The role of immune suppression in COVID-19 hospitalization: clinical and epidemiological trends over three years of SARS-CoV-2 epidemic
Articolo
Data di Pubblicazione:
2023
Citazione:
The role of immune suppression in COVID-19 hospitalization: clinical and epidemiological trends over three years of SARS-CoV-2 epidemic / M. Canuti, M.C. Monti, C. Bobbio, A. Muscatello, T. Muheberimana, S.L. Baldi, F. Blasi, C. Canetta, G. Costantino, A. Nobili, F. Peyvandi, M. Tettamanti, S. Villa, S. Aliberti, M.C. Raviglione, A. Gori, A. Bandera. - In: FRONTIERS IN MEDICINE. - ISSN 2296-858X. - 10:(2023), pp. 1260950.1-1260950.13. [10.3389/fmed.2023.1260950]
Abstract:
Specific immune suppression types have been associated with a greater risk of
severe COVID-19 disease and death. We analyzed data from patients >17 years that
were hospitalized for COVID-19 at the “Fondazione IRCCS Ca′ Granda Ospedale
Maggiore Policlinico” in Milan (Lombardy, Northern Italy). The study included 1727
SARS-CoV-2-positive patients (1,131 males, median age of 65 years) hospitalized
between February 2020 and November 2022. Of these, 321 (18.6%, CI: 16.8–20.4%)
had at least one condition defining immune suppression. Immune suppressed
subjects were more likely to have other co-morbidities (80.4% vs. 69.8%, p < 0.001)
and be vaccinated (37% vs. 12.7%, p < 0.001). We evaluated the contribution of
immune suppression to hospitalization during the various stages of the epidemic
and investigated whether immune suppression contributed to severe outcomes
and death, also considering the vaccination status of the patients. The proportion
of immune suppressed patients among all hospitalizations (initially stable at <20%)
started to increase around December 2021, and remained high (30–50%). This
change coincided with an increase in the proportions of older patients and patients
with co-morbidities and with a decrease in the proportion of patients with severe
outcomes. Vaccinated patients showed a lower proportion of severe outcomes;
among non-vaccinated patients, severe outcomes were more common in immune
suppressed individuals. Immune suppression was a significant predictor of severe
outcomes, after adjusting for age, sex, co-morbidities, period of hospitalization,
and vaccination status (OR: 1.64; 95% CI: 1.23–2.19), while vaccination was a
protective factor (OR: 0.31; 95% IC: 0.20–0.47). However, after November 2021,
differences in disease outcomes between vaccinated and non-vaccinated groups
(for both immune suppressed and immune competent subjects) disappeared.
Since December 2021, the spread of the less virulent Omicron variant and an
overall higher level of induced and/or natural immunity likely contributed to the
observed shift in hospitalized patient characteristics. Nonetheless, vaccination
against SARS-CoV-2, likely in combination with naturally acquired immunity,
effectively reduced severe outcomes in both immune competent (73.9% vs.
48.2%, p < 0.001) and immune suppressed (66.4% vs. 35.2%, p < 0.001) patients,
confirming previous observations about the value of the vaccine in preventing
serious disease.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
SARS-CoV-2; COVID-19; disease outcome; hospitalization; COVID-19 vaccination; immune suppression
Elenco autori:
M. Canuti, M.C. Monti, C. Bobbio, A. Muscatello, T. Muheberimana, S.L. Baldi, F. Blasi, C. Canetta, G. Costantino, A. Nobili, F. Peyvandi, M. Tettamanti, S. Villa, S. Aliberti, M.C. Raviglione, A. Gori, A. Bandera
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