SARS-CoV-2 (COVID-19) in patients with some degree of immunosuppression

Cajamarca-Barón, Jairo; Guavita-Navarro, Diana; Buitrago-Bohorquez, Jhon; Gallego-Cardona, Laura; Navas, Ángela; Cubides, Héctor; Arredondo, Ana María; Escobar, Alejandro; Rojas-Villarraga, Adriana

doi:10.1016/j.reumae.2020.08.001

Cited by 20 publications

(19 citation statements)

References 91 publications

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“…Approximately one tenth of the cohort had an immunosuppressive disorder, whereof two patients became critically ill and one with a newly diagnosed haematological malignancy deceased during the hospital stay. These findings are consistent with prior observations indicating a relatively low risk, compared to the general population, of severe COVID-19 due to immunosuppression (59)(60)(61)(62)(63). However, since not all patients with COVID-19 at the hospital were included in this study, definite conclusions cannot be drawn from the proportion of immunosuppressed relative to immunocompetent patients in the cohort.…”

Section: Discussionsupporting

confidence: 90%

Soluble Urokinase Plasminogen Activator Receptor (suPAR) Independently Predicts Severity and Length of Hospitalisation in Patients With COVID-19

et al. 2021

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Background: Efficient healthcare based on prognostic variables in hospitalised patients with COVID-19 could reduce the risk of complications and death. Recently, soluble urokinase Plasminogen Activator Receptor (suPAR) was shown to predict respiratory failure, kidney injury, and clinical outcome in patients with SARS-CoV-2 infection. The aim of this study was to investigate the value of suPAR as a prognostic tool, in comparison with other variables, regarding disease severity and length of hospital stay in patients with COVID-19.Patients and Methods: Individuals hospitalised with COVID-19 (40 males, 20 females; median age 57.5 years) with a median symptom duration of 10 days and matched, healthy controls (n = 30) were included. Admission levels of suPAR were measured in serum by enzyme-linked immunosorbent assay. Blood cell counts, C-reactive protein (CRP) levels, lactate dehydrogenase (LDH), plasma creatinine and estimated glomerular filtration rates were analysed and oxygen demand, level of care and length of hospitalisation recorded.Results: Patients had significantly higher suPAR levels compared to controls (P < 0.001). Levels were higher in severely/critically (median 6.6 ng/mL) compared with moderately ill patients (median 5.0 ng/mL; P = 0.002). In addition, suPAR levels correlated with length of hospitalisation (rho = 0.35; P = 0.006). Besides suPAR, LDH, CRP, neutrophil count, neutrophil-to-monocyte and neutrophil-to-lymphocyte ratio, body mass index and chronic renal failure were discriminators of COVID-19 severity and/or predictors of length of hospitalisation.Conclusion: Admission levels of suPAR were higher in patients who developed severe/critical COVID-19 and associated with length of hospital stay. In addition, we showed that suPAR functioned as an independent predictor of COVID-19 disease severity.

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Section: Discussionsupporting

confidence: 90%

Soluble Urokinase Plasminogen Activator Receptor (suPAR) Independently Predicts Severity and Length of Hospitalisation in Patients With COVID-19

et al. 2021

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“…In fact, the present work found immunocompromise associated with increased risk for mortality (Figure 3). Taken together, how immunosuppression is related to COVID‐19‐related mortality is dependent on the type of immunosuppression, as pointed out in some systematic reviews 23–25 …”

Section: Discussionmentioning

confidence: 93%

Is pregnancy a risk factor for in‐hospital mortality in reproductive‐aged women with SARS‐CoV‐2 infection? A nationwide retrospective observational cohort study

Leung

Paiva

2021

Intl J Gynecology & Obste

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Objective To examine the effect of pregnancy on coronavirus disease 2019 (COVID‐19) ‐related in‐hospital mortality in women of reproductive age (between 15 and 45 years), with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection confirmed with polymerase chain reaction tests, adjusted for factors such as co‐infection and intervention that were not considered in existing literature. Methods Data gathered from a nationwide database in Brazil were analyzed using multivariate logistic regression and multivariate Cox regression. Adjusted odds ratios and hazard ratios of independent factors associated with in‐hospital death were calculated. Results A total of 97 712 women were included in the study. After the adjustment for sociodemographic factors, epidemiologic characteristics, pre‐existing medical conditions, and intervention, pregnant women were found to be associated with lower risk for in‐hospital mortality as well as longer survival time compared with non‐pregnant women. When covariates of intervention were omitted from the analysis, pregnancy did not appear to be a significant factor associated with mortality. Conclusion With the adjustment for intervention that was shown to be an independent factor associated with mortality, pregnancy appeared to have a favorable effect on SARS‐CoV‐2 infection. Given the immunosuppressed state of pregnancy, this finding is in line with the hypothetical protective role of a weaker immune response that inhibits the production of proinflammatory cytokine.

