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Non‐severe immunosuppression might be associated with a lower risk of moderate–severe acute respiratory distress syndrome in COVID‐19: A pilot study
Author(s) -
Monreal Enric,
Maza S Sainz de la,
Gullón Pedro,
NateraVillalba Elena,
ChicoGarcía Juan Luis,
BeltránCorbellini Álvaro,
MartínezSanz Javier,
GarcíaBarragán Nuria,
Buisán Javier,
Toledano Rafael,
AlonsoCanovas Araceli,
PérezTorre Paula,
MatuteLozano María C.,
LópezSendón Jose Luis,
GarcíaRibas Guillermo,
Corral Íñigo,
Fortún Jesús,
MonteroErrasquín Beatriz,
Manzano Luis,
MáizCarro Luis,
CostaFrossard Lucienne,
Masjuan Jaime
Publication year - 2021
Publication title -
journal of medical virology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.782
H-Index - 121
eISSN - 1096-9071
pISSN - 0146-6615
DOI - 10.1002/jmv.26656
Subject(s) - ards , medicine , immunosuppression , mechanical ventilation , clinical endpoint , cohort study , covid-19 , severity of illness , disease , lung , randomized controlled trial , infectious disease (medical specialty)
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.