背景:患有COVID-19的免疫受损个体的预后仍然是一个重要问题。有关在Omicron变异期感染SARS-CoV-2的免疫功能低下患者的临床和病毒学特征的信息有限。
方法:回顾性分析我院在Omicron(BA.1-5)流行期间收治的COVID-19患者的病历。临床,病毒学(鼻咽拭子和血液),和血清学数据在接受免疫抑制药物(钙调神经磷酸酶抑制剂,霉酚酸酯,或类固醇)和未接受免疫抑制药物的对照患者。
结果:包括28名免疫功能低下患者(25名移植受者)和26名对照患者。14名免疫功能低下的患者(50%)接受了单克隆抗体。免疫受损组包括15个轻度/中度(53.6%),10严重(35.7%),和三个严重(10.7%)的疾病严重程度。免疫功能低下组住院期间因COVID-19导致的死亡率为3.6%(1/28),两组之间无差异。免疫功能低下组出院后再加重3例,对照组无一例。根据自症状发作以来的时间,基于鼻咽实时PCR循环阈值(Ct)值的线性回归显示,免疫受损组的病毒清除明显慢于对照组(P斜率=0.078)。在免疫受损组中,与未接受单克隆抗体的患者相比,接受单克隆抗体的患者表现出更快的病毒清除速度.在接受单克隆抗体的患者中,恢复期抗尖峰IgG滴度与对照组相当,而在未接受单克隆抗体的患者中,则显着低于对照组患者(P<0.001)。免疫受损组发病时病毒血症的患病率明显高于对照组(35.7%,[10/28]vs.11.5%,[3/26];P=0.003)。免疫功能低下组中所有3名严重疾病患者均表现为病毒血症,其中一人死亡。对照组3例病毒血症患者均为危重,其中两人死亡。
结论:接受免疫抑制药物治疗的免疫功能低下个体更有可能表现出感染后SARS-CoV-2病毒清除和病毒血症的延迟,可能导致严重程度和结果恶化,尤其是在病毒血症患者中,即使在Omicron流行病期间。
BACKGROUND: The prognosis of immunocompromised individuals with COVID-19 remains a significant concern. Information regarding the clinical and virological characteristics of immunocompromised patients infected with SARS-CoV-2 during the Omicron variant period is limited.
METHODS: Medical records of patients admitted to our hospital with COVID-19 during the Omicron (BA.1-5) epidemic were retrospectively reviewed. Clinical, virological (nasopharyngeal swabs and blood), and serological data were compared between immunocompromised patients receiving immunosuppressive medications (calcineurin inhibitors, mycophenolate mofetil, or steroids) and control patients not receiving immunosuppressive medications.
RESULTS: Twenty-eight immunocompromised patients (25 transplant recipients) and 26 control patients were included. Fourteen of the immunocompromised patients (50%) received monoclonal antibodies. The immunocompromised group included 15 mild/moderate (53.6%), 10 severe (35.7%), and three critical (10.7%) disease severities. The mortality rate due to COVID-19 during hospitalization was 3.6% (1/28) in the immunocompromised group, with no difference between the two groups. Three cases of re-exacerbation after discharge occurred in the immunocompromised group and none in the control group. Linear regression based on nasopharyngeal real-time-PCR cycle threshold (Ct) values according to the time since symptom onset showed markedly slower viral clearance in the immunocompromised group than in the control group (Pslope = 0.078). In the immunocompromised group, patients who received monoclonal antibodies showed faster viral clearance than those who did not receive monoclonal antibodies. The convalescent anti-spike IgG titers were comparable to those in the control group in patients who received monoclonal antibodies and significantly lower than those in the control patients in patients who did not receive monoclonal antibodies (P < 0.001). The prevalence of viremia at onset was significantly higher in the immunocompromised group than in the control group (35.7%, [10/28] vs. 11.5%, [3/26]; P = 0.003). All three patients with critical disease severity in the immunocompromised group exhibited viremia, one of whom died. All three patients with viremia in the control group were critical, of whom two died.
CONCLUSIONS: Immunocompromised individuals receiving immunosuppressive medications are more likely to show delayed post-infection SARS-CoV-2 viral clearance and the development of viremia, potentially resulting in worsening severity and outcomes, especially in viremic patients, even during the Omicron epidemic.