Comparison of COVID-19 and Non-COVID-19 Pneumonia in Down Syndrome

Abstract

Whether the increased risk for coronavirus disease 2019 (COVID-19) hospitalization and death observed in Down syndrome (DS) are disease specific or also occur in individuals with DS and non-COVID-19 pneumonias is unknown. This retrospective cohort study compared COVID-19 cases in persons with DS hospitalized in Spain reported to the Trisomy 21 Research Society COVID-19 survey (n = 86) with admissions for non-COVID-19 pneumonias from a retrospective clinical database of the Spanish Ministry of Health (n = 2832 patients). In-hospital mortality rates were significantly higher for COVID-19 patients (26.7% vs. 9.4%), especially among individuals over 40 and patients with obesity, dementia, and/or epilepsy. The mean length of stay of deceased patients with COVID-19 was significantly shorter than in those with non-COVID-19 pneumonias. The rate of admission to an ICU in patients with DS and COVID-19 (4.3%) was significantly lower than that reported for the general population with COVID-19. Our findings confirm that acute SARS-CoV-2 infection leads to higher mortality than non-COVID-19 pneumonias in individuals with DS, especially among adults over 40 and those with specific comorbidities. However, differences in access to respiratory support might also account for some of the heightened mortality of individuals with DS with COVID-19.

Clinical characteristics and comorbidities of COVID-19 in unvaccinated patients with Down syndrome: first year report in Brazil

“…Asua et al (2021) compared patients with DS and COVID-19 and patients with DS and non-COVID-19 pneumonia. Those authors observed higher in-hospital mortality in patients with COVID-19 and DS (Real de Asua et al 2021 ). Finally, one of the most extensive trials reported that hospitalized patients with DS and positive COVID-19 were more likely to be of advanced age, male, obese, and have diabetes mellitus (Hüls et al 2021 ).…”

“…Moreover, there are few heterogeneous studies on DS and COVID-19, and because of that, it is difficult to establish the exact risk factors linked to death or high infection rate in patients with DS (Babamahmoodi et al 2020 ; Villani et al 2020 ; Malik and Kathuria 2021 ; Vazquez-Hernández et al 2021 ; Newman et al 2021 ; Vita et al 2021 ; Alsahabi et al 2021 ; Hüls et al 2021 ; Malle et al 2021b ; Illouz et al 2021 ; Clift et al 2021 ; El Kaouini et al 2012 ; Emami et al 2021 ; Real de Asua et al 2021 ; Kuczborska et al 2022 ). For instance, Illouz et al ( 2021 ) observed that patients with DS and COVID-19 were younger and presented lower socioeconomic status; and, curiously, in a recent study, it was demonstrated that the socioeconomic status evaluated by the Human Development Index was associated with a higher case fatality rate in Brazil (Palamim et al 2022 ).…”

“…Thus, these features were associated with a high hospitalization rate, the need for mechanical ventilation, and critical illnesses that culminated in a higher mortality rate (Petrilli et al 2020 ; Telle et al 2021 ; Bhaskaran et al 2021 ). However, among the health conditions that may favor a worse prognosis for SARS-CoV-2 infection, few studies have evaluated people with Down syndrome (DS) (Hüls et al 2021 ; Malle et al 2021b ; Illouz et al 2021 ; Clift et al 2021 ; Emami et al 2021 ; Real de Asua et al 2021 ).…”

“…Patients with DS and Coronavirus Disease (COVID)-19 presented a longer hospitalization time, worse severity, higher incidence of superinfections, and increased mortality rate, especially in those patients aged ≥ 40 years and with comorbidities such as kidney failure and diabetes mellitus (Villani et al 2020 ; Hüls et al 2021 ; Malle et al 2021b ; Illouz et al 2021 ; Clift et al 2021 ; Emami et al 2021 ; Real de Asua et al 2021 ) when compared with other populations. Furthermore, patients with DS and COVID-19 were also younger, and more likely to have chronic lung diseases, autoimmune diseases, obesity, and dementia (Villani et al 2020 ; Hüls et al 2021 ; Malle et al 2021b ; Illouz et al 2021 ; Clift et al 2021 ; Emami et al 2021 ; Real de Asua et al 2021 ). However, the actual effect of COVID-19 in patients with DS is not wholly elucidated yet since few studies addressed the subject, mainly based on case reports (Babamahmoodi et al 2020 ; Malik and Kathuria 2021 ; Vazquez-Hernández et al 2021 ; Newman et al 2021 ; Vita et al 2021 ; Alsahabi et al 2021 ; El Kaouini et al 2012 ; Malle et al 2021a ; Kuczborska et al 2022 ).…”

High case fatality rate in individuals with Down syndrome and COVID-19 in Brazil: a two-year report

“…High case fatality rate in individuals with Down syndrome and COVID-19 in Brazil: a two-year report Few studies have evaluated the outcomes of COVID-19 in individuals with Down syndrome (DS), which indicated a higher association between DS and longer hospitalisation time, COVID-19 severity and mortality rate. [1][2][3][4][5][6][7][8] From these studies, four out of five have presented a small cohort with less than 40 individuals with DS and COVID-19, [1][2][3][4] except one report that has included 750 individuals. 5 Thus, the real effect of COVID-19 in individuals with DS is not entirely clear, and it would be important to know it, mainly for its importance as a risk factor for death.…”