therapy infected with the Omicron variant, were included. Patients were contacted regularly until symptom resolution. Clinical characteristics of consenting patients were collected through their electronic patient files. To identify possible risk factors for hospitalization, a univariate logistic analysis was performed. Results A total of 114 consecutive immunocompromised patients were enrolled. Eighty-nine percent had previously received three mRNA vaccinations. While only one patient died, 23 (20%) required hospital admission for a median of 11 days. A low SARS-CoV-2 IgG antibody response (<300 BAU/mL) at diagnosis, higher age, being a lung transplant recipient, more comorbidities and a higher frailty were associated with hospital admission (all p < 0.01). At the end of follow-up, 25% had still not fully recovered. Of the 23 hospitalized patients, 70% had a negative and 92% a low IgG (<300 BAU/mL) antibody response at admission. Sotrovimab was administered to 17 of them, of which one died. Conclusions While the mortality in immunocompromised patients infected with Omicron was low, hospital admission was frequent and the duration of symptoms often prolonged. Besides vaccination, other interventions are needed to limit the morbidity from COVID-19 in immunocompromised patients.

Outcome of Transplant Recipients Infected with Omicron BA.1 and BA.2: A Single-Center Retrospective Study in Saudi Arabia

“…We described 20% mortality in a single-center cohort of hospitalized transplant patients in Saudi Arabia infected with Omicron variants while a recent study in USA showed that the mortality of hospitalized transplant recipients during the Omicron surge was only 4%. The main reason for the high mortality in our study is the lower three doses vaccination status compared to the other study; 36% versus 89% [6]. In addition, COVID-19 monoclonal antibodies were used in 74% of patients in the second study while none of our patients received sotrovimab.…”

T Cell and Antibody Response Following Double Dose of BNT162b2 mRNA Vaccine in SARS-CoV-2 Naïve Heart Transplant Recipients

“…With an overall 20% mortality rate, solid organ transplant recipients have worse outcomes after SARS-CoV-2 infection [ 1 ]. Even when infected by the less lethal SARS-CoV-2 Omicron variant, hospital admission rate is higher and the duration of symptoms is more prolonged in HTx patients, compared to non-immunocompromised individuals [ 9 ]. Although a lot of effort and hope has been put on vaccines, as a strategy to protect this group of patients, the large randomized clinical trials excluded immunocompromised patients in their design.…”

Real-World Effectiveness of SARS-CoV-2 Vaccine Booster in Hemodialysis Patients with COVID-19 Receiving Molnupiravir

“…Although the severity of the COVID-19 illness caused by the Omicron variant appears to have been reduced compared to that in the pre-Omicron era, probably owing to the attenuated virulence of the strain and the pre-existing immunity derived from previous infection and vaccination, its rapid spread has resulted in a cumulative increase in acute care visits, hospitalizations, and mortality events [ 6 , 7 ]. Additionally, there are still concerns regarding the impact of COVID-19 on vulnerable populations, such as immunocompromised patients and those with multimorbidity, who have increased risks of hospitalization and prolonged illness durations, even in the Omicron era [ 8 , 9 , 10 , 11 ]. As one of the populations susceptible to this contagious disease, hemodialysis (HD) patients have a remarkably high risk of COVID-19 infection and disease progression owing to the need for regular dialysis visits, multiple comorbidities, and impaired immune responses to pathogens and vaccinations [ 12 , 13 , 14 , 15 ].…”