COVID‐19 in solid organ transplant recipients: Dynamics of disease progression and inflammatory markers in ICU and non‐ICU admitted patients

Abstract

Background: COVID-19 infection varies in severity from minimal symptoms to critical illness associated with a hyperinflammatory response. Data on disease progression in immunosuppressed solid organ transplant (SOT) recipients are limited. Methods: We examined the electronic medical records of all SOT recipients with COVID-19 from 12 Massachusetts hospitals between February 1, and May 6, 2020. We analyzed the demographics, clinical parameters, course, and outcomes of illness in these patients. Results: Of 52 COVID-19-positive SOT patients, 77% were hospitalized and 35% required ICU admission. Sixty-nine percent of hospitalized patients had immunosuppression reduced, 6% developed suspected rejection. Co-infections occurred in 45% in ICU vs 5% in non-ICU patients (P = .037). A biphasic pattern of evolution of laboratory tests was observed. In the first 5 days of illness, inflammatory markers were moderately increased. Subsequently, WBC, CRP, ferritin, and D Dimer increased with increasing stay in the ICU, and lymphocyte counts were similar. Five patients (16%) died. Conclusions: Our data indicate that SOT is associated with high rate of hospitalization, ICU admission, and death from COVID-19 compared to data in the general population of patients with COVID-19. Despite reduction in immunosuppression, suspected rejection was rare. The clinical course and trend of laboratory biomarkers is biphasic with a later, pronounced peak in inflammatory markers seen in those admitted to an ICU. CRP is a useful marker to monitor disease progression in SOT.

Clinical features and prognostic factors of intensive and non-intensive 1014 COVID-19 patients: an experience cohort from Alahsa, Saudi Arabia

“…We report similar results of previous studies regarding the laboratory abnormalities that have been described in severe COVID-19 patients who necessitated ICU admission including elevated white blood cells [ 9 , 32 , 56 ], neutrophils [ 9 , 32 , 56 , 57 ], alanine aminotransferase and aspartate aminotransferase [ 9 , 24 , 32 , 35 , 45 , 56 , 58 ], creatinine [ 9 , 32 , 35 , 43 , 45 ], creatinine kinase [ 9 , 35 , 45 , 56 , 58 ], lactate dehydrogenase [ 9 , 24 , 31 , 32 , 35 , 43 , 45 , 56 , 58 , 59 ], and ferritin [ 24 , 31 , 45 , 56 , 58 , 59 ]. Continuous tracking of laboratory findings during the management of COVID-19 cases is crucial to early identify those patients who may progress to severe status.…”

A retrospective matched cohort single‐center study evaluating outcomes of COVID‐19 and the impact of immunomodulation on COVID‐19‐related cytokine release syndrome in solid organ transplant recipients

“…Although reasons for this are unclear, one possibility is a protective effect of immunosuppression from the deleterious effects of CRS, the development of which can be monitored using specific biomarkers such as CRP and IL‐6, as previously reported in general population 24 . Similarly, CRP has been found to be a useful marker of disease severity in SOT recipients with COVID‐19 25 . Interestingly, in our study, SOT patients had a higher, although not statistically significant, median CRP level compared with the non‐SOT group despite the presence of immunosuppression.…”

Comorbidities and Age Are Associated With Persistent COVID-19 PCR Positivity

“…Coronavirus Disease 2019 (COVID-19) was declared a public health emergency by the World Health Organization (WHO) in January 2020 ( Guan et al., 2020 ). Patients with COVID-19 present with a wide variety of symptoms, such as cough, shortness of breath, headache or body aches, fatigue, and loss of taste or smell ( Guan et al., 2020 ; Izzy et al., 2020 ; Roberts et al., 2020 ). As of December 2020, COVID-19 resulted with over 67.8 million confirmed cases worldwide in 215 countries with over 1.5 million deaths ( Worldometers.info., 2020 ).…”