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Introduction <p>COVID-19 severely impacted global health, especially older adults and those with comorbidities. Immunosuppressed patients are at high risk for severe outcomes, yet studies yield conflicting mortality rates for this group. This study examines the clinical characteristics and outcomes of immunosuppressed (IS) versus non-immunosuppressed (nIS) patients with COVID-19 in ICUs.</p> Methods <p>A multicenter, observational case–control study included 5,824 ICU patients with COVID-19 from the CIBERESUCICOVID study. Patients were categorized as IS or nIS based on history of transplantation, HIV, active neoplasia, and use of immunosuppressive drugs or corticosteroids. The primary outcome was 90-day mortality; secondary outcomes included in-hospital, 15-day, 30-day and 1-year mortality, ICU-free days, ventilator-free days, and hospital length of stay. Subgroup analyses examined vaccination status and tocilizumab treatment. Propensity score (PS) matching was used to obtain balance among the baseline variables in the two groups.</p> Results <p>IS patients (n = 689, 11.8%) were older, had more comorbidities, and higher APACHE-II scores. After PS matching, IS patients had higher 90-day mortality (39 vs. 33%; HR 1.30, 95% CI 1.04 to 1.62), as well as higher in-hospital (37 vs. 29%; sHR 1.35, 95% CI 1.08 to 1.69), 30-day (28 vs 23%; HR 1.31, 95% CI 1.01 to 1.69) and 1-year mortality (45 vs. 38%; HR 1.26, 95% CI 1.02 to 1.57). Among IS patients, transplant recipients had significantly higher 90-day mortality after matching (HR 4.45, 95% CI 1.46 to 13.58). Vaccinated IS patients showed higher mortality than vaccinated nIS patients, though differences were not significant after PS matching. Tocilizumab treatment in IS patients was associated with reduced mortality; multivariable analysis confirmed a significant decrease in in-hospital mortality (sHR 0.56, 95% CI 0.42 to 0.76).</p> Conclusion <p>Critical immunosuppressed patients with COVID-19 have higher mortality, particularly transplant recipients. Tocilizumab shows potential benefits for IS patients. These findings highlight the need for tailored therapeutic strategies for immunosuppressed individuals with severe COVID-19. Further research is needed to confirm these results in the current clinical context.</p>

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Immunosuppressed patients with COVID-19 pneumonia in ICU: clinical characteristics and factors influencing outcomes

