Impact of COVID-19 on immunocompromised populations during the Omicron era: insights from the observational population-based INFORM study

The Lancet Regional Health - Europe, Journal Year: 2023, Volume and Issue: 35, P. 100747 - 100747

Published: Oct. 13, 2023

Immunocompromised individuals are not optimally protected by COVID-19 vaccines and potentially require additional preventive interventions to mitigate the risk of severe COVID-19. We aimed characterise describe across immunocompromised groups as pandemic began transition an endemic phase.

Language: Английский

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SARS-CoV-2-specific immune responses and clinical outcomes after COVID-19 vaccination in patients with immune-suppressive disease

Nature Medicine, Journal Year: 2023, Volume and Issue: 29(7), P. 1760 - 1774

Published: July 1, 2023

Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immune responses and infection outcomes were evaluated in 2,686 patients with varying immune-suppressive disease states after administration of two Coronavirus Disease 2019 (COVID-19) vaccines. Overall, 255 2,204 (12%) failed to develop anti-spike antibodies, an additional 600 (27%) generating low levels (<380 AU ml −1 ). Vaccine failure rates highest ANCA-associated vasculitis on rituximab (21/29, 72%), hemodialysis immunosuppressive therapy (6/30, 20%) solid organ transplant recipients (20/81, 25% 141/458, 31%). SARS-CoV-2-specific T cell detected 513 580 (88%) patients, lower magnitude or proportion hemodialysis, allogeneic hematopoietic stem transplantation liver (versus healthy controls). Humoral against Omicron (BA.1) reduced, although cross-reactive sustained all participants for whom these data available. BNT162b2 was associated higher antibody but cellular compared ChAdOx1 nCoV-19 vaccination. We report 474 SARS-CoV-2 episodes, including 48 individuals hospitalization death from COVID-19. Decreased both the serological response severe we identified clinical phenotypes that may benefit targeted COVID-19 therapeutic strategies.

Language: Английский

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Disparities in COVID-19 mortality amongst the immunosuppressed: A systematic review and meta-analysis for enhanced disease surveillance

Journal of Infection, Journal Year: 2024, Volume and Issue: 88(3), P. 106110 - 106110

Published: Jan. 30, 2024

BackgroundEffective disease surveillance, including that for COVID-19, is compromised without a standardised method categorising the immunosuppressed as clinical risk group.MethodsWe conducted systematic review and meta-analysis to evaluate whether excess COVID-associated mortality compared immunocompetent could meaningfully subdivide immunosuppressed. Our study adhered UK Immunisation against infectious (Green Book) criteria defining immunosuppression. Using OVID (EMBASE, MEDLINE, Transplant Library, Global Health), PubMed, Google Scholar, we examined relevant literature between entirety of 2020 2022. We selected cohort studies provided data subgroups controls. Meta-analyses, grey any original works failed provide comparator or reported all-cause paediatric outcomes were excluded.Odds Ratios (OR) 95% confidence intervals (CI) COVID-19 meta-analysed by category subcategory. Subgroup analyses differentiated estimates effect measure, country income, setting, level adjustment, use matching publication year. Study screening, extraction bias assessment performed blinded independently two researchers; conflicts resolved with oversight third researcher. PROSPERO registration number CRD42022360755.FindingsWe identified 99 unique studies, incorporating from 1,542,097 56,248,181 patients infection, respectively. Compared people (pooled OR, 95%CI), solid organ transplants (2.12, 1.50-2.99) malignancy (2.02, 1.69-2.42) had very high mortality. Patients rheumatological conditions (1.28, 1.13-1.45) HIV (1.20, 1.05-1.36) just slightly higher risks than baseline. Case type, setting income adjustment significant modifiers some subgroups.InterpretationExcess among was seen vary significantly across subgroups. This novel means subdivision has prospective benefit targeting patient triage, shielding vaccination policies during periods transmission.FundingSupported EMIS Health Medical Research Council. Grant number: MR/R015708/1.

