Morbidity and Mortality in Immunocompromised COVID-19 Patients: Which Factors Are Responsible?

Abstract

Objective: The COVID-19 pandemic has caused significant morbidity and mortality and has challenged health systems worldwide. Immunosuppression is considered a risk factor for development of severe COVID-19. In this study, we aimed to determine the factors affecting morbidity and mortality in immunocompromised patients diagnosed with COVID-19. Methods: In this retrospective, cross-sectional study, laboratory findings and outcomes of 340 COVID-19 patients with secondary immunosuppression in a university hospital in Turkey from March 2020 to April 2022 were analyzed according to the 28-day clinical outcomes. Mortality-related factors were investigated in 3 patient groups with different forms of immunodeficiency: 1) malignancy (hematologic/solid), 2) organ transplantation, and 3) rheumatological diseases. Results: 172 (51%) of the patients were female, and the mean age was 61±15 years. A total of 122 (35.8%) patients died during hospitalization. The mortality rate (73.4%) in patients admitted to the intensive care unit (ICU) was significantly higher than those not admitted (p<0.001). The highest laboratory median values of urea, lactate dehydrogenase (LDH), D-dimer, ferritin, C-reactive protein (CRP), and fibrinogen values were found to be significantly higher, and the first measurement lymphocyte value was found to be considerably lower compared to the surviving patients (p<0.001) in the 28-day follow-up, ICU admission increased the mortality risk 13.6 (p<0.001) times. Anticoagulant treatment (p=0.029) and nasal oxygen support (p<0.001) led to a decrease in the risk of mortality. Conclusion: Immunocompromised patients are at risk for serious COVID-19 complications. LDH, D-dimer, CRP, and lymphocyte values can be used as markers to evaluate survival, and standard treatment is essential in immunosuppressive COVID-19 patients.