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  • 发表日期：

    2025年11月25日

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  • Flavia Galli,
  • Edoardo Forin,
  • Ana Motos,
  • Francisco José Molina Saldarriaga,
  • Albert Gabarrus,
  • Joan Canseco,
  • Laia Fernandez‑Barat,
  • Enric Barbeta,
  • Davide Calabretta,
  • Adrian Ceccato,
  • Jesus F. Bermejo‑Martin,
  • Ricard Ferrer,
  • Jordi Riera,
  • Oscar Penuelas,
  • Jose Angel Lorente,
  • David de Gonzalo‑Calvo,
  • Rosario Menendez,
  • Jessica Gonzalez,
  • Andrea Palomeque,
  • Alba Soler-Comas,
  • Rosario Amaya‑Villar,
  • Jose Manuel Anon,
  • Ana Balan Marino,
  • Carme Barbera,
  • Jose Barberan,
  • Aaron Blandino Ortiz,
  • Elena Bustamante‑Munguira,
  • Jesus Caballero,
  • Maria Luisa Canton‑Bulnes,
  • Cristina Carbajales Perez,
  • Nieves Carbonell,
  • Mercedes Catalan‑Gonzalez,
  • Raul de Frutos,
  • Nieves Franco,
  • Cristobal Galban,
  • Ana Lopez Lago,
  • Victor D. Gumucio‑Sanguino,
  • Maria del Carmen de la Torre,
  • Emilio Diaz,
  • Angel Estella,
  • Elena Gallego Curto,
  • Jose Luis Garcia‑Garmendia,
  • Jose Manuel Gomez,
  • Arturo Huerta,
  • Ruth Noemi Jorge Garcia,
  • Ana Loza‑Vazquez,
  • Judith Marin‑Corral,
  • Maria Cruz Martin Delgado,
  • Amalia Martinez de la Gandara,
  • Ignacio Martinez Varela,
  • Juan Lopez Messa,
  • Guillermo M. Albaiceta,
  • Maria Teresa Nieto,
  • Mariana Andrea Novo,
  • Yhivian Penasco,
  • Felipe Perez‑Garcia,
  • Juan Carlos Pozo‑Laderas,
  • Pilar Ricart,
  • Victor Sagredo,
  • Angel Sanchez‑Miralles,
  • Susana Sancho Chinesta,
  • Ferran Roche‑Campo,
  • Lorenzo Socias,
  • Jordi Sole‑Violan,
  • Fernando Suarez‑Sipmann,
  • Luis Tamayo Lomas,
  • Jose Trenado,
  • Alejandro Ubeda,
  • Luis Jorge Valdivia,
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  • Maria Victoria Boado,
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  • Miquel Ferrer,
  • Ferran Barbe,
  • Antoni Torres,
  • Rafael Mañez,
  • Felipe Rodríguez de Castro,
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  • Mateu Torres,
  • María Martinez,
  • Cynthia Alegre,
  • Sofía Contreras,
  • Javier Trujillano,
  • Montse Vallverdú,
  • Miguel León,
  • Mariona Badía,
  • Begoña Balsera,
  • Lluís Servià,
  • Judit Vilanova,
  • Silvia Rodríguez,
  • Neus Montserrat,
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  • Tommaso Bardi,
  • Carmen Gómez Gonzalez,
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  • Joan Ramon Masclans,
  • Ana Salazar Degracia,
  • Judit Bigas,
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  • Clara Vilà-Vilardel,
  • Francisco Parrilla,
  • Irene Dot,
  • Ana Zapatero,
  • Yolanda Díaz,
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  • Purificación Pérez,
  • Andrea Castellví,
  • Cristina Climent,
  • Lidia Serra,
  • Laura Barbena,
  • Iosune Cano,
  • Alba Herraiz,
  • Pilar Marcos,
  • Laura Rodríguez,
  • Maria Teresa Sariñena,
  • Ana Sánchez,
  • Juan Fernando Masa Jimenez,
  • Gemma Gomà,
  • Mercedes Ibarz,
  • Diego De Mendoza,
  • Victoria Alcaraz-Serrano,
  • Joan Ramon Badia,
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  • Leticia Bueno,
  • Catia Cillóniz,
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  • Javier Fernández,
  • Karsa Kiarostami,
  • Alexandre López-Gavín,
  • Cecilia L. Mantellini,
  • Carla Speziale,
  • Nil Vázquez,
  • Hua Yang,
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  • Carlos Ferrando,
  • Pedro Castro,
  • Marta Arrieta,
  • Jose Maria Nicolas,
  • Rut Andrea,
  • Marta Barroso,
  • Sergio Álvarez,
  • Dario Garcia-Gasulla,
  • Adrián Tormos,
  • Cesar Aldecoa,
  • Rubén Herrán-Monge,
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  • Pablo Cardinal Fernández,
  • Alberto Rubio López,
  • Orville BáezPravia,
  • Leire Pérez Bastida,
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  • Anna Parera Pous,
  • Ana López Lago,
  • Eva Saborido Paz,
  • Patricia Barral Segade,
  • Manuel Valledor Mendez,
  • Luciano Aguilera,
  • Esther López-Ramos,
  • Ángela Leonor Ruiz-García,
  • Belén Beteré,
  • Rafael Blancas,
  • Cristina Dólera,
  • Gloria Perez Planelles,
  • Enrique Marmol Peis,
  • Maria Dolores Martinez Juan,
  • Miriam Ruiz Miralles,
  • Eva Perez Rubio,
  • Maria Van der Hofstadt Martin-Montalvo,
  • Tatiana Villada Warrington,
  • Sara Guadalupe Moreno Cano,
  • Federico Gordo,
  • Basilisa Martinez Palacios,
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  • Ana Ortega,
  • Miguel Sanchez,
  • Bitor Santacoloma

摘要

Introduction

COVID-19 severely impacted global health, especially older adults and those with comorbidities. Immunosuppressed patients are at high risk for severe outcomes, yet studies yield conflicting mortality rates for this group. This study examines the clinical characteristics and outcomes of immunosuppressed (IS) versus non-immunosuppressed (nIS) patients with COVID-19 in ICUs.

Methods

A multicenter, observational case–control study included 5,824 ICU patients with COVID-19 from the CIBERESUCICOVID study. Patients were categorized as IS or nIS based on history of transplantation, HIV, active neoplasia, and use of immunosuppressive drugs or corticosteroids. The primary outcome was 90-day mortality; secondary outcomes included in-hospital, 15-day, 30-day and 1-year mortality, ICU-free days, ventilator-free days, and hospital length of stay. Subgroup analyses examined vaccination status and tocilizumab treatment. Propensity score (PS) matching was used to obtain balance among the baseline variables in the two groups.

Results

IS patients (n = 689, 11.8%) were older, had more comorbidities, and higher APACHE-II scores. After PS matching, IS patients had higher 90-day mortality (39 vs. 33%; HR 1.30, 95% CI 1.04 to 1.62), as well as higher in-hospital (37 vs. 29%; sHR 1.35, 95% CI 1.08 to 1.69), 30-day (28 vs 23%; HR 1.31, 95% CI 1.01 to 1.69) and 1-year mortality (45 vs. 38%; HR 1.26, 95% CI 1.02 to 1.57). Among IS patients, transplant recipients had significantly higher 90-day mortality after matching (HR 4.45, 95% CI 1.46 to 13.58). Vaccinated IS patients showed higher mortality than vaccinated nIS patients, though differences were not significant after PS matching. Tocilizumab treatment in IS patients was associated with reduced mortality; multivariable analysis confirmed a significant decrease in in-hospital mortality (sHR 0.56, 95% CI 0.42 to 0.76).

Conclusion

Critical immunosuppressed patients with COVID-19 have higher mortality, particularly transplant recipients. Tocilizumab shows potential benefits for IS patients. These findings highlight the need for tailored therapeutic strategies for immunosuppressed individuals with severe COVID-19. Further research is needed to confirm these results in the current clinical context.