Language: Английский

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Immunocompromised individuals remain at risk of COVID-19: 2023 results from the observational INFORM study

Journal of Infection, Journal Year: 2025, Volume and Issue: 90(3), P. 106432 - 106432

Published: Jan. 31, 2025

Language: Английский

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Remdesivir Reduced Mortality in Immunocompromised Patients Hospitalized for COVID-19 Across Variant Waves: Findings From Routine Clinical Practice

Clinical Infectious Diseases, Journal Year: 2023, Volume and Issue: 77(12), P. 1626 - 1634

Published: Aug. 8, 2023

Abstract Background Immunocompromised patients are at high risk of severe coronavirus disease 2019 (COVID-19) and death, yet treatment strategies for immunocompromised hospitalized COVID-19 reflect variations in clinical practice. In this comparative effectiveness study, we investigated the effect remdesivir on inpatient mortality among across all variants concern (VOC) periods. Methods Data between December 2020 April 2022 were extracted from US PINC AITM Healthcare Database. Patients who received within 2 days hospitalization matched 1:1 using propensity score matching to did not receive remdesivir. Additional criteria included admission month, age group, hospital. Cox proportional hazards models used examine 14- 28-day during VOC Results A total 19 184 11 213 non-remdesivir patients. Overall, 11.1% 17.7% died 14 28 days, respectively, compared with 15.4% 22.4% Remdesivir was associated a reduction (hazard ratio [HR], 0.70; 95% confidence interval, .62–.78) (HR, 0.75; CI, .68–.83). The survival benefit remained significant pre-Delta, Delta, Omicron Conclusions Prompt initiation is variant waves. These findings provide much-needed evidence relating foundational high-risk population.

Language: Английский

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Systematic review and meta‐analysis of the clinical effectiveness of tixagevimab/cilgavimab for prophylaxis of COVID ‐19 in immunocompromised patients

British Journal of Haematology, Journal Year: 2023, Volume and Issue: 201(5), P. 813 - 823

Published: April 3, 2023

Immunocompromised patients, such as those with a haematological malignancy, are at higher risk of SARS-CoV-2 infection, severe outcomes and mortality. Tixagevimab/cilgavimab is monoclonal antibody combination which binds to the spike protein. The PROVENT phase III clinical trial reported that tixagevimab/cilgavimab prophylaxis significantly reduced COVID-19 infection in immunocompromised participants. However, was conducted before Omicron variant became prevalent. This systematic review meta-analysis provide an up-to-date summary real-world effectiveness including patients malignancies. Clinical studies from 1 January 2021 October 2022, breakthrough infections after tixagevimab/cilgavimab, were included. COVID-19-related hospitalisations, intensive care admissions mortality also assessed. A performed ascertain overall effectiveness. Eighteen studies, 25 345 participants, 5438 pathologies, included review. against hospitalisation, admission COVID-19-specific 40.54%, 66.19%, 82.13% 92.39%, respectively. highlights reducing for immunosuppressed individuals, during Omicron-predominant era. Real-world important ongoing certainty benefit new variants.

Language: Английский

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Impact of Prior COVID-19 Immunization and/or Prior Infection on Immune Responses and Clinical Outcomes

Viruses, Journal Year: 2024, Volume and Issue: 16(5), P. 685 - 685

Published: April 26, 2024

Cellular and humoral immunity exhibit dynamic adaptation to the mutating SARS-CoV-2 virus. It is noteworthy that immune responses differ significantly, influenced by whether a patient has received vaccination or there co-occurrence of naturally acquired vaccine-induced immunity, known as hybrid immunity. The different reactions, conditional on status viral variant involved, bear implications for inflammatory responses, outcomes, pathogen transmission rates, lingering post-COVID conditions. Considering these developments, we have performed review recently published literature, aiming disentangle intricate relationships among immunological profiles, transmission, long-term health effects infection poses, resultant clinical manifestations. This investigation directed toward understanding variability in longevity potency cellular elicited immunization infection.