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“…Surprisingly, immunosuppressed patients were not the clusters with the lowest RRs. Yet, immunosuppression has not been confirmed as a relevant factor for disease severity, except for cancer patients 39,40 . MC6 also holds few CKD patients, a factor which has been widely studied as a key factor for disease progression 41,42 and it may be the cause for the immunosuppression in this group (OR 9.65 95%CI [9.05-10.28]) according to the prevalence of immunosuppression of CKD patients vs non-CKD patients.…”

Section: Discussionmentioning

confidence: 99%

Subphenotyping of COVID-19 patients at pre-admission towards anticipated severity stratification: an analysis of 778 692 Mexican patients through an age-gender unbiased meta-clustering technique

Zhou¹,

Romero²,

Martı́nez-Miranda

et al. 2021

Preprint

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Objective To describe COVID-19 subphenotypes regarding severity patterns including prognostic, ICU and morbimortality outcomes, through stratification based on gender and age groups, as described by inter-patient variability patterns in clinical phenotypes and demographic features. Materials and methods We used the COVID-19 open data from the Mexican Government including patient-level epidemiological and clinical data from 778 692 SARS-CoV-2 patients from January 13, 2020 to September 30, 2020. Inter-patient variability was analyzed by combining dimensionality reduction and hierarchical clustering methods. We produced cluster analyses for all combinations of gender and age groups (<18, 18-49, 50-64, and >64). For each group, the optimum number of clusters was selected combining a quantitative approach using the Silhouette coefficient, and a qualitative approach through a subgroup expert inspection via visual analytics. Using the features of the resultant age-gender clusters, we performed a meta-clustering analysis to provide an overall description of the population. Results We observed a total of 56 age-gender clusters, grouped in 11 clinically distinguishable meta-clusters with different outcomes. Meta-clusters 1 to 3 showed the highest recovery rates (90.27-95.22%). These clusters include: (1) healthy patients of all ages, (2) children with comorbidities who had priority in medical resources, (3) young patients with obesity and smoking habit. Meta-clusters 4 and 5 showed moderate recovery rates (81.3-82.81%): (4) patients with hypertension or diabetes of all ages, (5) typical obese patients with three highly correlated conditions, namely, pneumonia, hypertension and diabetes. Meta-clusters 6 to 11 had very low recovery rates (53.96-66.94%) which include: (6) immunosuppressed patients with the highest comorbidity rate in many diseases, (7) CKD patients with the worse survival length and recovery, (8) elderly smoker with mild COPD, (9) severe diabetic elderly with hypertension, (10, 11) oldest obese smokers with severe COPD and mild cardiovascular disease with the latter (11) showing a relatively higher age and smoke rate, severe COPD and shorter survival length, reinforcing a high correlation between smoking habit and COPD among elderly. Additionally, the source Mexican state and type of clinical institution proved to be an important factor for heterogeneity in severity. Discussion The proposed unsupervised learning approach successfully uncovered discriminative COVID-19 severity patterns for both genders and all age groups from clinical phenotypes and demographic features. A careful read of group outcomes showed consistent results regarding recent literature. Regarding the Mexican population, our results suggest that habits and comorbidities may play a key role in predicting mortality in older patients. Centenarians tended to fall in the groups with better outcomes repeatedly. Additionally, immunosuppression was not found as a relevant factor for severity alone but did when present along with chronic kidney disease. Further useful correlations could be found by evaluating the duration of unhealthy habits, demographic features, comorbidities, the time since diagnosis, recovery progress, readmission record, and the effect of source variability. Conclusion The resultant eleven meta-clusters provide bases to comprehend the classification of patients with COVID-19 based on comorbidities, habits, demographic characteristics, geographic data and type of clinical institutions, as well as revealing the correlations between the above characteristics thereby help to anticipate the possible clinical outcomes for every specifically characterized patient. These subphenotypes can establish target groups for automated stratification or triage systems to provide personalized therapies or treatments. Code available at: https://github.com/bdslab-upv/covid19-metaclustering Dynamic results visualization at: http://covid19sdetool.upv.es/?tab=mexicoGov

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SARS-CoV-2 (COVID-19) in patients with some degree of immunosuppression

Cited by 20 publications

References 91 publications

Soluble Urokinase Plasminogen Activator Receptor (suPAR) Independently Predicts Severity and Length of Hospitalisation in Patients With COVID-19

Soluble Urokinase Plasminogen Activator Receptor (suPAR) Independently Predicts Severity and Length of Hospitalisation in Patients With COVID-19

Is pregnancy a risk factor for in‐hospital mortality in reproductive‐aged women with SARS‐CoV‐2 infection? A nationwide retrospective observational cohort study

Subphenotyping of COVID-19 patients at pre-admission towards anticipated severity stratification: an analysis of 778 692 Mexican patients through an age-gender unbiased meta-clustering technique

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