PDF(Pubmed)
Abstract：
BACKGROUND: Effective disease surveillance, including that for COVID-19, is compromised without a standardised method for categorising the immunosuppressed as a clinical risk group.
METHODS: We conducted a systematic review and meta-analysis to evaluate whether excess COVID-associated mortality compared to the immunocompetent could meaningfully subdivide the immunosuppressed. Our study adhered to UK Immunisation against infectious disease (Green Book) criteria for defining and categorising immunosuppression. Using OVID (EMBASE, MEDLINE, Transplant Library, and Global Health), PubMed, and Google Scholar, we examined relevant literature between the entirety of 2020 and 2022. We selected for cohort studies that provided mortality data for immunosuppressed subgroups and immunocompetent comparators. Meta-analyses, grey literature and any original works that failed to provide comparator data or reported all-cause or paediatric outcomes were excluded. Odds Ratios (OR) and 95% confidence intervals (CI) of COVID-19 mortality were meta-analysed by immunosuppressed category and subcategory. Subgroup analyses differentiated estimates by effect measure, country income, study setting, level of adjustment, use of matching and publication year. Study screening, extraction and bias assessment were performed blinded and independently by two researchers; conflicts were resolved with the oversight of a third researcher. PROSPERO registration number is CRD42022360755.
RESULTS: We identified 99 unique studies, incorporating data from 1,542,097 and 56,248,181 unique immunosuppressed and immunocompetent patients with COVID-19 infection, respectively. Compared to immunocompetent people (pooled OR, 95%CI), solid organ transplants (2.12, 1.50-2.99) and malignancy (2.02, 1.69-2.42) patients had a very high risk of COVID-19 mortality. Patients with rheumatological conditions (1.28, 1.13-1.45) and HIV (1.20, 1.05-1.36) had just slightly higher risks than the immunocompetent baseline. Case type, setting income and mortality data matching and adjustment were significant modifiers of excess immunosuppressed mortality for some immunosuppressed subgroups.
CONCLUSIONS: Excess COVID-associated mortality among the immunosuppressed compared to the immunocompetent was seen to vary significantly across subgroups. This novel means of subdivision has prospective benefit for targeting patient triage, shielding and vaccination policies during periods of high disease transmission.
METHODS: We conducted a systematic review and meta-analysis to evaluate whether excess COVID-associated mortality compared to the immunocompetent could meaningfully subdivide the immunosuppressed. Our study adhered to UK Immunisation against infectious disease (Green Book) criteria for defining and categorising immunosuppression. Using OVID (EMBASE, MEDLINE, Transplant Library, and Global Health), PubMed, and Google Scholar, we examined relevant literature between the entirety of 2020 and 2022. We selected for cohort studies that provided mortality data for immunosuppressed subgroups and immunocompetent comparators. Meta-analyses, grey literature and any original works that failed to provide comparator data or reported all-cause or paediatric outcomes were excluded. Odds Ratios (OR) and 95% confidence intervals (CI) of COVID-19 mortality were meta-analysed by immunosuppressed category and subcategory. Subgroup analyses differentiated estimates by effect measure, country income, study setting, level of adjustment, use of matching and publication year. Study screening, extraction and bias assessment were performed blinded and independently by two researchers; conflicts were resolved with the oversight of a third researcher. PROSPERO registration number is CRD42022360755.
RESULTS: We identified 99 unique studies, incorporating data from 1,542,097 and 56,248,181 unique immunosuppressed and immunocompetent patients with COVID-19 infection, respectively. Compared to immunocompetent people (pooled OR, 95%CI), solid organ transplants (2.12, 1.50-2.99) and malignancy (2.02, 1.69-2.42) patients had a very high risk of COVID-19 mortality. Patients with rheumatological conditions (1.28, 1.13-1.45) and HIV (1.20, 1.05-1.36) had just slightly higher risks than the immunocompetent baseline. Case type, setting income and mortality data matching and adjustment were significant modifiers of excess immunosuppressed mortality for some immunosuppressed subgroups.
CONCLUSIONS: Excess COVID-associated mortality among the immunosuppressed compared to the immunocompetent was seen to vary significantly across subgroups. This novel means of subdivision has prospective benefit for targeting patient triage, shielding and vaccination policies during periods of high disease transmission.
