Non‐severe immunosuppression might be associated with a lower risk of moderate–severe acute respiratory distress syndrome in COVID‐19: A pilot study

The role of immunosuppression among coronavirus disease 2019 (COVID‐19) patients has not been elucidated and management may be challenging. This observational study included confirmed COVID‐19 patients. The primary endpoint was the development of moderate–severe acute respiratory distress syndrome (ARDS). Time to moderate–severe ARDS, the need for mechanical or noninvasive ventilation (MV/NIV), death, and a composite of death or MV/NIV were secondary endpoints. Of 138 patients included, 27 (19.6%) were immunosuppressed (IS) and 95 (68.8%) were male, with a median (IQR) age of 68 (54–78) years. A significantly lower proportion of IS patients (25.9%) compared to non‐IS patients (52.3%) developed moderate–severe ARDS, in both unadjusted (0.32; 95% CI, 0.13–0.83; p  = .017) and adjusted (aOR, 0.25; 95% CI, 0.08–0.80; p  = .019) analyses. After stratifying by pathologies, only IS patients with autoimmune diseases remained significant (aOR 0.25; 95% CI, 0.07–0.98; p  = .046). Nonsignificant trends toward a longer time to moderate or severe ARDS, a lower need for MV/NIV, and a lower risk of death or MV/NIV were detected among IS. In our cohort of COVID‐19 patients, nonsevere immunosuppression was associated with a lower risk of moderate–severe ARDS, especially among AD. This suggests a potential protective effect from a hypothesized hyper‐inflammatory response.