Language: Английский

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Immunocompromised individuals are at increased risk of COVID‐19 breakthrough infection, hospitalization, and death in the post‐vaccination era: A systematic review

Immunity Inflammation and Disease, Journal Year: 2024, Volume and Issue: 12(4)

Published: April 1, 2024

Immunocompromised individuals have been shown to mount a reduced response vaccination, resulting in vaccine effectiveness this cohort. Therefore, the postvaccination era, immunocompromised remain at high risk of breakthrough infection and COVID-19 related hospitalization death, which persist despite vaccination efforts. There has marked paucity systematic reviews evaluating existing data describing clinical measures efficacy specifically populations. In particular, there is scarcity comprehensive evaluations exploring infections severe patient population.

Language: Английский

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Clinical Outcomes of Hospitalized Immunocompromised Patients With COVID-19 and the Impact of Hyperinflammation: A Retrospective Cohort Study

Journal of Inflammation Research, Journal Year: 2025, Volume and Issue: Volume 18, P. 3385 - 3397

Published: March 1, 2025

Purpose: Immunocompromised patients are at increased risk for severe outcomes from COVID-19 due to their altered immune responses, yet inflammatory profiles and the interplay between immunosuppression remain poorly understood. We aimed illustrate inflammation profile clinical of hospitalized immunocompromised with COVID-19. Methods: conducted a retrospective study using multicenter database included adult Corona virus disease 2019 (COVID-19) in China's late 2022 wave. Crude adjusted 28- 60-day mortality was compared two groups. Inflammatory phenotypes were evaluated by serum interleukin-6 (IL-6) C-reactive protein (CRP) level. The overt analyzed. Results: Among 4078 patients, 348 (8.5%) immunocompromised. had lower crude but higher 28-day (hazard ratio [HR] = 1.55; 95% CI 1.08 2.23) (HR 1.47; 1.05 2.06). Besides, developing hyperinflammation (odd [OR] =1.92; 1.47 2.50, p < 0.001). Moreover, mediated major part deleterious survival effect on Conclusion: Immunodeficiency not only increases short-term also predisposes hyperinflammation. complex immunosuppression, hyperinflammation, warrants more detailed profiling immunity this population. Keywords: COVID-19, in-hospital mortality,

Language: Английский

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Changes in hospital mortality in patients with cancer during the COVID-19 pandemic (ISARIC-CCP-UK): a prospective, multicentre cohort study

The Lancet Oncology, Journal Year: 2024, Volume and Issue: 25(5), P. 636 - 648

Published: April 12, 2024

BackgroundPatients with cancer are at greater risk of dying from COVID-19 than many other patient groups. However, how this evolved during the pandemic remains unclear. We aimed to determine, on basis UK national protocol, factors influencing hospital mortality could differentially affect patients undergoing treatment. also examined changes in and escalation care treatment first 2 years UK.MethodsWe conducted a prospective cohort study aged older 19 admitted 306 health-care facilities confirmed SARS-CoV-2 infection, who were enrolled International Severe Acute Respiratory emerging Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol (CCP) across April 23, 2020, Feb 28, 2022; analysis included all complete dataset when closed. The primary outcome was 30-day in-hospital mortality, comparing those without cancer. approved by South Central–Oxford C Research Ethics Committee England (Ref: 13/SC/0149) Scotland A (Ref 20/SS/0028), is registered ISRCTN Registry (ISRCTN66726260).Findings177 871 eligible adult either no history (n=171 303) or (n=6568) enrolled; 93 205 (52·4%) male, 84 418 (47·5%) female, 248 (13·9%) sex gender details not specified data missing. Patients followed up for median 13 (IQR 6–21) days. Of 6568 receiving treatment, 2080 (31·7%) died 30 days, compared 901 (18·0%) 171 303 younger 50 had highest age-adjusted relative (hazard ratio [HR] 5·2 [95% CI 4·0–6·6], p<0·0001; vs 50–69 2·4 [2·2–2·6], 70–79 1·8 [1·6–2·0], >80 1·5 [1·3–1·6], p<0·0001) but lower absolute (51 [6·7%] 763 <50 459 [30·2%] 1522 years). In-hospital decreased higher throughout period.InterpretationPeople have death. Continued action needed mitigate poor outcomes cancer, such as through optimising vaccination, long-acting passive immunisation, early access therapeutics. These findings underscore importance ISARIC-WHO preparedness initiative.FundingNational Institute Health Medical Council.

Language: Английский

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