摘要：
背景：有效的疾病监测，包括COVID-19在内，如果没有将免疫抑制患者归类为临床风险组的标准化方法，就会受到损害。
方法：我们进行了系统评价和荟萃分析，以评估与免疫功能者相比，与COVID相关的死亡率过高是否可以有意义地细分免疫抑制者。我们的研究遵循英国针对传染病的免疫（绿皮书）标准来定义和分类免疫抑制。使用OVID(EMBASE,MEDLINE,移植图书馆,和全球健康)，PubMed,和谷歌学者，我们研究了2020年至2022年的相关文献。我们选择了提供免疫抑制亚组和免疫活性对照死亡率数据的队列研究。荟萃分析，灰色文献和任何未能提供比较数据或报告的全因结局或儿科结局的原创作品均被排除.按免疫抑制类别和亚类对COVID-19死亡率的赔率比（OR）和95%置信区间（CI）进行荟萃分析。亚组分析按效果度量区分估计，国家收入,研究设置，水平的调整，使用匹配和出版年份。研究筛选,提取和偏倚评估由两名研究人员盲法独立进行;冲突在第三名研究人员的监督下得到解决.PROSPERO的注册号是CRD42022360755。
结果：我们确定了99项独特的研究，纳入来自1,542,097和56,248,181例独特的免疫抑制和免疫功能正常的COVID-19感染患者的数据，分别。与有免疫能力的人相比(汇集OR，95CI),实体器官移植(2.12,1.50-2.99)和恶性肿瘤(2.02,1.69-2.42)患者的COVID-19死亡风险非常高.患有风湿病（1.28，1.13-1.45）和HIV（1.20，1.05-1.36）的患者的风险略高于免疫活性基线。案例类型,设定的收入和死亡率数据匹配和校正是一些免疫抑制亚组的过度免疫抑制死亡率的显著修饰.
结论：与免疫功能正常相比，免疫抑制人群中与COVID相关的死亡率在不同亚组之间存在显着差异。这种新的细分方法对于针对患者分诊具有前瞻性益处，在高疾病传播期间的屏蔽和疫苗接种政策。
背景：由EMISHealth和英国医学研究委员会支持。授权号：MR/R015708/1。
方法：我们进行了系统评价和荟萃分析，以评估与免疫功能者相比，与COVID相关的死亡率过高是否可以有意义地细分免疫抑制者。我们的研究遵循英国针对传染病的免疫（绿皮书）标准来定义和分类免疫抑制。使用OVID(EMBASE,MEDLINE,移植图书馆,和全球健康)，PubMed,和谷歌学者，我们研究了2020年至2022年的相关文献。我们选择了提供免疫抑制亚组和免疫活性对照死亡率数据的队列研究。荟萃分析，灰色文献和任何未能提供比较数据或报告的全因结局或儿科结局的原创作品均被排除.按免疫抑制类别和亚类对COVID-19死亡率的赔率比（OR）和95%置信区间（CI）进行荟萃分析。亚组分析按效果度量区分估计，国家收入,研究设置，水平的调整，使用匹配和出版年份。研究筛选,提取和偏倚评估由两名研究人员盲法独立进行;冲突在第三名研究人员的监督下得到解决.PROSPERO的注册号是CRD42022360755。
结果：我们确定了99项独特的研究，纳入来自1,542,097和56,248,181例独特的免疫抑制和免疫功能正常的COVID-19感染患者的数据，分别。与有免疫能力的人相比(汇集OR，95CI),实体器官移植(2.12,1.50-2.99)和恶性肿瘤(2.02,1.69-2.42)患者的COVID-19死亡风险非常高.患有风湿病（1.28，1.13-1.45）和HIV（1.20，1.05-1.36）的患者的风险略高于免疫活性基线。案例类型,设定的收入和死亡率数据匹配和校正是一些免疫抑制亚组的过度免疫抑制死亡率的显著修饰.
结论：与免疫功能正常相比，免疫抑制人群中与COVID相关的死亡率在不同亚组之间存在显着差异。这种新的细分方法对于针对患者分诊具有前瞻性益处，在高疾病传播期间的屏蔽和疫苗接种政策。
背景：由EMISHealth和英国医学研究委员会支持。授权号：MR/R015708/1。
